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16-08-2022 | Anticoagulant | Original Article

Predictors of success and puncture site complications in the distal radial approach

Authors: Akihiro Ikuta, Shunsuke Kubo, Kohei Osakada, Makoto Takamatsu, Kotaro Takahashi, Masanobu Ohya, Hiroyuki Tanaka, Takeshi Tada, Yasushi Fuku, Kazushige Kadota

Published in: Heart and Vessels | Issue 2/2023

Abstract

The distal radial approach (DRA) has been proposed as an alternative approach for coronary angiography (CAG) and percutaneous coronary intervention (PCI); however, the predictors of DRA failure and puncture site complications are unclear. Among 7153 consecutive patients undergoing CAG or PCI between November 2018 and January 2021, 3610 patients undergoing CAG or PCI with DRA were analyzed. The primary endpoint of this study was the procedural success, and the secondary endpoint of this study was puncture site complications during procedure. Puncture site complications during procedure were defined as a composite of major bleeding, minor bleeding, arteriovenous fistula, pseudoaneurysm, and neuropathy. The DRA success rate and the puncture site complication rate were 90.4% and 7.7%, respectively. The predictors of DRA failure were low body weight and dual antiplatelet therapy; those of DRA success were PCI and ultrasonography-guided DRA; those of puncture site complications during procedure were low body weight, peripheral arterial disease, dual antiplatelet therapy, anticoagulant therapy, and PCI; and that of no puncture site complications were previous PCI and ultrasonography-guided DRA. The negative predictors of DRA success with no puncture site complication during procedure were low body weight and dual antiplatelet therapy. The positive predictor of DRA success with no puncture site complication during procedure was ultrasonography-guided DRA. We identified the predictors of DRA failure and puncture site complications during procedure in patients undergoing CAG and PCI with DRA. Ultrasonography-guided DRA was associated with a high DRA success rate and a low puncture site complication rate in patients undergoing CAG or PCI with DRA.

Valgimigli M, Gagnor A, Calabró P, Frigoli E, Leonardi S, Zaro T, Rubartelli P, Briguori C, Andò G, Repetto A, Limbruno U, Cortese B, Sganzerla P, Lupi A, Galli M, Colangelo S, Ierna S, Ausiello A, Presbitero P, Sardella G, Varbella F, Esposito G, Santarelli A, Tresoldi S, Nazzaro M, Zingarelli A, de Cesare N, Rigattieri S, Tosi P, Palmieri C, Brugaletta S, Rao SV, Heg D, Rothenbühler M, Vranckx P, Jüni P, Investigators MATRIX (2015) Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet 385:2465–2476CrossRef

Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO, ESC Scientific Document Group (2019) 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J 40(2):87–165CrossRef

Kiemeneij F (2017) Left distal transradial access in the anatomical snuffbox for coronary angiography (ldTRA) and interventions (ldTRI). EuroIntervention 13(7):851–857CrossRef

Hadjivassiliou A, Cardarelli-Leite L, Jalal S, Chung J, Liu D, Ho S, Klass D (2020) Left distal transradial access (ldTRA): a comparative assessment of conventional and distal radial artery size. Cardiovasc Interv Radiol 43(6):850–857CrossRef

Lee JW, Park SW, Son JW, Ahn SG, Lee SH (2018) Real-world experience of the left distal transradial approach for coronary angiography and percutaneous coronary intervention: a prospective observational study (LeDRA). EuroIntervention 14(9):e995–e1003CrossRef

Naito T, Sawaoka T, Sasaki K, Iida K, Sakuraba S, Yokohama K, Sato H, Soma M, Okamura E, Harada T, Yoshimachi F (2019) Evaluation of the diameter of the distal radial artery at the anatomical snuff box using ultrasound in Japanese patients. Cardiovasc Interv Ther 34(4):312–316CrossRef

Norimatsu K, Kusumoto T, Yoshimoto K, Tsukamoto M, Kuwano T, Nishikawa H, Matsumura T, Miura SI (2019) Importance of measurement of the diameter of the distal radial artery in a distal radial approach from the anatomical snuffbox before coronary catheterization. Heart Vessels 34(10):1615–1620CrossRef

Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, Kaul S, Wiviott SD, Menon V, Nikolsky E, Serebruany V, Valgimigli M, Vranckx P, Taggart D, Sabik JF, Cutlip DE, Krucoff MW, Ohman EM, Steg PG, White H (2011) Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 123(23):2736–2747CrossRef

Kim Y, Ahn Y, Kim I, Lee DH, Kim MC, Sim DS, Hong YJ, Kim JH, Jeong MH (2018) Feasibility of coronary angiography and percutaneous coronary intervention via left snuffbox approach. Korean Circ J 48(12):1120–1130CrossRef

10.

Kashiwagi M, Tanimoto T, Kitabata H, Arita Y, Yamamoto Y, Mori K, Terada K, Nishiguchi T, Taruya A, Kubo T, Tanaka A, Akasaka T (2019) Usefulness of rescue ultrasound guidance for transradial cardiac catheterization. Cardiovasc Revasc Med 20(4):311–315CrossRef

11.

Dehghani P, Mohammad A, Bajaj R, Hong T, Suen CM, Sharieff W, Chisholm RJ, Kutryk MJ, Fam NP, Cheema AN (2009) Mechanism and predictors of failed transradial approach for percutaneous coronary interventions. JACC Cardiovasc Interv 2(11):1057–1064CrossRef

12.

Nakamura M, Kadota K, Nakao K, Nakagawa Y, Shite J, Yokoi H, Kozuma K, Tanabe K, Iijima R, Harada A, Kuroda T, Murakami Y (2021) High bleeding risk and clinical outcomes in East Asian patients undergoing percutaneous coronary intervention: the PENDULUM registry. EuroIntervention 16:1154–1162CrossRef

13.

Yoshioka N, Takagi K, Morita Y, Kanzaki Y, Nagai H, Watanabe N, Morishima I (2021) Bleeding events and mid-term mortality in the patients undergoing endovascular interventions for peripheral artery disease of the lower limbs based on the academic research consortium high bleeding risk criteria. Heart Vessels 36(9):1336–1349CrossRef

14.

Yoshimachi F, Ikari Y (2021) Distal radial approach: a review on achieving a high success rate. Cardiovasc Interv Ther 36(1):30–38CrossRef

15.

Akioka H, Yufu K, Harada T, Akamine K, Uemura T, Takahashi M, Nishimizu K, Hirota K, Ishii Y, Kira S, Yonezu K, Abe I, Tawara K, Kondo H, Saito S, Fukui A, Okada N, Shinohara T, Teshima Y, Nakagawa M, Takahashi N (2022) Reduction of bleeding complications on puncture site after percutaneous coronary intervention using a 6.5-French sheathless guiding catheter. Heart Vessels 37(6):954–960CrossRef

16.

Honda T, Fujimoto K, Miyao Y, Koga H, Hirata Y (2012) Access site-related complications after transradial catheterization can be reduced with smaller sheath size and statins. Cardiovasc Interv Ther 27(3):174–180CrossRef

17.

Natsuaki M, Morimoto T, Shiomi H, Ehara N, Taniguchi R, Tamura T, Tada T, Suwa S, Kaneda K, Watanabe H, Tazaki J, Watanabe S, Yamamoto E, Saito N, Fuki M, Takeda T, Eizawa H, Shinoda E, Mabuchi H, Shirotani M, Uegaito T, Matsuda M, Takahashi M, Inoko M, Tamura T, Ishii K, Onodera T, Sakamoto H, Aoyama T, Sato Y, Ando K, Furukawa Y, Nakagawa Y, Kadota K, Kimura T, CREDO-Kyoto PCI/CABG Registry Cohort-3 Investigators (2021) Application of the modified high bleeding risk criteria for Japanese patients in an all-comers registry of percutaneous coronary intervention—from the CREDO-Kyoto Registry Cohort-3. Circ J. 85(6):769–781CrossRef

18.

Mori S, Hirano K, Yamawaki M, Kobayashi N, Sakamoto Y, Tsutsumi M, Honda Y, Makino K, Shirai S, Ito Y (2020) A comparative analysis between ultrasound-guided and conventional distal transradial access for coronary angiography and intervention. J Interv Cardiol 2020:7342732CrossRef

19.

Sgueglia GA, Lee BK, Cho BR, Babunashvili A, Lee JB, Lee JW, Schenke K, Lee SY, Harb S (2021) Distal radial access: consensus report of the first Korea-Europe transradial intervention meeting. JACC Cardiovasc Interv 14(8):892–906CrossRef

20.

Quan Z, Tian M, Chi P, Cao Y, Li X, Peng K (2014) Modified short-axis out-of-plane ultrasound versus conventional long-axis in-plane ultrasound to guide radial artery cannulation: a randomized controlled trial. Anesth Analg 119(1):163–169CrossRef

21.

Hadjivassiliou A, Kiemeneij F, Nathan S, Klass D (2021) Ultrasound-guided access of the distal radial artery at the anatomical snuffbox for catheter-based vascular interventions: a technical guide. EuroIntervention 16(16):1342–1348CrossRef

22.

Kurisu K, Osanai T, Kazumata K, Nakayama N, Abumiya T, Shichinohe H, Shimoda Y, Houkin K (2016) Ultrasound-guided femoral artery access for minimally invasive neuro-intervention and risk factors for access site hematoma. Neurol Med Chir 56(12):745–752CrossRef

Title: Predictors of success and puncture site complications in the distal radial approach
Authors: Akihiro Ikuta
Shunsuke Kubo
Kohei Osakada
Makoto Takamatsu
Kotaro Takahashi
Masanobu Ohya
Hiroyuki Tanaka
Takeshi Tada
Yasushi Fuku
Kazushige Kadota
Publication date: 16-08-2022
Publisher: Springer Japan
Keywords: Anticoagulant
Arteriovenous Fistula
Peripheral Arterial Disease
Peripheral Arterial Disease
Arteriovenous Fistula
Published in: Heart and Vessels / Issue 2/2023
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI: https://doi.org/10.1007/s00380-022-02152-6

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