institut cardiovasculaire paris sud radial access: state of the art n y. louvard n massy, france
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IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Radial Access: state of the artRadial Access: state of the art
Y. LouvardY. Louvard Massy, FranceMassy, France
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Radial Access: state ofRadial Access: state ofthethe artart
Y. Y. LouvardLouvard
Massy, FranceMassy, France11th Kamakura Live11th Kamakura Live DemonstrationDemonstration
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Transradial approach: the best way Transradial approach: the best way to reduce the vascular complication to reduce the vascular complication rate and the cost, and to improve rate and the cost, and to improve
patient comfortpatient comfort
II nstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Transradial approachTransradial approach:: thethe bestbest waywaytoto reduce the vascularreduce the vascular complication complication raterate and the costand the cost, , andand toto improveimprove
patient patient comfortcomfort
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
E-SI RI US: Success MeasuresEE--SI RI US:SI RI US: Success MeasuresSuccess Measures
Device Success 171 (100% ) 171 (99.4% )
Lesion Success 171 (100% ) 172 (100% )
Procedure Success 167 (97.7% ) 169 (98.3% )
Major Bleeding 6 (3.4% ) 4 (2.3% )
Major Vasc. Compl. 4 (2.3% ) 4 (2.3% )
Device SuccesDevice Success s 171 (171 (100%100% )) 171 (171 (99.4%99.4% ))
Lesion SuccessLesion Success 171 (171 (100%100% )) 172 (172 (100%100% ))
Procedure SuccessProcedure Success 167 (167 (97.797.7%% )) 169 (169 (98.3%98.3% ))
Major BleedingMajor Bleeding 6 (6 (3.4%3.4% )) 4 (4 (2.3%2.3% ))
Major Vasc. Compl.Major Vasc. Compl. 4 (4 (2.3%2.3% )) 4 (4 (2.3%2.3% ))
ControlControl(n (n == 172)172)
SirolimusSirolimus(n (n == 171)171)
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Impact of Access Site Hematoma Impact of Access Site Hematoma With Transfusion in Patients With Transfusion in Patients
Undergoing PCIUndergoing PCI
6613 PCI (98-00)(NHLBI): hematoma w transfusion 1.8% (97% 6613 PCI (98-00)(NHLBI): hematoma w transfusion 1.8% (97% femoral)femoral)
Independent predictors: Older age, female, thrombotic lesion, Independent predictors: Older age, female, thrombotic lesion, 3-VD, renal disease, emergent PCI, prior aspirin3-VD, renal disease, emergent PCI, prior aspirin
HWT no HWT pHWT no HWT p
Procedural death (%): 10.3 1.2 <0.001Procedural death (%): 10.3 1.2 <0.001
death/MI (%): 18.1 3.55 <0.001 death/MI (%): 18.1 3.55 <0.001
HWT is a predictor of death/MI (OR = 3.49; 95% CI: 1.98-6.14)HWT is a predictor of death/MI (OR = 3.49; 95% CI: 1.98-6.14)
J. Slater Am J Cardiol 2003 (suppl) 92: J. Slater Am J Cardiol 2003 (suppl) 92: 18L 18L
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Clinical Significance of Bleeding Clinical Significance of Bleeding ComplicationsComplications
From Blankenship Am Heart J 1999; 138: S287-S296From Blankenship Am Heart J 1999; 138: S287-S296
Median Length Median Length of Hospital Stay of Hospital Stay
(Day)(Day)
Extra Extra CostCost OthersOthers
Any Vascular Site Any Vascular Site Bleeding / Vascular Bleeding / Vascular ComplicationComplication
+ 1+ 1Incapacitation (days-Incapacitation (days-weeks)weeks)
Return to normal Return to normal activity delayactivity delay
Major or Minor Major or Minor Vascular Site Bleeding Vascular Site Bleeding / Vascular / Vascular ComplicationComplication
+ 2+ 2 + 1327 $+ 1327 $ --
Major Vascular Site Major Vascular Site Bleeding / Vascular Bleeding / Vascular Complication Complication (Surgical)(Surgical)
+ 4+ 4 + 5896 $+ 5896 $ --
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Radial / Femoral Approach meta-Radial / Femoral Approach meta-analysis: Entry site complications analysis: Entry site complications
Agostini P personal communicationAgostini P personal communication
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Transradial approach: for Transradial approach: for PCI, for Diagnosis, for PCI, for Diagnosis, for
Both?Both?
II nstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Transradial approachTransradial approach: for PCI , : for PCI , for for DiagnosisDiagnosis, for , for BothBoth??
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
ACCESS StudyACCESS Study
RadialRadial Brachial Femoral p Brachial Femoral p
Approach failure (%)Approach failure (%) 7 7 4.3 0.3 <0.001 4.3 0.3 <0.001
Procedural success (%) 91.7Procedural success (%) 91.7 90.7 90.7 90.7 90.7 NS NS
Equipment:Equipment:
Guiding cath. (n) 1.3Guiding cath. (n) 1.3 1.3 1.3 1.3 1.3 NS NS
Balloons (n)Balloons (n) 1.3 1.3 1.3 1.3 1.3 1.3 NS NS
Stenting (%)Stenting (%) 4.7 4.7 7 4.7 7 4.7 NS NS
Procedural time (Min) 40Procedural time (Min) 40++2424 39 39++25 3825 38++2424 NS NS
Fluoro. Time (Min 13Fluoro. Time (Min 13++1111 12 12++10 1110 11++10 0.0610 0.06
Hospital stay (days) 1.5Hospital stay (days) 1.5++2.52.5 1.8 1.8++3.8 1.83.8 1.8++4.24.2 NS NS
Kiemeneij JACC 1997;29:1269-75Kiemeneij JACC 1997;29:1269-75
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Radial Artery Diameter (Ultrasound)Radial Artery Diameter (Ultrasound)n=120n=120
0
10
20
30
40
50
<2,1mm 2,1-2,4mm 2,5-2,7mm 2,8-3,1mm >3,1mm
2,92,9++0,6 mm0,6 mm
5f 6f 7f 8f5f 6f 7f 8f
Y. LouvardY. Louvard unpublishedunpublished
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Catheters / DevicesCatheters / Devices / Technique Compatibility / Technique Compatibility
Catheter SizeCatheter Size DevicesDevices TechniquesTechniques Radial Radial CompatibilityCompatibility
5f5f Balloons Balloons << 5 mm 5 mm
Stents Stents << 4.5 mm 4.5 mm
IvusIvus
Rota 1.25 mmRota 1.25 mm
No Kissing BalloonNo Kissing Balloon
100%100%
6f6f All Coronary balloonsAll Coronary balloons
All Coronary stentsAll Coronary stents
Cutting BalloonCutting Balloon
Rota Rota << 1.75 mm 1.75 mm
Protection device Protection device (EPI…)(EPI…)
Kissing BalloonKissing Balloon
86.9%86.9%
7f7f AngioguardAngioguard
Rota 2 mmRota 2 mmKissing StentKissing Stent 76.9%76.9%
8f8f PercusurgePercusurge
SimpsonSimpson
Rota >2 mmRota >2 mm
64.7%64.7%
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
A randomized trial of 5 vs. 6 French A randomized trial of 5 vs. 6 French transradial percutaneous coronary transradial percutaneous coronary
interventionsinterventions
5 Fr / 6 Fr guiding catheter, 171 pts with coronary lesions 5 Fr / 6 Fr guiding catheter, 171 pts with coronary lesions suitable for 5 Fr transradial approachsuitable for 5 Fr transradial approach
5 Fr 6 Fr p5 Fr 6 Fr p
Procedural success (%) 95.4 92.9Procedural success (%) 95.4 92.9Cor. cannulation failure (%) 1.1 4.8 0.08 Cor. cannulation failure (%) 1.1 4.8 0.08 Minor hematomas (%) 1.1 4.8 0.07Minor hematomas (%) 1.1 4.8 0.07Loss of radial pulse (%) 1.1 5.9 0.05Loss of radial pulse (%) 1.1 5.9 0.05
Dahm JB CCVI 2002; 57(2):172-6
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
CARAFE (Technical CARAFE (Technical Data)Data)
Femoral Right RadialFemoral Right Radial Left Left
RadialRadial
N= 70 70 70
Cross overCross over 0 0 1 (1.4%)* 1 (1.4%)* 0 0
LCA catheter (n)LCA catheter (n) 1.1 1.1++0.30.3 1.2 1.2++0.60.6
1.11.1++0.30.3
RCA catheter (n)RCA catheter (n) 1.0 1.0++0.20.2 1.1 1.1++0.30.3
1.01.0++0.20.2
Total catheters (n)Total catheters (n) 2.1 2.1++0.40.4 1.4 1.4++0.7** 0.7**
2.12.1++0.40.4
* p=ns : L Rad , ** p<.000 vs Femoral and L * p=ns : L Rad , ** p<.000 vs Femoral and L RadRad
Y. Louvard CCVI 2001; 52: 181-Y. Louvard CCVI 2001; 52: 181-187187
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Looking for the best multipurpose Looking for the best multipurpose catheter for Right transradial coronary catheter for Right transradial coronary
angiographyangiography
Multipurpose (too much rotation)Multipurpose (too much rotation)
Amplatz AL2 (AL1)Amplatz AL2 (AL1)
Champ (dead…)Champ (dead…)
JL 3.5 (for left and right!)JL 3.5 (for left and right!)
Tiger II +++Tiger II +++
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Transradial Approach Reduces Bleeding Transradial Approach Reduces Bleeding Complications and Length of Stay in Patients With Complications and Length of Stay in Patients With
GP IIb/IIIa InhibitorsGP IIb/IIIa Inhibitors
G. Revtyak Am J Cardiol 2001; 88: 39G
*p <0.05, major bleeding (TIMI criteria), major (requiring surgical repair), and minor (pseudoaneurysm or charted hematoma) access site complications
FA RA p valueN= 2432 164GPIIbIIIa – (%) 61 90Major bleeding (n) 164 0 <0.05Major complication (n) 21 0 <0.05Minor complication (n) 59 6 <0.05Thrombocytopenia (n) 17 3 <0.05Length of stay (hrs) 70.6 36.6 <0.05
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Transradial vs. transfemoral approach in Transradial vs. transfemoral approach in primary stent implantation for patients with primary stent implantation for patients with acute myocardial infarction: TEMPURA trialacute myocardial infarction: TEMPURA trial
149 pts with AMI 149 pts with AMI << 12 hr, randomized into 2 groups 12 hr, randomized into 2 groups
TRI TFI TRI TFI
N= 77 72 N= 77 72
Cross over (n) 1 0Cross over (n) 1 0
Severe bleeding complication (n) 0 2Severe bleeding complication (n) 0 2
Success of reperfusion (%) 96.1 Success of reperfusion (%) 96.1 97.197.1
in-hospital MACE (%) 5.2 8.3in-hospital MACE (%) 5.2 8.3
Saito CCVI 2003; 59(1):26-33
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
OCTOPLUS: Primary OCTOPLUS: Primary endpoint, Intention to treat endpoint, Intention to treat
analysisanalysisFemoralFemoral RadialRadial p p
valuevalue
n=n= 185185 192192
Vasc. Surgery (%)Vasc. Surgery (%) 00 0.50.5 nsns
Transfusion (%)Transfusion (%) 1.61.6 1.01.0 nsns
Hb drop > 3g/DL (%)Hb drop > 3g/DL (%) 3.83.8 0.50.5 0.0630.063
False aneurysm compression (%)False aneurysm compression (%) 1.11.1 0.50.5 nsns
Arm or leg ischemia (%)Arm or leg ischemia (%) 00 00 nsns
Forearm compartment syndrom Forearm compartment syndrom (%)(%)
00 00 nsns
Large hematoma* (%)Large hematoma* (%) 6.56.5 1.61.6 0.0310.031
COMPOSITE END-POINT $ (%)COMPOSITE END-POINT $ (%) 6.56.5 1.61.6 0.0290.029
Hematoma (%)Hematoma (%) 11.411.4 3.53.5 0.0030.003
CVA (%)CVA (%) 0.60.6 00 NsNs$ surgery, transfusion, Hb loss>3g/100ml-Ht loss>10%, ischemia, FA, vasc. Complic. leading to discharge delay *Large hematoma: discharge delay
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Safety of same-day-discharge Safety of same-day-discharge radial percutaneous coronary radial percutaneous coronary
interventionintervention
943 Pts same-day discharge radial PCI: entry site complications 943 Pts same-day discharge radial PCI: entry site complications or repeat angiogram and/or PCI within 24 hours and 1 or repeat angiogram and/or PCI within 24 hours and 1 month , month ,
811 patients responded , 38 patients died, 94 alive but refused 811 patients responded , 38 patients died, 94 alive but refused to participate/impossible to contactto participate/impossible to contact
24 h 1 month24 h 1 month
Access complication (%) 2.8 0Access complication (%) 2.8 0
Chest pain (%) 2 11.5Chest pain (%) 2 11.5 repeat angio (%) 0.1 1.3repeat angio (%) 0.1 1.3 Vessel occlusion (%) 0 0.5Vessel occlusion (%) 0 0.5 (+ lost for FU pts) 0.2(+ lost for FU pts) 0.2
Ziakas Am Heart J. 2003; 146: 699-704
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Transradial Approach for Transradial Approach for non- Coronary Diagnosis non- Coronary Diagnosis
and Intervention ?and Intervention ?
II nstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Transradial Approach Transradial Approach for nonfor non--Coronary Diagnosis andCoronary Diagnosis and
Intervention ?Intervention ?
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Right Transradial selective Right Transradial selective vertebral and carotid vertebral and carotid
angiographyangiography
AuthorAuthor nnRight Right vertebralvertebral
Right Right carotidcarotid Left carotidLeft carotid
Left Left subclavian/subclavian/
vertebralvertebral
ChaCha 103103 98%98% 86%86%
NagayosNagayoshihi 8383 91%91% 100%100% 100%100% 56%56%
IwasakiIwasaki 526526 99%99%
NoharaNohara 6060 95%95%
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud J. Théron, Caen, France, personal communication
Transradial carotid bifurcation stentingTransradial carotid bifurcation stenting
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Transradial Approach Transradial Approach Drawbacks ?:Drawbacks ?:
It has to be learned (!)…It has to be learned (!)…and teachedand teached
II nstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Transradial Approach Transradial Approach Drawbacks ?:Drawbacks ?:I t I t has to has to be learned be learned (!)…(!)…
and teachedand teached
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Radial approach learning curve in Radial approach learning curve in non selected populationnon selected population
0
10
20
30
40
50
60
70
80
90
100
1- 10 11- 20 21- 30 31- 40 41- 50 51- 60 61- 70 71- 80 81- 90
Fellow 1
Fellow 2
Fellow 3
52%69%89%
Y. Louvard, preliminary
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Radial approach learning curve in Radial approach learning curve in non selected populationnon selected population
0
10
20
30
40
50
60
70
80
90
100
1- 10 11- 20 21- 30 31- 40 41- 50 51- 60 61- 70 71- 80 81- 90
+ Senior
+ Senior
+ Senior
96%97%98%
Y. Louvard, preliminary
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Transradial Approach Transradial Approach Failure in Relation to Failure in Relation to
VolumeVolume
y = - 1,2931Ln(x) + 11,464
0
1
2
3
4
5
6
7
8
0 400 800 1200 1600 2000 2400 2800
p= 0.002
%
*Failure to enter ascending aorta*Failure to enter ascending aorta
Y. Louvard, unpublishedY. Louvard, unpublished
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Predictive Factors of Radial Predictive Factors of Radial Approach FailureApproach Failure
Success Failure* pSuccess Failure* pn= 2347 53n= 2347 53
Age (years) 61.6Age (years) 61.6++11.3 6511.3 65++11.2 11.2 0.030.03
Male (%) 84 73.7 Male (%) 84 73.7 0.0680.068
Hypertension (%) 42.2 43.4 Hypertension (%) 42.2 43.4 nsns
Dyslipidemia (%) 72.9 69.8 Dyslipidemia (%) 72.9 69.8 nsns
Diabetes (%) 8.4 13.2 Diabetes (%) 8.4 13.2 nsns
Smoking (%) 26.9 22.6 Smoking (%) 26.9 22.6 nsns
Left radial (%) 3.2 18.9 Left radial (%) 3.2 18.9 0.0000.000
Re-radial (%) 21.9 17 Re-radial (%) 21.9 17 nsns
N° of Same Radial (n) 1.3N° of Same Radial (n) 1.3++0.7 1.30.7 1.3++0.6 0.6 nsns
N° Dis. Coro. Vessels (n) 1.8N° Dis. Coro. Vessels (n) 1.8++0.8 1.70.8 1.7++0.7 0.7 nsns
Weight (kg) 76.9Weight (kg) 76.9++13.5 72.813.5 72.8++13.8 13.8 0.0290.029
Height (cm) 169.3Height (cm) 169.3++8.3 166.48.3 166.4++10.3 10.3 0.030.03
*Failure to enter ascending aorta*Failure to enter ascending aorta
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
0
1
2
3
4
5
6
<40 y
n=64
40- 49 y
n=298
50- 59 y
n=606
60- 69 y
n=779
70- 79 y
n=552
> 80 y
n=110
Radial approach failure rate%
Radial Approach Failure Rate Radial Approach Failure Rate in Relation to Age in Relation to Age
Y. Louvard, unpublishedY. Louvard, unpublished
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Radial Approach Failure Rate in Radial Approach Failure Rate in Relation to WeightRelation to Weight
0
1
2
3
4
5
6
7
8
9
10
<50 kg 50- 59 kg 60- 69 kg 70- 79 kg 80- 89 kg 90- 99 kg 100- 09 kg >110 kg
Total Male Female
Y. Louvard, unpublishedY. Louvard, unpublished
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Predictors of Failure of Transradial Predictors of Failure of Transradial Approach for Coronary Angiography Approach for Coronary Angiography
and Interventionsand Interventions
Causes of the 475 TRA failures (7%): unsuccessful puncture (69%), Causes of the 475 TRA failures (7%): unsuccessful puncture (69%), difficult anatomy (16%), brachial artery spasm (8%), unsuccessful difficult anatomy (16%), brachial artery spasm (8%), unsuccessful canulation (5%) or miscellaneous (2%) canulation (5%) or miscellaneous (2%)
A multivariate analysis of a large series: 6,962 TRA (94-98)A multivariate analysis of a large series: 6,962 TRA (94-98)
G.Barbeau AHA 1999G.Barbeau AHA 1999
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Evaluation of a spasmolytic cocktail to Evaluation of a spasmolytic cocktail to prevent radial artery spasm during prevent radial artery spasm during
coronary procedurescoronary procedures
Automatic pullback device, efficacy of an intra-arterial vasodilating cocktail Automatic pullback device, efficacy of an intra-arterial vasodilating cocktail (verapamil 5 mg, nitroglycerine 200 µg) in reducing radial artery spasm (verapamil 5 mg, nitroglycerine 200 µg) in reducing radial artery spasm
Cocktail No cocktail p valueCocktail No cocktail p value
N= 50 50N= 50 50
Pain (%) 14 34 0.019Pain (%) 14 34 0.019
Pain score 1.7 Pain score 1.7 ++ 0.94 2.08 0.94 2.08 ++ 1.07 = 0.03 1.07 = 0.03
Maximal pullback force (kg) 0.53 Maximal pullback force (kg) 0.53 ++ 0.52 0.76 0.52 0.76 ++ 0.45 = 0.013 0.45 = 0.013
MPF > 1.0 kg (%) 8 22 = 0.029MPF > 1.0 kg (%) 8 22 = 0.029
Kiemeneij CCVI 2003; 58: 281-4
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Tortuous Right Subclavian Artery: Tortuous Right Subclavian Artery: Prevalence and Predictive FactorsPrevalence and Predictive Factors
2,341 consecutive right radial approaches2,341 consecutive right radial approaches
Prevalence (%) 10.8Prevalence (%) 10.8Cross-over to Left Radial or Femoral (%) 4Cross-over to Left Radial or Femoral (%) 4Complications (%) 0Complications (%) 0
Independent predictive factors:Independent predictive factors:
OR 95% CI p OR 95% CI p Hypertension 1.6 1.3-2.1 Hypertension 1.6 1.3-2.1
<0.0003 <0.0003 Age 1.4 1.2-1.7 Age 1.4 1.2-1.7
0.00010.0001BMI 1.2 1.0-1.4 0.015BMI 1.2 1.0-1.4 0.015
Cha CCVI 2002; 56: abst 69Cha CCVI 2002; 56: abst 69
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Transradial Approach Transradial Approach Drawbacks ?:Drawbacks ?:ComplicationsComplications
II nstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Transradial Approach Transradial Approach Drawbacks ?:Drawbacks ?:ComplicationsComplications
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
A New and Objective Method for Transradial A New and Objective Method for Transradial Approach Screening: Comparaison With the Approach Screening: Comparaison With the
Allen's Test in 1010 PatientsAllen's Test in 1010 Patients
1010 pts, 32% female, 19% diabetics, age 62y, weight 76 kg, 1010 pts, 32% female, 19% diabetics, age 62y, weight 76 kg, height 1.66 mheight 1.66 m
Right Left Right or Right Left Right or LeftLeft
MAT MAT << 9 seconds (%) 87 86 9 seconds (%) 87 86
Positive PL* + Ox (%) 96 95Positive PL* + Ox (%) 96 95
MAT exclusion (%) 6.3MAT exclusion (%) 6.3
PL + Ox (%) 1.5PL + Ox (%) 1.5
Barbeau 2001, 37, 2, Suppl A, 1A-648ABarbeau 2001, 37, 2, Suppl A, 1A-648A
MAT: modified Allen’s test, plethysmography (PL) and oxymetry (Ox)MAT: modified Allen’s test, plethysmography (PL) and oxymetry (Ox)
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Early ultrasonic resultsEarly ultrasonic results
Pre-procedurePre-procedure Post-procedurePost-procedure pp
Diameter (mm)Diameter (mm) 3.64 3.64 ± 0.74± 0.74 3.55 3.55 ± 0.77± 0.77 nsns
Upstream flow (cm/sec)Upstream flow (cm/sec) 29.13 29.13 ± 9.51± 9.51 30.8 30.8 ± 11.26± 11.26 nsns
Downstream flow(cm/sec)Downstream flow(cm/sec) 28.73 28.73 ± 11.84± 11.84 nsns
Duration (mn)Duration (mn) 2.92 2.92 ± 0.55± 0.55 3.35 3.35 ± 0.83± 0.83 nsns
270 patients4 radial occluded (1.3%) :
- 2 with a negative flow- 2 without flow
J. Monsegu
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Radial Artery/Sheath Diameter Ratio: A Radial Artery/Sheath Diameter Ratio: A Predictor of Severe Radial Artery Flow Predictor of Severe Radial Artery Flow
ReductionReduction
0
24
68
10
1214
Radial I nner
Diameter / Sheath
>1
Radial I nner
Diameter / Sheath
<1
Severe Radial Flow Reduction
Saïto CCVI 46: 173-178, 1999
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
IVUS after transradial IVUS after transradial approachapproach
JACC 2003;41;1109-14
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Use of the radial artery graft after Use of the radial artery graft after transradial catheterization: is it suitable as transradial catheterization: is it suitable as
a bypass conduit?a bypass conduit?
67 pts underwent isolated CABG using the radial artery (RA)67 pts underwent isolated CABG using the radial artery (RA)
preop. transradial no transradial p valuepreop. transradial no transradial p value catheterization catheterizationcatheterization catheterization
N= 22 45N= 22 45Stenosis-free graft patencyStenosis-free graft patency Left mammary artery (%) 88 90 = 0.87Left mammary artery (%) 88 90 = 0.87 Radial artery (%) 77 98 = 0.017Radial artery (%) 77 98 = 0.017 Saphenous vein (%) 87 84 = 0.42Saphenous vein (%) 87 84 = 0.42Intimal hyperplasia of RA (%) 68 39 = 0.046Intimal hyperplasia of RA (%) 68 39 = 0.046
Kamiya Ann Thorac Surg. 2003; 76(5): 1505-9
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud From P Garot
False Aneurysm after PTCAFalse Aneurysm after PTCA
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Conclusions (1)Conclusions (1)
Transradial approach is the best way to reduce the Transradial approach is the best way to reduce the vascular complication rate of diagnostic and vascular complication rate of diagnostic and therapeutic coronary (vascular) catheterism: less therapeutic coronary (vascular) catheterism: less expensive, preferred by patients and nurses…expensive, preferred by patients and nurses…
At the price of a slight increase in procedural At the price of a slight increase in procedural duration and X-Ray exposure for diagnosis onlyduration and X-Ray exposure for diagnosis only
It is specially effective in high risk populations like It is specially effective in high risk populations like old patients, AMI, patients treated with powerful old patients, AMI, patients treated with powerful anticoagulant or antiplatelet drugsanticoagulant or antiplatelet drugs
IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud
Conclusions (2)Conclusions (2)
Transradial approach allows the use of all Transradial approach allows the use of all devices and techniques of modern coronary devices and techniques of modern coronary intervention intervention
Peripheral vascular diagnosis and intervention Peripheral vascular diagnosis and intervention is feasible with the same advantages: is feasible with the same advantages: Subclavian, Renal, Mesenteric, Carotid?Subclavian, Renal, Mesenteric, Carotid?
Learn it in Kamakura Live Course…Learn it in Kamakura Live Course…