Intravascular Ultrasound Assessment of Distal Trans-Radial Access in Patients Undergoing Percutaneous Coronary Intervention.
dissection
distal trans‐radial
intravascular ultrasound
sheathless
vasospasm
Journal
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
ISSN: 1522-726X
Titre abrégé: Catheter Cardiovasc Interv
Pays: United States
ID NLM: 100884139
Informations de publication
Date de publication:
29 Oct 2024
29 Oct 2024
Historique:
revised:
11
10
2024
received:
12
09
2024
accepted:
18
10
2024
medline:
29
10
2024
pubmed:
29
10
2024
entrez:
29
10
2024
Statut:
aheadofprint
Résumé
Distal trans-radial access (dTRA) for percutaneous coronary interventions (PCI) is increasingly gaining attention due to its potential to mitigate radial artery occlusion (RAO). However, a comprehensive understanding of the mechanical impact of the devices on the radial artery (RA) wall remains limited. Using a complete intravascular ultrasound (IVUS) evaluation of the RA, including also the vascular access site, we aimed to evaluate all the consequences related to the catheterization on the RA wall, starting from the vascular access, comparing conventional sheath and sheathless approaches. This is an observational, prospective, multicenter study aimed to assess the entire RA wall immediately after IVUS-guided PCI via-dTRA. IVUS assessment included quantitative measurements (minimal lumen area [MLA], minimal vessel area [MVA]) and qualitative observations (dissections, vasospasm). Study objectives included delineating RA wall structure post-PCI and comparing findings between conventional and sheathless approaches. Fifty patients (21 [42%] with conventional sheath, 29 [58%] sheathless) were enrolled between March 2023 and February 2024. Female patients were more prevalent in the convention sheath group (38% vs. 7%, p < 0.001). Sheathless approach utilized 7-French guiding catheters more frequently (33% vs. 86%, p < 0.001). Post-procedural IVUS identified dissections in 12% of cases, with no significant difference between approaches. Arterial vasospasm was present in a quarter of patients, numerically higher in the conventional sheath group (29% vs. 21%, p = 0.5). MLA and MVA were comparable between groups, though MLA and MVA were lowest at the proximal segment of the RA only in the conventional sheath group (p < 0.001). No RAO was documented during the IVUS evaluation. The intravascular assessment of dTRA after coronary interventions, utilizing either conventional or sheathless approaches, including large-bore guiding catheters, demonstrated a relatively low incidence of access-related complications such as dissection and vasospasm, without affecting the flow and patency of the proximal RA.
Sections du résumé
BACKGROUND
BACKGROUND
Distal trans-radial access (dTRA) for percutaneous coronary interventions (PCI) is increasingly gaining attention due to its potential to mitigate radial artery occlusion (RAO). However, a comprehensive understanding of the mechanical impact of the devices on the radial artery (RA) wall remains limited. Using a complete intravascular ultrasound (IVUS) evaluation of the RA, including also the vascular access site, we aimed to evaluate all the consequences related to the catheterization on the RA wall, starting from the vascular access, comparing conventional sheath and sheathless approaches.
METHODS
METHODS
This is an observational, prospective, multicenter study aimed to assess the entire RA wall immediately after IVUS-guided PCI via-dTRA. IVUS assessment included quantitative measurements (minimal lumen area [MLA], minimal vessel area [MVA]) and qualitative observations (dissections, vasospasm). Study objectives included delineating RA wall structure post-PCI and comparing findings between conventional and sheathless approaches.
RESULTS
RESULTS
Fifty patients (21 [42%] with conventional sheath, 29 [58%] sheathless) were enrolled between March 2023 and February 2024. Female patients were more prevalent in the convention sheath group (38% vs. 7%, p < 0.001). Sheathless approach utilized 7-French guiding catheters more frequently (33% vs. 86%, p < 0.001). Post-procedural IVUS identified dissections in 12% of cases, with no significant difference between approaches. Arterial vasospasm was present in a quarter of patients, numerically higher in the conventional sheath group (29% vs. 21%, p = 0.5). MLA and MVA were comparable between groups, though MLA and MVA were lowest at the proximal segment of the RA only in the conventional sheath group (p < 0.001). No RAO was documented during the IVUS evaluation.
CONCLUSIONS
CONCLUSIONS
The intravascular assessment of dTRA after coronary interventions, utilizing either conventional or sheathless approaches, including large-bore guiding catheters, demonstrated a relatively low incidence of access-related complications such as dissection and vasospasm, without affecting the flow and patency of the proximal RA.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : The authors received no specific funding for this work.
Informations de copyright
© 2024 Wiley Periodicals LLC.
Références
I. Bernat, A. Aminian, S. Pancholy, et al., “Best Practices for the Prevention of Radial Artery Occlusion After Transradial Diagnostic Angiography and Intervention,” JACC: Cardiovascular Interventions 12 (2019): 2235–2246.
A. Babunashvili and D. Dundua, “Recanalization and Reuse of Early Occluded Radial Artery Within 6 Days After Previous Transradial Diagnostic Procedure,” Catheterization and Cardiovascular Interventions 77 (2011): 530–536.
F. Kiemeneij, “Left Distal Transradial Access in the Anatomical Snuffbox for Coronary Angiography (IdTRA) and Interventions (IdTRI),” EuroIntervention 13 (2017): 851–857.
G. Eid‐Lidt, A. Rivera Rodríguez, J. Jimenez Castellanos, J. I. Farjat Pasos, K. E. Estrada López, and J. Gaspar, “Distal Radial Artery Approach to Prevent Radial Artery Occlusion Trial,” JACC: Cardiovascular Interventions 14 (2021): 378–385.
G. Tsigkas, A. Papageorgiou, A. Moulias, et al., “Distal or Traditional Transradial Access Site for Coronary Procedures,” JACC: Cardiovascular Interventions 15 (2022): 22–32.
A. Aminian, G. A. Sgueglia, M. Wiemer, et al., “Distal Versus Conventional Radial Access for Coronary Angiography and Intervention,” JACC: Cardiovascular Interventions 15 (2022): 1191–1201.
G. A. Sgueglia, A. Di Giorgio, A. Gaspardone, and A. Babunashvili, “Anatomic Basis and Physiological Rationale of Distal Radial Artery Access for Percutaneous Coronary and Endovascular Procedures,” JACC: Cardiovascular Interventions 11 (2018): 2113–2119.
R. E. S. Tan and A. Lahiri, “Vascular Anatomy of the Hand in Relation to Flaps,” Hand Clinics 36 (2020): 1–8.
G. L. Gasparini, R. Garbo, A. Gagnor, J. Oreglia, and P. Mazzarotto, “First Prospective Multicentre Experience With Left Distal Transradial Approach for Coronary Chronic Total Occlusion Interventions Using a 7 Fr Glidesheath Slender,” EuroIntervention 15 (2019): 126–128.
C. Ungureanu, G. L. Gasparini, A. Aminian, et al., “Railtracking: A Novel Technique to Overcome Difficult Anatomy During Transradial Approach,” Journal of Invasive Cardiology 34 (2022): E757–E762.
Y. Kim, S. Y. Lee, D. I. Lee, et al., “Assessment of the Conventional Radial Artery With Optical Coherent Tomography After the Snuffbox Approach,” Cardiology Journal 28 (2021): 849–854.
E. S. Shin, S. H. Ann, G. B. Singh, et al., “Oct‐Defined Morphological Characteristics of Coronary Artery Spasm Sites in Vasospastic Angina,” JACC: Cardiovascular Imaging 8 (2015): 1059–1067.
E. Poletti, G. Castaldi, B. Scott, et al., “Alternative (Transulnar or Distal Radial) Arterial Access for Chronic Total Occlusion Percutaneous Coronary Intervention (Subanalysis From the Minimalistic Hybrid Approach Algorithm Registry),” American Journal of Cardiology 200 (2023): 57–65.
T. Wakeyama, H. Ogawa, H. Iida, et al., “Intima‐Media Thickening of the Radial Artery After Transradial Intervention,” Journal of the American College of Cardiology 41 (2003): 1109–1114.
T. Wakeyama, H. Ogawa, T. Iwami, et al., “Distal Radial Arterial Hypertrophy After Transradial Intervention: A Serial Intravascular Ultrasound Study,” Journal of Cardiology 72 (2018): 501–505.