A comparative study on transradial vs transfemoral artery access for primary percutaneous coronary intervention in patients with acute myocardial infarction

Objective Comparative study on the feasibility,safety and outcome of transradial artery and transfemoral artery access for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(AMI).Methods Two hundred and eight patients with AMI episoded within 12 hours, male 159, female 49, age 58.9 ±11.9 (34～88)years, were randomly divided into transradial artery access for primary PCI (TRA pPCI) group of 106 cases and transfemoral artery access for PCI (TFA pPCI) group of 102 cases during Sept, 2000 to Aug, 2002. The protocols of the manipulation duration and the effect for TRA pPCI and TFA pPCI procedures were respectively compared, including the time of transradial artery puncture and the rate of puncture success at first time ; the time of guiding catheter engaging into target coronary ostium; the rate of patence in infarct related artery (IRA); total duration of manipulation and the successful rate.The incidence of complications such as bleeding, vessel injury,thrombi and embolism as well as the average stay of hospitalization between two groups was compared. The status and the incidance of vessel spasm were observed and the effect of medicine administration to prevent from and relieve the vascular spasm was evaluated. The time of Allen’s test before and after TRA pPCI , the inner diameter and the peak of blood velocity of the right and left radial artery were investigated with color Doppler vessel echography as well as the complications of radial artery were followed up 1 month after TRA pPCI procedure. Results Two cases in every TRA pPCI and TFA pPCI groups were crossed over each other because procedure of the transradial or transfemoral access was failure. One handred and six vessels (48 vessels in LAD,22 vessels in LCX and 36 vessels in RCA) associated with 28 vessels of total occlusion in TRA pPCI group and 102 vessels (51 vessels in LAD,18 veesles in LCX and 33 vessels in RCA) with 24 vessels in total occlusion in TFA pPCI group were angioplasticized . The successful rates of the first time puncture in access artery, the re patence IRA and pPCI were similar in TRA pPCI and TFA pPCI groups ( 93.4% vs 96.1% ;100% vs 100%; 96.2% vs 97.1% , P >0.05 ). There were no significant diffierence in the average time of puncture time of access artery ,engaging in target vessels of guiding catheters and the total procedure of PCI between the two groups ( 1.3 ±0.3s vs 1.2 ±0.3s ; 6.0 ±1.6min vs 5.8 ±0.9min ; 49.2 ±24.1min vs 46.5 ± 26.4min , P >0.05 ). The access artery complications such as bleeding ,hematoma and embolism as well the veneous thrombosis in TFA pPCI group were much more than those in TRA pPCI group(p< 0.01 ). Although slight artery spasm of 4.7% cases in TRA pPCI group was happened during the procedure of PCI , the procedure had being continued after administration of medicine to release the spasm. The time of Allen’s test ,diameter and the systolic velocity of blood in daul radial arteries were no significant change before and after pPCI.Conclusions The duration and effect by TRA pPCI for AMI with stable hemodynamics was similar to TFA pPCI. The complications such as of bleeding,vessel injury, thrombi and embolism by TRA pPCI were few, and it was unnecessary to discontinue the anticoagulation medicine. TRA pPCI might be selected as a access vessel for pPCI in AMI patients with stable hemodynamics.

Assessment of early radial injury after transradial coronary intervention by high-resolution ultrasound biomicroscopy： innovative technology application

Background Transradial coronary intervention （TRI） introduces injury to the radial artery （RA） which will affect repeat transradial coronary procedure and the quality as a bypass conduit. We sought to compare the early radial injury after TRI between first-TRI and repeat-TRI by ultrasound biomicroscopy （UBM）. Methods A total of 1116 patients who underwent the transradial coronary procedures were enrolled. The patients depending on whether for the first time to accept transradial coronary procedure were divided into first-TRI group and repeat-TRI group. The RA was examined by UBM before and one day after the procedure. Results Compared with first-TRI group, the mean RA diameter of repeat-TRI one day after the procedure decreased significantly （P 〈0.05）. In first-TRI group, the mean RA diameter was （2.32±0.53） and （1.93±0.57） mm before procedure and one day after the procedure respectively （P 〈0.05）. In repeat-TRI group, the mean RA diameter was （2.37±0.51） and （1.79±0.54） mm before procedure and one day after the procedure, respectively （P 〈0.01）. Compared with first-TRI group, the mean RA diameter was reduced significantly in repeat-TRI group one day after the procedure （P〈0.05）. The early radial injuries and intimal thickening were compared between first-TRI and repeat-TRl. The mean intima-media thickness of RA was （,0.24±0.13） mm and （0.59±0.28） mm before procedure and one day after the procedure in first-TRI group. The mean intima-media thickness of RA was （0.29±0.16） mm and （0.68±0.32） mm before procedure and one day after the procedure in repeat-TRI group. Compared with first-TRI group, the mean intimal thickening was increased significantly in repeat-TRI group one day after the procedure （P〈0.05）. Intimal dissection, stenosis and occlusion were all significantly greater in repeat-TRI RAs （P 〈0.05）. Linear regression analysis revealed that diameter, repeated TRI procedure and PCI procedure were the independent predictors of intimal thickening. Conclusions RA early injuries were greater in repeat-TRI patients than in first-TRI patients. We first use high-resolution UBM imaging to demonstrate the rate of radial injury and revealed that diameter, repeated TRI procedure and PCI procedure were the independent predictors of intimal thickening.

Application of a rapid exchange extension catheter technique in type

BACKGROUND In transradial intervention procedures,poor back-up support and noncoaxial alignment of the guide catheter(GC)may result in failure of the balloon or stent to reach the targeted lesion.Methods to provide extra back-up support using the original GC and wire can improve procedural success with reduced complications.A rapid exchange guide extension catheter provides convenient and efficient back-up support while preserving the initial GC and inserted wire.AIM To evaluate the efficacy and safety of rapid exchange extension catheter in the treatment of type B2/C nonocclusive coronary lesions via the radial access.METHODS A total of 135 patients with type B2/C nonocclusive lesions who were treated via the transradial approach were enrolled in the study.The clinical characteristics,indications for use of the rapid exchange extension catheter,and procedural details and results were reviewed and analyzed.All procedure-related complications and major adverse cardiovascular events were recorded during the in-hospital stay and follow-up period.RESULTS The most common indication for the use of a rapid exchange extension catheter was vascular tortuosity(37.8%),followed by heavy calcification(28.9%),long lesions(20.0%),proximal stent(6.7%),in-stent restenosis(5.2%),and coronary origin anomalies(1.5%).The following technologies failed in passing targeted lesions before delivering the rapid exchange catheter:Multiple predilatation technique(57%),buddy wire technique(33.4%),balloon anchoring technique (5.9%), and cutting balloon modification (3.7%). The mean depth of the extensioncatheter intubation was 20.56 ± 13.05 mm, and the mean rapid exchange catheterservice time was 18.9 ± 9.7 min. The mean length and diameter of stents were 33.5± 14.4 mm and 2.75 ± 0.45 mm, respectively. The total rate of technique success(balloon or stent successful crossing of the target lesion with this technique) was94.8%.CONCLUSIONThe rapid exchange extension catheter technique showed acceptable safety andefficacy in the transradial coronary interventions of type B2/C nonocclusivecoronary lesions. We recommend this technique to assist in complex lesionintervention via radial access.

Comparison of immediate and followup results between transradial and transfemoral approach for percutaneous coronary intervention in true bifurcational lesions

Background A comparison of efficacy and safety between transradial and transfemoral approach for percutaneous coronary intervention （PCI） in bifurcations has not been done. This study evaluated feasibility of transradial PCI （TRI） and compared the immediate and followup results with transfemoral PCI （TFI） in bifurcations. Methods One hundred and thirty-four consecutive patients with bifurcations were treated with PCI in our hospital from April 2004 to October 2005. Of these, there were 60 patients （88 lesions） in TRI group and 74 patients （101 lesions） in TFI group. Bifurcations type was classified according to the Institut Cardiovasculaire Paris Sud Classification. Results TRI group had smaller stent diameter （（3.06±0.37） mm vs （3.18±0.35） mm, P=0.023） and postprocedural in-stent minimum lumen diameter （（2.62±0.37） mm vs （2.74±0.41） mm, P=0.029） than TFI, but there were not significant differences in in-stent subacute thrombosis rate （0% vs 1.0%, P=0.349）, target lesion revascularization （TLR） （0% vs 1.0%, P=0.349） following procedure and thrombosis （2.3% vs 1.0%, P=0.482）, in-stent restenosis （12.5% vs 10.9%, P=0.731）, in-segment restenosis （17.0% vs 14.9%, P=0.681）, TLR （10.2% vs 13.9%, P=0.446） and TLR-free cumulative survival rate （89.8% vs 86.1%, P=0.787） at seven months followup. No death was reported in the two groups. Conclusion Transradial intervention is feasible and appears to be as effective and safe as transfemoral PCI in treatment of true bifurcational lesions.

Nursing observation of transradial coronary intervention combined with tirofiban hydrochloride for acute coronary syndrome in elderly patients

Background As the most effective approach in treatment of revascularization in coronary perfusion for acute coronary syndromes（ACSs）, percutaneous coronary intervention（PCI） can also increase the risk of detachment of thrombus and embolism of distal microcirculation. Tirofiban hydrochloride is a reversible antagonist of platelet glycoprotein Ⅱb / Ⅲa receptor, which can inhibit platelet aggregation quickly. However,it may also increase the risk of bleeding when in combination with other anti-thrombus drugs. It is important in medication observation for charge nurse when using Ⅱ b / Ⅲ a receptor inhibitor. Methods For 116 elderly patients with ACS who had transradial coronary interventional therapy combined with tirofiban hydrochloride,we conducted medication care, nursing observation of hemorrhage, nursing of puncture of upper limb,postoperative adverse cardiovascular events, observation of myocardial perfusion, blood flow and health education. Results A total of 10 patients had mild bleeding, no serious bleeding, and 2 with major adverse cardiac event（MACE）. Conclusions Tirofiban hydrochloride after PCI can significantly reduce cardiovascular events in acute coronary syndromes, but there is an increased risk of bleeding. It showed that strengthen inspection, closely observe condition and detecting bleeding in time after PCI can significantly reduce postoperative complications for charge nurses.