Transradial access in percutaneous coronary interventions : Technique and procedure.
Dahm JB, Wolpers HG, Becker J et al.
After showing significantly lower complication rates in diagnostic coronary angiography, the radial artery access was successfully introduced as a useful vascular access site for transradial percutaneous coronary intervention in order to enhance patients’ comfort and reduce hospital workload and costs. Moreover, due to the reduced need for antiplatelet therapy cessation as a result of lower bleeding complications, patients treated with transradial access showed a significantly better cardiac outcome in randomized interventional acute coronary syndrome studies. Procedural success and postprocedural radial arteritis or radial occlusions are closely related to anatomical circumstances (e.g., anomalous radial branching patterns, tortuosity, e.g., radial loops and small radial artery diameters), or risk factors for radial spasms (e.g. smoking, anxiety, vessel diameter, age, gender) which can effectively be reduced by the use of smaller catheters (4-5 Fr) and the administration of an adjuvant pharmacological therapy before (3000 U heparin, verapamil, nitroglycerine) and after (ibuprofen) the intervention.For successful radial sheath access and transradial catheterization, it is important to use dedicated radial access needles ≤21-gauge and steel wires ≤0.018 in. In order to pass the brachiocephalic trunk without difficulties or complications and access the ascending aorta, the use of inspiration maneuvers is of central importance.
Herz. 2010 Sep 22. [Epub ahead of print]