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. 2018 Dec;48(12):1120-1130.
doi: 10.4070/kcj.2018.0181. Epub 2018 Aug 6.

Feasibility of Coronary Angiography and Percutaneous Coronary Intervention via Left Snuffbox Approach

Yongcheol Kim  1 , Youngkeun Ahn  2 , Inna Kim  1 , Doo Hwan Lee  1 , Min Chul Kim  1 , Doo Sun Sim  1 , Young Joon Hong  1 , Ju Han Kim  1 , Myung Ho Jeong  1
Affiliations

Feasibility of Coronary Angiography and Percutaneous Coronary Intervention via Left Snuffbox Approach

Yongcheol Kim et al. Korean Circ J. 2018 Dec.

Abstract

Background and objectives: Feasibility of coronary angiography (CAG) and percutaneous coronary intervention (PCI) via left snuffbox approach is still concerned. We aimed to investigate efficacy and safety of the left snuffbox approach for CAG and PCI.

Methods: Left snuffbox approach was tried in 150 patients who planned to perform CAG or PCI for suspected myocardial ischemia between 1 November 2017 and 31 March 2018.

Results: Success rate of radial artery (RA) cannulation via snuffbox approach was 88.0% (n=132). Among 132 individuals, 58 (43.9%) acute coronary syndrome (ACS) patients were included. The diameter of snuffbox RA was significantly smaller than conventional RA (2.57 mm vs. 2.72 mm, p<0.001) from quantitative computed angiography of 101 patients. However, CAG via snuffbox approach by 6 French sheath was successfully performed in all 132 patients. In addition, there was significant correlation between the snuffbox and conventional RA diameter (r=0.856, p<0.001). In 42 PCI cases, including 25 patients with acute myocardial infarction (AMI), the success rate of PCI via snuffbox approach was 97.6% (n=41). Intravascular imaging-guided PCI was performed in 8 (19.5%) patients and multi-vessel PCI in 4 (9.8%) cases. Regarding vascular complication, forearm swelling with bruising, not requiring surgery or transfusion, occurred in 2 (4.9%) PCI cases.

Conclusions: Left snuffbox approach is suitable for CAG and PCI compared with the conventional radial approach.

Keywords: Coronary angiography; Percutaneous coronary intervention; Radial artery.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Figure 1
Figure 1. Patient's position for the left snuffbox approach (A) and operator on the right side of the patient preparing left snuffbox approach (B). Inserted 6 French sheath via left snuffbox approach (C) and hemostasis by manual compressive bandage with gauze (D).
Figure 2
Figure 2. Angiography of the left radial artery to investigate the maximal diameter of snuffbox and conventional radial artery.
Figure 3
Figure 3. The maximal diameter in the snuffbox and conventional radial artery (A) and the correlation of the maximal diameter between the snuffbox and conventional radial artery (B).
RA = radial artery.
Figure 4
Figure 4. The left radial artery angiography demonstrating the tortuosity of snuffbox radial artery with spasm (A) and successful wiring into the proximal radial artery using 0.018-inch stainless steel wire (B).
See this image and copyright information in PMC

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