Distal radial artery access in the anatomical snuffbox for coronary angiography and percutaneous coronary intervention

Abstract

Objective: Compared with transfemoral access, transradial access (TRA) has been shown to reduce major adverse cardiac events, major bleeding, and access site-related vascular complications. This study aimed to investigate the safety and feasibility of the novel distal TRA in the anatomical snuffbox (AS) for coronary angiography and percutaneous coronary intervention (PCI).
Materials and methods: This cross-sectional study included a total of 102 consecutive patients (67 male; mean age: 56.1±13.2 years) who underwent coronary angiography and/or PCI via distal TRA in the AS.
Results: Distal TRA was successfully performed in 98% of the patients. The crossover rate was very low (2%). The right distal TRA was the preferred approach and was used in 90.2% of the patients. Mean artery puncture time was 3.9±1.6 min. Mean compression time to achieve hemostasis at puncture site was 17.0±6.9 min. The post-procedural hematoma rate was very low (1%). One-month follow-up Doppler ultrasound showed zero cases of arteriovenous fistula and pseudo-aneurysm. However, proximal radial artery occlusion was observed in 1 patient (1%) and it was asymptomatic. Artery puncture time, unfractionated heparin dose, time to sheath removal, procedural numerical rating scale (NRS) score and post-procedural NRS score at 6 h were significantly different between diagnostic catheterization and PCI procedures (p<0.001).
Conclusion: The distal TRA in the AS is safe and feasible for coronary angiography and PCI. However, further studies are warranted.

Keywords

• Anatomical snuffbox
• coronary angiography
• distal transradial access
• percutaneous coronary intervention

Koroner anjiyografi ve perkütan koroner girişimlerde, anatomik enfiye çukurundan distal radyal arter girişimi

Abstract

Amaç: Transfemoral erişim ile karşılaştırıldığında, transradyal erişimin majör advers kardiyak olayları, majör kanamayı ve girişim bölgesine bağlı vasküler komplikasyonları azalttığı gösterilmiştir. Bu çalışmada koroner anjiyografi ve perkütan koroner girişim için anatomik enfiye çukurundaki distal transradyal erişimin güvenilirliği ve fizibilitesi araştırıldı.
Gereç ve yöntem: Bu kesitsel çalışmaya anatomik enfiye çukurundaki distal transradyal erişim yoluyla yapılan koroner anjiyografi ve/veya perkütan koroner girişim uygulanan toplam 102 ardışık hasta (67 erkek, ortalama yaş: 56,1±13,2 yıl) dahil edildi.
Bulgular: Hastaların %98'inde distal transradyal erişim başarıyla gerçekleştirildi. Başarısızlık oranı çok düşüktü (%2). Sağ distal transradyal erişim tercih edilen yaklaşımdı ve hastaların %90,2'sinde kullanıldı. Ortalama arter ponksiyon süresi 3,9±1,6 dakika idi. Ponksiyon bölgesinde hemostaz elde etmek için ortalama kompresyon süresi 17,0±6,9 dakika idi. İşlem sonrası hematom oranı çok düşüktü (%1). Bir aylık takipte Doppler ultrasonografide arteriyovenöz fistül ve/veya psödo-anevrizma saptanmadı. Ancak 1 hastada (%1) proksimal radyal arter oklüzyonu izlendi ve asemptomatik seyretti. Arter ponksiyon süresi, fraksiyone olmayan heparin dozu, kılıf çıkarılma süresi, işlem sırasındaki NRS skoru ve işlemden 6 saat sonraki NRS skoru tanısal kateterizasyon ve perkütan koroner girişim prosedürleri arasında anlamlı olarak farklıydı (p<0,001).
Sonuç: Anatomik enfiye çukurundaki distal transradyal erişim koroner anjiyografi ve perkütan koroner girişim için güvenli ve uygulanabilirdir. Bununla birlikte, bu teknik için daha fazla araştırma gerekmektedir.

Keywords

• anatomical snuffbox
• coronary angiography
• distal transradial access
• percutaneous coronary intervention

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