Postprocedural radial artery occlusion rate using a sheathless guiding catheter for left ventricular endomyocardial biopsy performed by transradial approach

For coronary interventions the arterial access via the radial artery is associated with fewer vascular access site complications, and has been shown to reduce major bleeding when compared to the femoral approach. But the endomyocardial biopsy (EMB) approach is usually done by a transfemoral or cervical access known to be associated with an increased risk of artery puncture and its potential complications (i.e., false aneurysm, artery-venous fistula), and moreover needs post-procedural immobilization. A transradial approach for EMBs is not standardized. The aim of our study is to validate safety and efficacy of the transradial access approach for left ventricular EMB, and to define patients eligible for a safe and successful procedure.

We evaluated the transradial access using a 7.5 F sheathless multipurpose guiding catheter to obtain EMB from the left ventricle (LV). 18 patients were included. The transradial success rate was 100% (18/18). There were no periprocedural cardiac complications. Immediate post-procedural ambulation could be achieved in all patients. Although radial artery pulse was confirmed by ultrasonic vascular Doppler after removal of the guide in 100% (18/18) of the patients, 50% (9/18) of the patients showed occlusion of the radial artery (RAO) by duplex sonography proximal to the access site (RAO group). 33% (3/9) of the patients in the RAO group, and 11,1% (1/9) of the patients in the patent radial artery (RAP) group, respectively, experienced mild pain in the right lower arm after the procedure. Color Doppler ultrasonography of the right radial artery performed 24 h after the procedure revealed radial occlusion in 50% (9/18) of the patients. The diameter of the radial artery was significantly smaller in the RAO group (p = 0,034), and peak systolic velocity (PSV) of the right ulnar artery was significantly higher in the RAO group (p = 0.012). In comparison, peak systolic velocity of the opposite radial artery was significantly lower (p = 0,045). Gender, diabetes, radial artery inner diameter ≤2.5 mm and lower peak systolic velocity of < 50 cm/s are predictors of RAO.

The present study demonstrates the safety and efficacy of a transradial access for EMB using a hydrophilic sheathless guiding catheter.