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Comment
. 2009 Nov;2(11):1057-64.
doi: 10.1016/j.jcin.2009.07.014.

Mechanism and predictors of failed transradial approach for percutaneous coronary interventions

Payam Dehghani  1 , Atif Mohammad, Ravi Bajaj, Tony Hong, Colin M Suen, Waseem Sharieff, Robert J Chisholm, Michael J B Kutryk, Neil P Fam, Asim N Cheema
Affiliations
Free article
Comment

Mechanism and predictors of failed transradial approach for percutaneous coronary interventions

Payam Dehghani et al. JACC Cardiovasc Interv. 2009 Nov.
Free article

Abstract

Objectives: The study aimed to determine the mechanism and predictors of procedural failure in patients undergoing percutaneous coronary intervention (PCI) from the transradial approach (TR).

Background: Transradial approach PCI reduces vascular complications compared with a transfemoral approach (TF). However, the mechanism and predictors of TR-PCI failure have not been well-characterized.

Methods: The study population consisted of patients undergoing TR-PCI by low-to-intermediate volume operators with traditional TF guide catheters. Baseline characteristics, procedure details, and clinical outcomes were prospectively collected. Univariate and multivariate analyses were performed to determine independent predictors of TR-PCI failure.

Results: A total of 2,100 patients underwent TR-PCI and represented 38% of PCI volume. Mean age was 64 +/- 12 years, and 17% were female. Vascular complications occurred in 22 (1%), and TR-PCI failure was observed in 98 (4.7%) patients. The mechanism of TR-PCI failure included inability to advance guide catheter to ascending aorta in 50 (51%), inadequate guide catheter support in 35 (36%), and unsuccessful radial artery puncture in 13 (13%) patients. The PCI was successful in 94 (96%) patients with TR-PCI failure by switching to TF. On multivariate analysis, age >75 years (odds ratio [OR]: 3.86; 95% confidence interval [CI]: 2.33 to 6.40, p = 0.0006), prior coronary artery bypass graft surgery (OR: 7.47; 95% CI: 3.45 to 16.19, p = 0.0002), and height (OR: 0.97; 95% CI: 0.95 to 0.99, p = 0.02) were independent predictors of TR-PCI failure.

Conclusions: Transradial approach PCI can be performed by low-to-intermediate volume operators with standard equipment with a low failure rate. Age >75 years, prior coronary artery bypass graft surgery, and short stature are independent predictors of TR-PCI failure. Appropriate patient selection and careful risk assessment are needed to maximize benefits offered by TR-PCI.

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Comment on

  • Transradial access: just do it!
    Mann T. Mann T. JACC Cardiovasc Interv. 2009 Nov;2(11):1065-6. doi: 10.1016/j.jcin.2009.08.023. JACC Cardiovasc Interv. 2009. PMID: 19926045 No abstract available.

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