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. 2020 Sep 8:2020:7342732.
doi: 10.1155/2020/7342732. eCollection 2020.

A Comparative Analysis between Ultrasound-Guided and Conventional Distal Transradial Access for Coronary Angiography and Intervention

Shinsuke Mori  1 , Keisuke Hirano  1 , Masahiro Yamawaki  1 , Norihiro Kobayashi  1 , Yasunari Sakamoto  1 , Masakazu Tsutsumi  1 , Yohsuke Honda  1 , Kenji Makino  1 , Shigemitsu Shirai  1 , Yoshiaki Ito  1
Affiliations

A Comparative Analysis between Ultrasound-Guided and Conventional Distal Transradial Access for Coronary Angiography and Intervention

Shinsuke Mori et al. J Interv Cardiol. .

Abstract

Objectives: To compare feasibility and safety between ultrasound-guided and conventional distal transradial access (dTRA).

Background: Distal transradial access, a new technique for coronary angiography (CAG) and percutaneous coronary interventions (PCI), is safe and feasible and will become popular worldwide. Ultrasound-guided dTRA has been advocated to reduce failure rate and access-site complications. However, to date, the comparison of feasibility and safety between ultrasound-guided and conventional dTRA has not been reported.

Method: Overall, 137 patients (144 procedures) who underwent CAG or PCI using dTRA between September 2018 and February 2019 were investigated. These patients were classified into two groups: C (dTRA with conventional punctures; 76 patients, 79 procedures) and U (dTRA with ultrasound-guided punctures; 61 patients, 65 procedures) groups. Successful procedural rate, procedural outcomes, and complication rate during hospital stays were compared between the two groups.

Results: The procedural success rate was significantly higher in the U group than in the C group (97% vs. 87%, P=0.0384). However, the rate of PCI, puncture time, total fluoroscopy time, the volume of contrast medium, the rate of access-site ecchymosis, and incidence of nerve disorder were similar between the two groups. Additionally, radial artery occlusion after the procedure did not occur in this study.

Conclusion: The ultrasound-guided dTRA for CAG or PCI was associated with a lower failure rate than conventional dTRA. However, there were no significant differences in puncture time and complication rate between the two procedures.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study flowchart. CAG: coronary angiography; PCI: percutaneous coronary intervention.
Figure 2
Figure 2
(a) A puncture with a 20 G needle under the long-axis ultrasound guidance. (b) The way of using the patient's hand that has a wineglass makes us puncture under ultrasound guidance easily. (c) Long-axis ultrasound shows the distal radial artery. (d) The Doppler-ultrasound shows the blood flow in the radial artery. (e) Ultrasound shows the puncture with a 20 G needle.
Figure 3
Figure 3
The success rate of puncture.
Figure 4
Figure 4
Procedural outcomes. (a) Puncture time. (b) Procedural time. (c) Contrast volume. (d) Radiation dose. (e) Radiation time.
Figure 5
Figure 5
Complication rate. RAO: radial artery occlusion. (a) Access-site ecchymosis. (b) Minor bleeding. (c) Major bleeding. (d) Nerve disorder. (e) RAO.
Figure 6
Figure 6
(a) Angiography from the distal radial artery shows the total occlusion of the radial artery (arrow). (b) Guidewire advance into the brachial artery. (c) After an exchange to 0.014-inch guidewire, balloon dilatation is performed. (d) Angiography from the distal radial artery shows the patency of the radial artery after the procedure.
See this image and copyright information in PMC

References

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