Indian heart journal
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Indian heart journal · May 2010
ReviewTransradial percutaneous coronary interventions: indications, success rates & clinical outcome.
Before ten years, radial artery was discovered as a useful vascular access site for percutaneous coronary procedures. It has the advantage of reduced access site complications but is associated with specific technical challenges in comparison with the transfemoral approach. Although earlier data from a meta-analysis indicated higher procedure failure rates with radial--as compared to femoral access (7.2 vs. 2.4%), more recent data from prospective multicenter studies and large meta analysis showed significantly better outcomes with radial access versus femoral access in contemporary, real-world clinical settings of percutaneous cardiovascular procedures (e.g. ⋯ Transradial procedure failures can sometimes be due to variation in radial artery anatomy (e.g. vessel diameter, anomalous branching patterns, tortuosity) or risk factors for radial spasms (e.g. smoking, anxiety, vessel diameter, age, gender). Postprocedural radial occlusions (0.6-1.2%) seems strongly be related to these anatomical variances, which possibly may be reduced by the use of smaller catheter, however 5 French lumen diameter guiding catheter include limitations regarding treating options in complex coronary lesion. In conclusion, the transradial access for coronary angiography and interventions is not only to enhance patients comfort, but shows significant better long-term results due to less bleeding complications as compared to the femoral access.
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Transradial approach for diagnostic and interventional procedures is becoming common practice. It has not been well determined how many times the same radial artery can be cannulated without complications. Aim of the study was to evaluate safety, feasibility and efficacy of repeat transradial procedures. ⋯ Failure of repeat puncture may be due to thickening of the tunica intima resulting from sheath insertion injuries or because of periarterial fibrosis at the prior radial puncture site. We believe that repeated use of the same radial artery is effective in considering its high procedural success and low complication rates in majority of patients in the hands of experienced operators.