Transradial Approach For Diagnostic Coronary Angiography And Coronary Interventions

BackgroudCoronary artery radiography now are widely used to diagnosis for coronary artery disease (CHD). Percutaneous coronary interventions (PCI) are one of the most important method for the therapy of CHD. Though PCI come to perfection gradually , this technique still face some problems. How to minimize the chance of injury and the access site complications remain a big challenge. In our country, the majority of coronary angiography and coronary interventions are still performed via the femoral artery. Though most doctors are proficient in the femoral routine, the incidence of access site vascular complicatios remain concerned. The management of PCI always involves intensive anticoagulation which may include thrombolytic therapy or plateletglycoprotein IIb/IIIa receptor inhibition in addition to heparin and aspirin. Coronary interventions from the femoral approach in these patients is associated with an increased incidence of access site complications, such as access site bleeding. When patients have peripheral vascular disease , coronary angiography by the femoral approach is relative contraindicated. Alternative vascular access include brachial and radial approaches. Feasibility and safety of transradial coronary catheterization has been demonstrated in several studies from overseas centers. Access site bleeding complications are virtually eliminated . Patients may ambulate immediately after the procedure and hospital lengths of stay are significantly reduced. Thus patients overwhelmingly prefer the transradial over the femoral approach. objectiveThe purpose of the present study was to evaluate the feasibility and safety of transradial approach for coronary angiography and interventions. methodsCoronary angiography was tried to be performed via transradial approach in 107 patients (71 males, 36 females, mean age 61.03 10.43 years) during October 2003 to March 2004. Before angiography, 36 patients was diagnosis as stable angina while 34 patients as unstable angina, 3 patients as acute myocardial infarction, and 34 patientscombined with other disease, such as heart failure, hypertension, hypertrophic cardiomyopathy and so on. Allen test was negative in all patients.ResultsAll patients had a right-side arterial puncture. Transradial puncture failed in 3 cases and coronary angiography were performed via transfemoral approach instead. Coronary cannulation failed in 1 case and coronary interventions failed in 1 case although transradial puncture succeeded. Forty four narrowed coronary arteries were dilated (LAD 28, LCX 5, RCA 11). Forty five coronary lesions were treated. Forty five stents were implanted in 30 coronary arteries of 29 patients. Hematoma was found in one case. Perforation of a branch of brachial artery happened in another case. None of patients had been found to be suffered a loss of radial pulsations. No transfusion and surgery repair needed. ConclusionCoronary angiography and interventions via transradial approach was feasible and safe. Access site vascular complications are less, but the radial artery puncture was somewhat difficlt and require a skilled operator.