RESUMEN

BACKGROUND: The Woven EndoBridge (WEB) device is a minimally invasive endovascular treatment option for patients with cerebral aneurysms. Transradial access (TRA) is a technique that involves accessing the arterial system through the radial artery in the wrist rather than the femoral artery in the groin. Several studies have investigated the use of TRA for WEB device deployment in treating intracranial aneurysms. METHODS: A systematic review was conducted to evaluate the TRA for WEB device deployment in treating intracranial aneurysms. The databases PubMed, Cochrane, Embase, Scopus, and Web of Science were searched. To reduce the risk of bias, this systematic review only included studies reporting on using TRA in WEB device deployment for intracranial aneurysm treatment with a minimum of four patients. RESULTS: In this systematic review, 186 patients were included across five studies, with TRA used in 183 cases analyzed. The study population had a higher proportion of females (n = 118%-69%) than males, with a mean age of 62 years old. Among the aneurysms treated, 46 were ruptured, and 119 were located at bifurcation sites, with a mean maximum diameter/width of 6.6 mm and mean height of 5.9 mm. Adjunctive coiling was used in three cases, and adjunctive stenting was used in nine cases. In two cases, conversion to a femoral artery access was necessary. CONCLUSION: The available results suggest TRA with the WEB device is a safe and effective alternative. However, using TRA versus TFA should be individualized based on patient factors and operator experience.

Asunto(s)

RESUMEN

INTRODUCTION: Carotid artery stenting (CAS) through transradial access (TRA) is emerging as an alternative to carotid endarterectomy. However, the current evidence base is limited, mainly comprising single-center studies. OBJECTIVE: This systematic review and meta-analysis aim to assess the safety and effectiveness of TRA for CAS, providing evidence to support clinical decisions. METHODS: We conducted searches on PUBMED, Cochrane Library, Embase, and Web of Science databases, including studies on TRA for CAS. Studies with fewer than 20 patients, non-primary outcomes, and non-full-text articles were excluded. RESULTS: We analyzed 14 studies involving 1,166 patients who underwent CAS via TRA. Procedural success rate was high in 13 studies, with a 95% rate (95% CI; 92%-98%). Crossover to TFA access was observed in 12 studies at 6% (95% CI: 3%-9%). Transradial access failure was reported in four studies, with a rate of 0% (95% CI: 0%-0%). Cannulation failure resulted in a rate of 4% (95% CI: 2%-7%). Asymptomatic radial artery occlusion (ARAO) occurred at a rate of 2% based on eight studies (95% CI: 0%-5%). Forearm hematoma was reported in 10 studies, with an occurrence of 1% (95% CI: 0%-2%). Cerebral vascular attacks (CAV) within 30 days were assessed in 13 studies, indicating a 2% occurrence (95% CI: 1%-2%). CONCLUSION: The findings suggest that TRA for CAS yields promising outcomes with high success rates and low complication rates. Further research should focus on randomized controlled trials and long-term outcomes to validate and extend findings.

Asunto(s)

RESUMEN

Transradial access is associated with fewer access site-related complications, earlier patient mobilization, and greater postprocedural comfort. Pseudoaneurysms are an extremely rare complication after transradial procedures and the radial artery itself is the most atypical arterial site of occurrence. We report a case in which a non-surgical, non-invasive, simple, and effective solution (prolonged pneumatic compression) was used to manage a radial artery pseudoaneurysm, a very rare and challenging complication of transradial procedures.

O acesso arterial transradial está associado a menos complicações relacionadas ao sítio de punção, com deambulação precoce do paciente e maior conforto pós-procedimento. O pseudoaneurisma é uma complicação extremamente rara após procedimentos transradiais, sendo a artéria radial, por si só, o sítio mais incomum para tal ocorrência. Relata-se um caso de um pseudoaneurisma de artéria radial, uma complicação rara e desafiadora, resolvido com êxito e de maneira simples, não invasiva e não cirúrgica (compressão pneumática prolongada).

RESUMEN

BACKGROUND: Cerebral angiography has two common access sites: Transradial approach and transfemoral approach. However, there's no definitive answer to which one is superior. OBJECTIVE: Compare transradial approach and transfemoral approach for a cerebral angiography procedure. METHODS: A systematic review of the literature of studies reporting both transradial approach and transfemoral approach results was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed, Cochrane Library, and Embase were queried. RESULTS: The meta-analysis examined 18 studies comprising 9388 patients undergoing cerebral angiography. Among the patients, 4598 underwent transradial approach (48.9%) and 4790 underwent transfemoral approach (51.1%). Our results revealed no statistical differences between the approaches regarding procedure success, crossover to transfemoral approach, procedure and fluoroscopy time between both approaches in cerebral angiography. Total, major, and minor complications comparisons were more favorable to transradial approach for this procedure. CONCLUSION: These findings suggest, despite the ultimate decision regarding the choice of access method might be influenced by the physician's experience and personal preference, the data distinctly lean toward transradial approach as the preferable option for cerebral angiography. The advantages of transradial approach, highlighted by its lower complication rates, especially major complications, suggest that its adoption could contribute to enhanced patient safety and procedural outcomes.

RESUMEN

BACKGROUND: Older patients are at a higher risk of access site complications and bleeding. Systematic reviews and meta-analysis have highlighted the benefits of distal over proximal transradial access (mainly, lower rates of radial artery occlusion and faster hemostasis). We aimed to evaluate the feasibility and safety of distal transradial access (dTRA) for routine coronary procedures in older patients compared with non-older patients. METHODS: Retrospective analysis of a large and real-world sample of 5524 consecutive all-comers patients who underwent coronary procedures via dTRA were included in the DISTRACTION registry. RESULTS: In the older patients (greater than or equal to 65 years) group (n = 2594, 47%), there were higher rates of hypertension (83% vs 71.1%; P less than .0001), diabetes (45.1% vs 34.7%; P less than .0001), previous stroke (2.9% vs 2%; P=.0425), chronic heart failure (9.2% vs 7.1%; P=.0040), severe aortic valvar disease (4.2% vs 2.9%; P=.0070), chronic kidney disease stages 3 and 4 (8.1% vs 3.1%; P less than .0001), previous percutaneous coronary intervention (27.2% vs 24.5%; P=.0253), previous coronary artery bypass grafting (5.1% vs 2.2%; P less than .0001), cardiogenic shock at presentation (1.3% vs 0.4%; P=.0003), rotational atherectomy (0.7% vs 0.2%; P=.0050), and left main percutaneous coronary intervention (2.7% vs 1.5%; P=.0033). No significant differences were observed in the rates of access site crossovers. No major adverse cerebrovascular and cardiac events directly related to dTRA, no hand/thumb dysfunction or ischemia after any procedure, and no access site-related hematomas (early discharge after transradial stenting of coronary arteries greater than or equal to 2) were recorded. CONCLUSIONS: Despite more comorbidities, more complex coronary disease, and more challenging presentation, the adoption of dTRA as the default approach for routine coronary procedures in older patients, by proficient operators, appears to be safe and feasible.

Asunto(s)

RESUMEN

As the population continues to grow, and life expectancy has increased, aortic stenosis (AS) has become the most common valvular disease requiring surgical treatment. The evolution of valve replacement therapies has progressed significantly since 1960. In the last 20 years, transcatheter aortic valve implantation (TAVI) has been a game changer, and has potential to become the standard of care. Despite uncertain prognosis benefits, balloon aortic valvuloplasty (BAV) can be useful in a broad range of patients with AS, as well as being a bridging therapy to valve replacement, or as a destination therapy, besides its role in TAVI procedures. This review describes the contemporary role of BAV in AS treatment, and focuses on technical improvements that reframe BAV as an effective tool in a variety of clinical scenarios. One of these improvements is transradial BAV, either with the conventional approach of BAV or applying the bilateral technique with two balloons.

RESUMEN

One limitation to transradial access (TRA) is the occurrence of spasms (RAS), for which the use of prophylactic medications is recommended. Improvement in TRA material combined with the increase in operators' expertise, might mitigate this benefit. We assess the effect of preventive nitroglycerin on RAS during TRA, evaluating the role of the operator's experience. Patients received 500 µg nitroglycerin or placebo. The operator's expertise was classified as: inexperienced (I), intermediate (M), and experienced (E). 2040 patients were included. Prophylactic use of nitroglycerin did not reduce RAS (10.8% vs. 13.4% (placebo), p = 0.07). RAS incidence was 14.5% in I, 12.5% in M, and 9.7% in E (p = 0.01). In group I, nitroglycerin reduced RAS (17.4% vs. 11.1%, p = 0.04), which was not observed in other groups. Overall, nitroglycerin does not prevent RAS, which is more common among inexperienced operators. More experienced operators could abolish preventive nitroglycerin use.

Asunto(s)

RESUMEN

BACKGROUND: Distal transradial access (dTRA) as a refinement of the conventional transradial access (TRA) has advantages in terms of risk of radial artery occlusion (RAO). In order to evaluate the real-world feasibility and safety of dTRA as the default access site for routine coronary angiography (CAG) and percutaneous coronary intervention (PCI) in a Latin-American centre, this prospective observational registry was conducted. METHODS: Consecutive patients with a prior assessment for CAG and/or PCI were enrolled in this single-centre prospective registry from October 2018 to March 2019. The primary endpoints were the success rate of CAG and PCI. Secondary endpoints included the success rate of puncture of the distal radial artery, complications at the puncture site and puncture time. RESULTS: The success rates of CAG and PCI were 100% (155/155) and 97% (69/71), respectively. Puncture time and fluoroscopic time were 52 ± 19 seconds and 16.3 ± 35.4 minutes, respectively. Haemostasis time was 142 ± 45 min. A total of 19 (12.5%) puncture site complications occurred, including 18 (11.6%) minor haematomas and one (0.6%) arterial perforation, in which the artery was patent at the one-month follow-up. Five patients complained of left thumb numbness at a one-month follow-up. No distal radial artery occlusion, pseudoaneurysm, or arteriovenous fistula occurred. CONCLUSIONS: The success and complication rates of ldTRA support the feasibility and safety of this procedure using the appropriate materials in previously selected patients.

Asunto(s)

RESUMEN

Abstract Transradial access is associated with fewer access site-related complications, earlier patient mobilization, and greater postprocedural comfort. Pseudoaneurysms are an extremely rare complication after transradial procedures and the radial artery itself is the most atypical arterial site of occurrence. We report a case in which a non-surgical, non-invasive, simple, and effective solution (prolonged pneumatic compression) was used to manage a radial artery pseudoaneurysm, a very rare and challenging complication of transradial procedures.

Resumo O acesso arterial transradial está associado a menos complicações relacionadas ao sítio de punção, com deambulação precoce do paciente e maior conforto pós-procedimento. O pseudoaneurisma é uma complicação extremamente rara após procedimentos transradiais, sendo a artéria radial, por si só, o sítio mais incomum para tal ocorrência. Relata-se um caso de um pseudoaneurisma de artéria radial, uma complicação rara e desafiadora, resolvido com êxito e de maneira simples, não invasiva e não cirúrgica (compressão pneumática prolongada).

RESUMEN

Abstract A 53-year-old man with an asymptomatic fistula from the Vieussens ring to the pulmonary artery presented with progressive respiratory distress. Coil embolization of this type of fistula has been described by femoral access. The advanced transradial "grandmother-mother-son" technique for high active support safely allows successful embolization of this type of coronary fistulae.

Resumen Un hombre de 53 años con una fístula asintomática del anillo de Vieussens a la arteria pulmonar comenzó con dificultad respiratoria progresiva. La embolización con coils de este tipo de fístulas ha sido descrita por acceso femoral. La técnica transradial avanzada "abuela-madre-hijo" para un alto soporte activo permite de manera segura la embolización exitosa de este tipo fístulas coronarias.

RESUMEN

A 53-year-old man with an asymptomatic fistula from the Vieussens ring to the pulmonary artery presented with progressive respiratory distress. Coil embolization of this type of fistula has been described by femoral access. The advanced transradial "grandmother-mother-son" technique for high active support safely allows successful embolization of this type of coronary fistulae.

Un hombre de 53 años con una fístula asintomática del anillo de Vieussens a la arteria pulmonar comenzó con dificultad respiratoria progresiva. La embolización con coils de este tipo de fístulas ha sido descrita por acceso femoral. La técnica transradial avanzada "abuela-madre-hijo" para un alto soporte activo permite de manera segura la embolización exitosa de este tipo fístulas coronarias.

Asunto(s)

RESUMEN

Background: Distal transradial access (dTRA) as an improvement of the traditional transradial approach has several potential advantages including operator and patient comfort, faster hemostasis, and lower risk of proximal radial artery occlusion (RAO). We aim to describe our real-world experience with dTRA as default approach for routine coronary angiography and percutaneous coronary interventions (PCI) in a broad and prospective cohort of all-comers patients. Methods: In the DISTRACTION registry, a total of 3,683 consecutive all-comers patients who underwent coronary procedures via dTRA were included. Results: The mean patient age was 63.3±13.5-year-old, 66.1% were male, 39.7% had diabetes, and 50.2% presented with acute coronary syndromes (ACS). Overall, 20% of patients had non-ST-elevation myocardial infarction (NSTEMI), 22.9% had ST-elevation myocardial infarction (STEMI), and 2.6% presented in cardiogenic shock. There were 2.5% access site crossovers, 16% of those were performed via contralateral dTRA; thus, in only 77 (2.1%) patients dTRA sheath insertion could not be obtained. Right dTRA (rdTRA) was the most frequent access (80.2%), followed by redo ipsilateral dTRA (10.5%), left dTRA (ldTRA) (8.6%) and simultaneous bilateral dTRA (0.7%). PCI was performed in 60.4% of all cases, and left anterior descending was the most treated vessel (29%). No access site-related hematoma type ≥2, according to EASY classification was recorded. No hand/thumb dysfunction after any procedure was documented. One patient developed a pseudoaneurysm, and one had guidewire-induced forearm radial artery perforation. There were neither major complications nor major adverse cerebrovascular and cardiac events directly related to dTRA. Conclusions: In this large, prospective, all-commers patients registry the adoption of dTRA as standard for routine coronary interventions appears to be safe and feasible.

RESUMEN

Background Endovascular treatment of vascular pathologies through the transradial approach has been increasingly used and has demonstrated a low rate of complications. Objective To report our initial experience in the endovascular treatment of cerebrovascular diseases with the transradial approach and to determine its safety and feasibility. Methods Consecutive patients who underwent the transradial approach for endovascular treatment of aneurysms and vascular malformations were reviewed at a single institution. Technical success, fluoroscopy time, and access-related complications were analyzed. Results Eight patients underwent endovascular treatment with the transradial approach. One arteriovenous fistula, one superficial temporal artery aneurysm, three arteriovenous malformations, and four aneurysms were treated successfully. The radial artery was successfully approached and a 6-F sheath was used in all the cases. Navigation of guiding catheters (5 and 6 F) was done without complications. The most commonly approached artery was the right internal carotid artery, followed by the right vertebral artery. Postoperative vasospasm was identified in three patients. Mean fluoroscopy time was 34.7 minutes. Conversion to transfemoral approach was not required. No postoperative complications were reported. Conclusions In our initial experience, the transradial approach is a safe and feasible alternative for the endovascular treatment of cerebrovascular pathologies.

RESUMEN

Introducción: En los últimos años la utilización de la vía radial como forma de acceso para la realización de estudios diagnósticos e intervencionista ha cobrado mayor importancia e interés dentro de los servicios de cardiología intervencionista a nivel mundial. Nuestro país no escapa de este auge por la baja tasa de complicación y la mayor comodidad para el paciente. Objetivo: Caracterizar la intervención coronaria percutánea mediante la vía de acceso radial en pacientes atendidos en el Instituto de Cardiología y Cirugía Cardiovascular. Método: Estudio observacional, descriptivo, transversal. Muestra compuesta por 211 pacientes a los que se les realizó intervencionismo coronario percutáneo mediante la vía de acceso radial. Resultados: Predominó el sexo masculino (61,2 por ciento). La edad media fue 60,1 ±9,8 años. El Síndrome Coronario Crónico (76,3 por ciento ) fue el diagnóstico mayoritario, la hipertensión arterial el factor de riesgo más frecuente (73,9 por ciento ) y entre los antecedentes personales la cardiopatía isquémica (30,3 por ciento ). El intervencionismo de forma electiva se realizó en el 76,3 de los casos, utilizando la vía radial derecha en el 88,2 por ciento . Se demostró enfermedad de 2 y 3 vasos en el 45,1 por ciento de los pacientes. El proceder fue exitoso en el 96,7 por ciento de los pacientes. Las variables que demostraron relación estadísticamente significativa con el fracaso fueron: fracción de eyección del ventrículo izquierdo < 40 por ciento (p<0.0001), filtrado glomerular ≤ 60 ml/min (p=0.002), antecedente de cardiopatía isquémica (p= 0.016) y presencia de enfermedad coronaria de 3 vasos (p= 0.019). Conclusiones: La intervención coronaria percutánea mediante el acceso radial en el ICCCV es segura y eficaz, con una tasa de éxito elevada y escasas complicaciones(AU)

Introduction: In recent years the use of the radial approach as a form of access for diagnostic and interventional studies has become increasingly important and of interest in interventional cardiology services worldwide. Our country has not escaped this boom due to the low complication rate and greater patient comfort. Objective: To characterise percutaneous coronary intervention using the radial access route in patients attended at the Institute of Cardiology and Cardiovascular Surgery. Methods: Observational, descriptive, cross-sectional study. The sample consisted of 211 patients who underwent percutaneous coronary intervention via the radial access route. Results: Male sex predominated (61.2 percent). Mean age was 60.1 ±9.8 years. Chronic coronary syndrome (76.3 percent) was the most common diagnosis, hypertension the most frequent risk factor (73.9) percent and ischaemic heart disease (30.3 percent ). Elective intervention was performed in 76.3 percent of cases, using the right radial approach in 88.2 percent . Two- and three-vessel disease was demonstrated in 45.1 percent of patients. The procedure was successful in 96.7 percent of patients. Variables demonstrating statistically significant relationship with failure were: left ventricular ejection fraction < 40 percent (p(0.0001), glomerular filtration rate ≤ 60 ml/min (p=0.002), history of ischaemic heart disease (p= 0.016) and presence of 3-vessel coronary artery disease (p= 0.019). Conclusions: Percutaneous coronary intervention via radial access in ICCCV is safe and effective, with a high success rate and few complications(AU)

Asunto(s)

RESUMEN

Despite all well-known benefits of transradial access, patients presenting with cardiogenic shock are usually submitted to coronary angiography and percutaneous coronary intervention via traditional transfemoral access, mainly due to challenge puncture of radial artery in the setting of hemodynamic instability. We report a challenging case of STEMI-related cardiogenic shock requiring primary PCI of an occluded and unprotected left main, safety, and successfully performed via right distal trans radial access in the anatomical snuffbox.

RESUMEN

For ST-segment elevation myocardial infarction (STEMI) patients with multi-vessel coronary disease, complete revascularization is superior to culprit-only percutaneous coronary intervention (PCI). Chronic total occlusion represents the most challenging setting for PCI. Distal transradial access (dTRA) has advantages such as faster hemostasis and risk of proximal radial artery occlusion. We report a case of nonculprit coronary total occlusion recanalization concurrent to culprit primary PCI via dTRA in the setting of STEMI.

RESUMEN

RESUMEN El abordaje transradial está ganando territorio en el campo neuroendovascular para procedimientos diagnósticos y terapéuticos. Menos complicaciones, menor tiempo hospitalario y mayor confort del paciente son características de este abordaje. Sin embargo, la transición del abordaje femoral clásico al abordaje radial es difícil de lograr en instituciones con protocolos establecidos. Presentamos nuestra experiencia inicial utilizando el abordaje transradial para angiografía cerebral diagnóstica realizados exitosamente logrando la cateterización de todos los vasos supra-aórticos.

ABSTRACT The transradial approach for diagnostic cerebral angiography is aiming to become the standard technique in the neuroendovascular field for both diagnostic and therapeutic procedures. Some characteristics for this approach include less complications, shorter hospital stay and more comfort for patients. However, transitioning from the classical femoral approach to the radial approach is difficult to achieve in facilities with well-established protocols. We report our initial experience using the transradial approach for diagnostic cerebral angiography, where all supraaortic blood vessels were successfully catheterized.

RESUMEN

The treatment of endovascular leaks after endovascular abdominal aortic repair can be challenging, particularly in patients with a lack of vascular access. We describe the case of a critically ill elderly patient with an endoleak resulting from structural failure of an endograft years after endovascular abdominal aortic repair. The patient was treated with an aorto-uni-iliac endoprosthesis, but a few days later a new endoleak appeared and femoral or axillar access was not feasible. We successfully treated the endoleak using a novel technique via bilateral transradial access involving simultaneous insufflation of two peripheral low-profile balloons to achieve a diameter capable of improving the apposition of the stent graft. In selected cases, bilateral radial access allows procedures to be performed that would otherwise be impossible due to the inherent limitation in sheath size that can be used in the radial artery.

RESUMEN

Visceral artery pseudoaneurysms (PSAs) are relatively rare, and cases associated with distal vasculature of the superior mesenteric artery are largely unreported. Visceral artery PSAs, without intervention, can lead to morbidity or mortality from rupture or mesenteric ischemia. Historically, open aneurysmectomy is the gold standard; however, endovascular modalities have emerged as the first-line treatment in patients who are poor surgical candidates and/or have unfavorable anatomy. Herein, we describe a case of a symptomatic PSA of the distal superior mesenteric artery treated via the transradial approach with endovascular coil embolization, showing successful aneurysmal exclusion and preservation of enteric collateral flow.

RESUMEN

INTRODUCTION: Same-day discharge percutaneous coronary interventions (SDD-PCI) may be quite impactful on healthcare burden for small island developing states (SIDS) such as Trinidad and Tobago. METHODS: From June 2012 to November 2014, 11 patients underwent SDD trans-radial PCI and followed up at one-month and three months. Data was retrospectively reviewed from a prospectively entered unit-maintained cardiology database. Baseline patient characteristics, in-hospital expenditure, and complications were assessed. Descriptive statistical analysis was performed in Microsoft Excel. RESULTS: The mean age at SDD-PCI was 50.90±9.96 and nine were male. Nine patients were of East Indian Caribbean ethnicity. Six were diabetic and five were hypertensive. Procedural success was 100% with no major early complication or three-months complications; patient satisfaction was achieved with a potential in-hospital savings up to $1480 USD per patient. CONCLUSION: This SDD approach for elective trans-radial PCI may be safe and cost-effective in properly selected patients and merits a review of relevant policy issues in Trinidad and Tobago.