A Comparative Study On Efficacy And Safety Between TUA And TRA For Coronary Angiography And Coronary Angioplasty

Objective：To compare the efficacy and safety between transulnarapproach and transradial approach for coronary angiography and coronaryangioplasty.Methods: Consecutive patients referred to our department from October2011to August2012. Including angina, acute myocardial infarction, previousmyocardial infarction as well as those suspected of coronary artery disease.Exclusion criteria:(1) the forearm arterial coronary angiography or coronaryangioplasty history;(2) forearm deformity, trauma, surgical history;(3) ahistory of Raynaud’s;(4) acute pulmonary edema or cardiogenic shock.According to a random number table, all patients were randomized totransulnar (TUA group) or transradial (TRA group) before procedure. Allpatients were administrated with conventional drugs. All patients had aright-side artery puncture. After puncture successful, a6-F sheath wascannulated to the artery. We use4-F diagnostic catheters for coronaryangiography, and6-F guiding catheter for coronary angioplasty. Guidewire,balloon and stent were decided by operators according to the patient’scondition. At the same, a forearm angiography was performed. The time andnumber of artery puncture, the spasm situation, the angiography time, the PCItime, the coronary lesions, the model and number of stent, the fluoroscopytime as well as the DAP were recorded. After the procedure,30days clinicalfollow up was performed. Procedure complications were defined as theoccurrence of major adverse cardiac events (MACES), including all-causedeath, non-fatal myocardial infarction and target vessel revascularization (PCIor CABG). Puncture site complications including the size of the puncture sitebleeding, artery patency, nerve damage and hand movement disorder andischemic conditions. Forearm artery ultrasound was scheduled to the patients to evaluate the artery diameter and local complications such as arteriovenousfistula, pseudoaneurysm and vascular occlusion. Statistical analysis wasperformed with SPSS13.0.Continuous variables are expressed as mean±standard deviation(SD) and categorical variables as percentages. Continuousdata were analyzed using the t-test and categorical data were analyzed usingchi-square test. A P value <0.05was considered statistically significant.Results:1. Finally,67patients were randomized to the TUA group,71patients tothe TRA group. There was no significant difference between the TUA groupand TRA group in terms of gender, age, BMI, incidence of diabetes,hypertension, Dyslipidemia, previous myocardial infarction and stroke. Thebasis of drug administrative of aspirin, clopidogrel, low molecular weightheparin, statins, ACEI/ARB, calcium antagonists, nitrates was no significantdifference. The proportion of the two groups of patients with a plateletglycoprotein IIb/IIIa receptor antagonists also was no significant difference.2. The puncture success rate was97.1%in TUA group and100%in TRAgroup; there was no significant difference between the two groups. Theaverage number of punctures was1.63±0.85in TUR group and1.31±0.69in TRA group, P=0.017, there was a significant difference between the twogroups. The ulnar artery puncture time was166.5±40.7seconds and theradial was141.5±30seconds, P=0.000, there was a significant differencebetween the two groups. The stitch puncture achievement rate was56.7inTUA group and78.9%in TRA group, there was a significant difference. Theartery spasm was no significant difference.3. There was no significant difference between the two groups in terms ofangiography time, the dose of contrast, the fluoroscopy time and DAP. Thecoronary lesions had no significant difference.95patients were performedcoronary angioplasty. All patients received at least one stent successfully.There was no significant difference between the two groups in terms of lesiontype, target vessel angioplasty, average stent per patient, procedure time, thefluoroscopy time, DAP, the dose of contrast and the proportion of TIMI3 grade.According to the forearm angiography measurement, the artery diameterhad no significant difference. The radial artery diameter was2.56±0.38mmand2.59±0.37mm, respectively. The ulnar artery diameter was2.52±0.37mm and2.54±0.37mm, respectively. P=NS.All patients who received angioplasty were followed one month forMACEs. No one died in two groups. The incidence of non-fatal myocardialinfarction was no significant difference. One patient in the TUA groupreceived revascularization. The freedom from MACEs was observed95.6%inTUA group and96%in TRA group. P=NS.All patients received follow-up of the puncture site complications. Therewas no major bleeding in two groups.9patients in TUA group and11patientsin TRA group had minor bleeding, P=NS. Follow-up Doppler ultrasound ofthe forearm vessels was done in84.4%in TUA group and84%in TRA group.Ulnar artery diameter measured by Doppler ultrasound were2.70±0.46mmand2.75±0.44mm, respectively, radial artery diameter was2.57±0.44mmand2.53±0.43mm, respectively. P=NS. The artery stenosis was found8.8%in TUA group and10.2%in TRA group, P=NS. All patients had no arterialocclusion, arteriovenous fistula and pseudoaneurysm occurred. The patientswho did not undergo follow-up Doppler ultrasonography were interviewedover the phone; none reported symptoms or functional impairment at theaccess site.Conclusion: Compared with the transradial approach, the transulnarapproach for coronary angiography and coronary angioplasty is safe andeffective.