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Objectives: The present study aimed to examine whether the application of a topical cutaneous medication, compared to standard subcutaneous lidocaine infiltration, prior to radial artery puncture in the setting of diagnostic coronary angiography will impact the occurrence of radial artery spasm, pain experienced by the patient during the procedure, and mean attempts of radial artery cannulation. Patients and methods: Cumulative meta-analysis of data derived from 7 randomized controlled or prospective non-randomized placebo-controlled trials was performed. The primary outcomes of interest included relative risk of radial artery spasm during cannulation, mean pain score as perceived by the patient and quantified by visual analogue scale, and mean radial artery cannulation attempts. Risk ratio (RR) with 95% confidence intervals (95% CI) was used for the effect measurement of radial artery spasm while fixed effects method was applied. The mean difference was calculated by using the random effects model due to data exhibiting moderate to high heterogeneity. Meta-analysis was performed by using the Cochrane’s Review Manager software. Results: The data derived from seven studies enrolling a total of 1425 patients were included in the analysis. A total of 106 radial artery spasm events were recorded. Radial artery spasm occurred in 5.57% of cases in the experimental arm (topical solution), while in the arm receiving standard treatment radial vasospasm occurred in 9.32% of cases. This yielded a relative risk reduction of 41% in patients receiving topical medication (RR 0.59; 95% CI 0.41 to 0.86, P=0.005), compared to control arm. Analysis of 1342 patients from 6 studies in regards to pain quantified by VAS, the results showed a significant reduction in pain score by 1.54 points (MD -1.54; 95% CI -2.94 to -0.14 points, P=0.030) among patients that received topical medications vs. standard treatment. The mean number of radial artery cannulation attempts were recorded in 4 studies, including 744 patients. The results showed -0.07 fewer cannulation attempts in the experimental vs. control arm (MD -0.07, 95% CI -0.14 to 0.01), however, this result was not statistically significant (P=0.070). Conclusions: Preprocedural application of topical cutaneous medication, compared to standard-of-care consisting of subcutaneous lidocaine infiltration, prior to radial artery cannulation in the setting of transradial angiography in patients with stable or suspected CAD was associated with a significant reduction in the occurrence of radial spasm and pain perceived by the patient. Application of topical cutaenous medication, however, did not reduce the mean number of radial artery cannulation attempts, when compared to subcutaneous lidocaine infiltration., Ciljevi: Ova studija je kao glavni cilj imala istražiti je li primjena topikalnih lijekova koji se apliciraju na kožu, u usporedbi sa supkutanom infiltracijom lidokaina, a prije punkcije radijalne arterije za vrijeme dijagnostičke koronarne angiografije ima učinak na učestalost spazma radijalne arterije, bol koju pacijent osjeća za vrijeme kanulacije kao i prosječan broj pokušaja kanulacije radijalne arterije. Pacijenti i metode: Izvršena je kumulativna meta-analiza podataka koji su sakupljeni iz 7 randomiziranih kliničkih pokusa ili nerandomiziranih prospektivnih placebom kontroliranih studija. Glavni ishodi od posebnog interesa su bili relativni rizik spazma radijalne arterije za vrijeme kanulacije, prosječan osjećaj boli koju pacijent osjeća za vrijeme radijalne kanulacije, a koji je kvantificiran korištenjem vizualno-analogne skale te prosječan broj kanulacija radijalne arterije. Omjer rizika (RR) sa 95% intervalima pouzdanosti je korišten kao mjera učinka ishoda spazma radijalne arterije, a za istu je korištena statistička metoda fiksnih učinaka. Razlika u prosječnom zbroju bola i pokušaja kanulacije je analizirana korištenjem statističke metode nasumičnih učinaka obzirom da su navedeni podatci pokazali umjerenu do visoku heterogenost. Meta-analiza je izvršena korištenjem Cochraneovog Review Manager programskog paketa. Rezultati: Analizirani su ishodi 1,427 pacijenta iz sedam studija uključenih u analizu. Ukupno je zabilježeno 106 događaja spazma radijalne arterije. Spazam radijalne arterije zabilježen je u 5,57% slučajeva u grupi pacijenata koji su dobili topikalni lijek (eksperimentalna grupa) te u 9,32% slučajeva u grupi pacijenata koji su dobili standardnu skrb (kontrolna grupa). Navedena eksperimentalna intervencija bila je povezana sa smanjenjem relativnog rizika za spazam radijalne arterije za 41% (omjer rizika 0,59; 95%-tni interval pouzdanosti 0,41-0,86, P=0,005). Analizom ishoda boli prilikom kanulacije radijalne arterije kod 1,342 pacijenta iz 5 studija, pokazalo se da je intervencija topikalnim lijekom dovela do značajnog smanjenja boli za 1,54 boda u percepciji boli izmjerene VAS skalom u usporedbi sa pacijentima koji su dobili standardnu skrb (razlika u prosječnim vrijednostima -1,54 boda na VAS skali; 95%-tni interval pouzdanosti -2,94 do -0,14 bodova, P=0,030). Ishod prosječnog broja kanulacija radijalne arterije je analiziran u 744 pacijenta iz 4 studije. Za ovaj ishod nije utvrđena statistički značajna razlika između dvije skupine iako je u skupini pacijenata koji su primili topikalni lijek utvrđen trend smanjenja prosječnog broja pokušaja kanulacije radijalne arterije (razlika u prosječnim vrijednostima -0,07; 95%-tni interval pouzdanosti -0,14 do 0,01 pokušaja, P=0,070). Zaključci: Aplikacija kutanog topikalnog lijeka prije kanulacije radijalne arterije, u usporedbi sa standardnom skrbi korištenja supkutane infiltracije lidokainom u pacijenata koji se podvrgavaju transradijalnoj angiografiji je bila povezana sa značajnim smanjenjem rizika radijalnog spazma kao i smanjenjem percipirane boli za vrijeme kanulacije radijalne arterije. Intervencija sa topikalnim lijekom, međutim, nije smanjila prosječan broj pokušaja kanulacije radijalne arterije u usporedbi sa supkutanom infiltracijom lidokaina.

Common femoral artery (CFA) transfemoral access (TFA) has been the traditional route for neuroendovascular intervention with flow diversion including the pipeline embolization device (PED) for the treatment of wide-necked aneurysms. Successful deployment requires significant catheter support, thus making alternative access challenging. A 56-year-old-female presented with subarachnoid hemorrhage secondary to a large ruptured posterior communicating artery (PCOM) aneurysm as well as found to have an unruptured left superior cerebellar artery (SCA) aneurysm. Endovascular embolization of PCOM aneurysm via TFA was complicated by a right CFA pseudoaneurysm. The SCA aneurysm was treated 8 weeks later via left TFA with consequent development of a left CFA pseudoaneurysm. Contrasted magnetic resonance angiography revealed recurrence at the neck of the PCOM aneurysm at 4-month follow-up, treated via transradial access (TRA) PED flow diversion to avoid additional groin complications. Anatomic, procedural, and clinical considerations for TRA anterior circulation flow diversion using the PED are reviewed.

Objective The study aimed at to find out prevalence of abnormal upper limb arterial anatomy and its correlation with access failure during transradial coronary angiography. Method This was a prospective observational study of 1512 patients who had undergone transradial coronary angiography (CAG). Angiographic assessment of upper limb arterial tree was performed when the angiographic guidewire or the diagnostic catheter followed an abnormal path or got stuck in its course. Results About 5.29% patients (80/1512) were noted to have abnormal upper limb arterial anatomy. The most common abnormality detected were radio-ulnar loop in 22 (1.46%) patients, tortuous upper limb arteries 19 (1.25%) and abnormal high origin of radial artery 10 (0.66%) patients. Access failure was encountered in 4.4% (67/1512) of total patients and 64.17% (43/67) access failure was due to abnormal upper limb arterial anatomy. Conclusion Abnormal upper limb arterial anatomy was the most common cause of access failure in transradial coronary angiography in this study.

Limb loss is a traumatic event as it has physical and psychological effects on an amputee. Recent advancements in mechatronics and biomedical engineering have resulted in development of dexterous myoelectric prostheses for rehabilitation of amputees. In addition, evolution in manufacturing and sensing technology presents ample room for improvement in mechanical design and control system of prostheses to enhance amputee experience while using prosthetic devices. The present study is focused on design of a novel and cost-effective externally powered two-degree-of freedom prosthesis for assisting amputees to switch from body-powered devices to externally powered prosthesis. The control system of the developed prosthesis is based on the muscles signals acquired through force myography (FMG) technique. For precise integration of force-sensitive resistor (FSR) inside the socket to measure muscle activity, a stand-alone housing for FSR was designed with the feature of mechanical adjustment to control sensitivity of FSR and auto-calibrate its threshold to meet the requirements of individual amputees. The housing was designed to handle the fabrication inconsistencies during socket shaping process and thus ensure that sensor is in-firm contact with the muscle to sense volumetric changes. The developed mechanical design and FMG based muscle acquisition technique was successfully tested on a transradial amputee and extensive experimentation was performed for characterization of the prosthesis. FMG signal for various gestures was successfully extracted from muscles of the amputee to control the prosthesis according to the developed control technique. The results suggested that integration of FSR in the socket has significantly reduced the effect of sweat and volumetric changes on the performance of the sensor. Due to its novel design, embedded features, and cost-effectiveness the developed prototype holds the promise to be successfully commercialized to assist transradial amputees in becoming active citizens for contributing towards socio-economic growth of their country.

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.

© 2020 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/bync-nd/4.0/)., Introduction and objectives: Over the last decade, several studies have suggested that left ventricular endomyocardial biopsy is safer and has a higher diagnostic yield than transvenous right ventricular biopsy. In addition, recent publications indicate that the transradial approach is a feasible and safe alternative to the transfemoral approach for sampling the left ventricle. We report our initial experience with transradial endomyocardial biopsy with regards to feasibility, safety and usefulness. Methods: Single-center registry of consecutive patients undergoing intended transradial left endomyocardial biopsy. Clinical and technical data were collected prospectively, with a particular focus on success rate and complications. Results: Twenty-seven patients were screened for left ventricle biopsy. Twenty (25) were selected for an intended transradial approach (mean age 51±18 years old, 22 male). Success rate was 100% with no crossover to femoral approach. There were no major complications. Two patients experienced mild radial spasm. One of them also had a run of non-sustained ventricular tachycardia. Indication for biopsy was either myocarditis or cardiomyopathy of unknown etiology. The final diagnosis was acute lymphocytic myocarditis in five patients, chronic myocarditis in one patient, amyloid light-chain amyloidosis in four patients and transthyretin amyloidosis in six patients. Myocarditis was ruled out in eight patients and amyloidosis in one patient. Conclusions: Transradial left ventricle endomyocardial biopsy is a very safe and feasible method of sampling the myocardium for histopathological analysis, with a good diagnostic yield and clinically meaningful results in properly selected patients.

Objectives: To compare the feasibility, safety and effectiveness of transradial and transfemoral artery puncture cerebral angiography. Methods: The clinical data of 30 cases (radial artery group) and 256 cases (femoral artery group) of cerebrovascular angiography through radial artery puncture were retrospectively analyzed, and the puncture success rate, angiography time, exposure time and surgical complication rate were compared. Results: There was no significant difference in the success rate of puncture between the two groups (P > 0.05). The procedure time and radiation exposed time were longer than those in the femoral artery group (P

Background: Distal transradial access (dTRA) by the snuffbox approach for coronary catheterization has emerged as an alternative to the classic forearm TRA with certain advantages and limitations.The aim of this study was to evaluate the effectiveness and safety of the dTRA exclusively from the right arm. Methods: Forty-nine consecutive patients (31 males and 18 females, mean age 64 ± 12 years), who were candidates for coronary catheterization in two cath laboratory centers, regardless of the indication, were recruited. Right dTRA was exclusively used. Radial artery patency both at the forearm and at the snuffbox region was evaluated 24 h after successful hemostasis by triplex ultrasonography. All complications were recorded until 24 h after the procedure. Results: The indication for catheterization was an acute coronary syndrome in 24.5%, stable coronary artery disease in 22.4%, and other reasons in 53.1%. The overall failure attempt incidence was 10.2% and the mean puncture time 3.9 ± 4.1 min. Angiography only was performed in 81.8% and angiography followed by percutaneous coronary intervention in 18.2% of the patients. Manual hemostasis was applied in 63.6% of the patients, which had a significantly shorter duration than device hemostasis (11 ± 7 versus 198 ± 42 min, p

Transradial access is the commonly followed route for performing percutaneous coronary diagnostic and angioplasty interventions. Transradial access has drastically decreased the vascular access site complications when compared with the transfemoral access. Arteriovenous fistula developing at the transradial access site is one of the rare complications. The risk factors and the mechanism of development are not entirely known. We present a rare case of a 63-year-old female developing radiocephalic fistula a few days after transradial coronary angiography and discuss management.The transradial route is preferred for cardiovascular interventions. Complications arising out of this are rare even though this route is widely used. Arteriovenous fistula is one of the rare complications, and the mechanisms causing it are not always clearly evident. This report will elaborate on the possible causes and steps to prevent this complication and help in managing once it occurs.

Highlights • Vertebrobasilar junction aneurysms are rare and the treatment is challenging. • Endovascular management is generally preferred over neurosurgery. • Coiling, flow-diversion, and parent vessel occlusion are common techniques. • Transradial access is safe and offers advantages when vascular anatomy is difficult., Introduction Vertebrobasilar junction (VBJ) aneurysms are uncommon posterior circulation aneurysms. The treatment of VBJ aneurysms is challenging and in most cases, endovascular management is preferred over neurosurgery. Presentation of case We describe two patients with VBJ aneurysms who underwent successful neuro-interventional procedures. The first patient had concomitant basilar fenestration and was treated with balloon-assisted coiling. The second patient had difficult vascular anatomy and an anterior inferior cerebellar artery-posterior inferior cerebellar artery variant arising from the neck of the aneurysm. Braided stent-assisted coiling was done with transradial access. Both patients had a good neurologic recovery. Discussion Endovascular management of VBJ aneurysms is often complicated by anatomic difficulties like basilar fenestration, tortuosity of proximal vessels, atheromatous changes, and vascular stenosis. We achieved good post-procedure outcomes in both the patients. Optimal management of complex VBJ aneurysms often requires some modification to the usual interventional technique. Conclusion VBJ aneurysms are generally treated with endovascular techniques. The transradial access, although rarely used by neurointerventionalists, has some distinct advantages over the transfemoral access, especially when dealing with right-sided VBJ aneurysms with marked tortuosity of proximal great vessels.

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.

Transfemoral access for neurointerventions has been a time-tested technique of entering the vascular network of the body and reaching the intended targets. However, it has its own share of shortcomings in the form of long admission times leading to increased costs, patient inconvenience and local (though infrequent) adverse affects. Transradial route has taken the interventional cardiology domain by storm and is staring now at other vascular domains especially neurointervention. It has shown better outcomes than the transfemoral route in many aspects. The current article discusses the vascular access perspectives with an exhaustive overview of the transradial route concerning its historical perspectives, its requirement in the current clinical scenario, the procedure per se including the adverse effects and whether it has the real world charm to displace the transfemoral route into the backseat. Transradial access in neurointervention is here to stay, however it would require training, certain modifications in the standard catheters that one currently uses for cerebral procedures and constant practice by the operator to cross the learning curve and attain a certain level of competence before he becomes comfortable with the technique.

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Introduction and objectives: Today it has become increasingly common to perform procedures without withdrawing oral anticoagulation. However, the need to withdraw oral anticoagulants prior to cardiac catheterization in patients chronically anticoagulated (OACs) remains controversial. We evaluated the efficacy and safety of performing transradial catheterization in outpatients without withdrawing direct-action oral anticoagulants (DOACs). Methods: Prospective and observational study where 270 patients who underwent elective transradial cardiac catheterization were included from January 2013 through November 2017, divided into 3 groups of 90 patients based on their anticoagulant intake: group A (without OAC), with group B (with vitamin K antagonist), and group C (with DOACs), and matched according to the date of completion. In no case was the OAC discontinued before the procedure. We evaluated the complications of radial access within the first 24 h and 1 month after the procedure. Results: The group of patients on DOACs had a higher proportion of men compared to the vitamin K antagonist group (71.1% vs 47.8%; P = .01) and patients were younger in the group without OAC (63.45 ± 11.47 vs 70.22 ± 9.35; P = .03). Group B had a lower percentage of diabetic patients (22.2% vs 36.67% in group C, P = .03). In group A, patients were more prone to having a history of ischemic heart disease compared to the groups of anticoagulated patients (27.84% vs 14.44% in group C, P = .028) in addition to a more frequent intake of antiplatelet drugs. Radial access was the access of choice in most patients (98.2%). There were no significant differences when it comes to vascular access complications among the groups being the rate of hematoma and/or bleeding at discharge equal to 1.1% in the DOACs group and the arterial occlusion rates both at discharge and at 1 month between 0% and 2.2%. Conclusions: In our experience performing transradial diagnostic cardiac catheterizations without discontinuation of DOACs is safe, with low rates of thrombotic and hemorrhagic complications, without any differences with vitamin K antagonist and no OAC.

Transradial access has been used for percutaneous coronary interventions with success; however, there is limited literature on its use for visceral stenting in the setting of complex endovascular aneurysm repair. We present a case of transradial left renal salvage after renal artery thrombosis in the setting of complex endovascular aneurysm repair. Keywords: Transradial, Endovascular, Aortic, Renal

espanolIntroduccion y objetivos: Actualmente es cada vez mas habitual realizar procedimientos sin retirar la anticoagulacion oral (ACO), pero la necesidad o no de suspender la ACO antes del cateterismo cardiaco sigue siendo una cuestion controvertida. Se evaluan la eficacia y la seguridad de la realizacion de un cateterismo transradial en pacientes ambulatorios sin retirar los anticoagulantes orales de accion directa (ACOD). Metodos: Estudio observacional, prospectivo, que incluye 270 pacientes sometidos a cateterismo transradial electivo desde enero de 2013 hasta noviembre de 2017, divididos en 3 grupos de 90 pacientes: grupo A (sin ACO), grupo B (con antagonista de la vitamina K), grupo C (con ACOD), emparejados segun la fecha de realizacion del cateterismo. No se suspendio la ACO antes del procedimiento. Se evaluan las complicaciones del acceso radial en las primeras 24 h y un mes despues del cateterismo. Resultados: Habia mas varones tratados con ACOD que con un antagonista de la vitamina K (71,1 frente a 47,8%; p = 0,01) y los pacientes eran mas jovenes en el grupo sin ACO (63,45 ± 11,47 frente a 70,22 ± 9,35 anos; p = 0,03). En el grupo B hubo menos diabeticos (22,2 frente a 36,67% en el grupo C; p = 0,03). En el grupo A, los pacientes tenian mas antecedentes de cardiopatia isquemica que los pacientes con anticoagulacion (27,84 frente a 14,44% en el grupo C; p = 0,028), ademas de la toma concomitante de farmacos antiplaquetarios. El acceso fue radial en la mayoria de los pacientes (98,2%). No hubo diferencias significativas en las complicaciones del acceso vascular, con una tasa de hematoma o hemorragia al alta del 1,1% en el grupo con ACOD y tasas de oclusion arterial tanto al alta como al mes del 0-2,2%. Conclusiones: En nuestra experiencia, la realizacion de un cateterismo diagnostico transradial sin interrupcion de los ACOD es seguro, con tasas bajas de complicaciones tromboticas y hemorragicas, sin diferencias respecto a los pacientes en tratamiento con un antagonista de la vitamina K o sin ACO. EnglishIntroduction and objectives: Today it has become increasingly common to perform procedures without withdrawing oral anticoagulation. However, the need to withdraw oral anticoagulants prior to cardiac catheterization in patients chronically anticoagulated (OACs) remains controversial. We evaluated the efficacy and safety of performing transradial catheterization in outpatients without withdrawing direct-action oral anticoagulants (DOACs). Methods: Prospective and observational study where 270 patients who underwent elective transradial cardiac catheterization were included from January 2013 through November 2017, divided into 3 groups of 90 patients based on their anticoagulant intake: group A (without OAC), with group B (with vitamin K antagonist), and group C (with DOACs), and matched according to the date of completion. In no case was the OAC discontinued before the procedure. We evaluated the complications of radial access within the first 24 h and 1 month after the procedure. Results: The group of patients on DOACs had a higher proportion of men compared to the vitamin K antagonist group (71.1% vs 47.8%; p = .01) and patients were younger in the group without OAC (63.45 ± 11.47 vs 70.22 ± 9.35; p = .03). Group B had a lower percentage of diabetic patients (22.2% vs 36.67% in group C, p = .03). In group A, patients were more prone to having a history of ischemic heart disease compared to the groups of anticoagulated patients (27.84% vs 14.44% in group C, p = .028) in addition to a more frequent intake of antiplatelet drugs. Radial access was the access of choice in most patients (98.2%). There were no significant differences when it comes to vascular access complications among the groups being the rate of hematoma and/or bleeding at discharge equal to 1.1% in the DOACs group and the arterial occlusion rates both at discharge and at 1 month between 0% and 2.2%. Conclusions: In our experience performing transradial diagnostic cardiac catheterizations without discontinuation of DOACs is safe, with low rates of thrombotic and hemorrhagic complications, without any differences with vitamin K antagonist and no OAC.

Background: Acute Kidney Injury as a complication of cardiac catheterization is associated with increased length of hospital stay and mortality. In recent years, the use of the radial artery for cardiac catheterization is increasing in frequency. Objective: The objective of this concise review was to evaluate the method of cardiac access site and its impact on Acute Kidney Injury following cardiac catheterization. Methods: After a thorough search on Medline, Google Scholar and PubMed, we included all the literature relevant to Acute kidney injury following transradial and transfemoral cardiac catheterization. Results: While acute kidney injury was caused due to a variety of reasons, it was important to consider each case on an individual basis. We found a trend towards increased use of transradial approach in patients at high risk of developing kidney injury. However, limitations such as operator experience, anatomical challenges and so on do exist with this approach. Conclusion: Transradial access offers several advantages to a patient at high risk of acute kidney injury undergoing cardiac catheterization. Further large studies are needed to establish this trend in the years ahead.

AIM: This study was designed to compare the safety and feasibility of uterine fibroid embolisation (UFE) via transradial access (TRA) and transfemoral access (TFA). MATERIAL AND METHODS: A retrospective analysis was conducted for 2 cohorts: 13 cases with already established TFA (from February 2016 to September 2018) and the first 11 procedures performed via TRA (from October 2017 to October 2018). Indications for embolization included: heavy menstrual bleedings (n = 18), lower urinary tract symptoms (n = 2), pelvic pain (n = 3) and abdominal pain (n = 1). One interventional radiologist and one fellow performed all procedures at one institution. Technical success, procedural time, access site complications as well as feedback from patients were assessed for analysis. RESULTS: Technical success was achieved in 24/24 cases (100%). Unilateral uterine artery embolisation was performed in 7 cases (29.1%) and bilateral in 17 cases (70.8%). Mean procedure time was 72.4 minutes in TFA group, and 60.3 minutes in the TRA group. Mean fluoroscopy time was 25.3 minutes in the TFA group and 21.1 minutes in the TRA group. Access site-related and overall adverse events did not vary significantly among the study cohorts. CONCLUSIONS: TRA represents a safe and feasible approach for UFE with a comparable safety profile to TFA.

Introduction The prolonged fluoroscopic time during coronary angiography results in a higher radiation dose delivered to patients. Similarly, a higher contrast volume used is associated with higher rates of contrast-induced nephropathy. This study was designed to identify the better technique in terms of lesser fluoroscopic time and volume of contrast used during the procedure. Objective To compare mean fluoroscopic time and mean contrast volume used in patients undergoing coronary angiography through the transfemoral versus transradial route. Methods A randomized controlled trial (RCT) was conducted at the department of cardiology, Pakistan Institute of Medical Sciences (PIMS) Islamabad between June 2017 and December 2017. Ninety (n=90) patients planned for coronary angiography between 30 and 70 years of age were enrolled. Patients were randomly allocated to Group A (transfemoral route group) and Group B (transradial route group). Fluoroscopic time (minutes) and contrast volume (milliliters) used were measured in each patient. Results The mean contrast volume used in Group A was 70.4 ml (SD=8.7) and in Group B, it was 90.1 ml (SD=9.8) (P

L'autor d'aquest projecte és un gran apassionat dels esports, especialment del ciclisme, per tant, que uns altres no puguin gaudir d'ells per motius aliens a la seva pròpia decisió és una cosa que li fa sentir impotent. Aquest projecte sorgeix de voler, d'una manera o una altra, fer una petita aportació. A continuació, es mostra un treball centrat en desenvolupar un dispositiu protètic per a amputats transradiales, enfocat en el ciclisme. D'aquesta manera s'aconsegueix que persones que volen practicar ciclisme i no poden a causa de la seva discapacitat puguin realitzar-ho sense impediments. Per a dur a terme el projecte s'establiran uns objectius, els quals es pretenen aconseguir mitjançant dues metodologies de disseny completament compatibles: el Design thinking i la metodologia de doble diamant. Mitjançant la seva combinació es desenvolupen diversos punts, entre els més destacats es troben el Brífing, amb el qual s'aconsegueix una major informació del producte i usuari i la identificació del problema, on s'usen fins a 9 eines. Gràcies a tota la informació recopilada en els punts esmentats s'idea el producte i posteriorment es realitza un modelatge 3D. Mitjançant aquest modelatge es realitzen una sèrie de simulacions i càlculs d'esforços per a comprovar que el dispositiu protètic dissenyat és segur. Finalment, es defineix el producte definitiu mitjançant plans 2D i renderitzats 3D, gràcies als renderitzats el client es pot fer una idea aproximada de com serà el producte, però per a facilitar-li el treball es realitza una maqueta amb la qual podrà veure diferents aspectes com a forma, grandària o proporcions. Una vegada finalitzat, s'extreuen unes conclusions que valoren positivament el treball realitzat. El autor de este proyecto es un gran apasionado de los deportes, especialmente del ciclismo, por tanto, que otros no puedan disfrutar de ellos por motivos ajenos a su propia decisión es algo que le hace sentir impotente. Este proyecto surge de querer, de una manera u otra, hacer una pequeña aportación. A continuación, se muestra un trabajo centrado en desarrollar un dispositivo protésico para amputados transradiales, enfocado en el ciclismo. De este modo se consigue que personas que quieren practicar ciclismo y no pueden debido a su discapacidad puedan realizarlo sin impedimentos. Para llevar a cabo el proyecto se establecerán unos objetivos, los cuales se pretenden alcanzar mediante dos metodologías de diseño completamente compatibles: el Design thinking y la metodología de doble diamante. Mediante su combinación se desarrollan diversos puntos, entre los más destacados se encuentran el Briefing, con el cual se consigue una mayor información del producto y usuario y la identificación del problema, donde se usan hasta 9 herramientas. Gracias a toda la información recopilada en los puntos mencionados se idea el producto y posteriormente se realiza un modelado 3D. Mediante este modelado se realizan una serie de simulaciones y cálculos de esfuerzos para comprobar que el dispositivo protésico diseñado es seguro. Finalmente, se define el producto definitivo mediante planos 2D y renderizados 3D, gracias a los renderizados el cliente se puede hacer una idea aproximada de cómo será el producto, pero para facilitarle el trabajo se realiza una maqueta con la que podrá ver diferentes aspectos como forma, tamaño o proporciones. Una vez finalizado, se extraen unas conclusiones que valoran positivamente el trabajo realizado. The author of this project is a great passionate about sports (especially cycling) and that others cannot enjoy them for reasons beyond their own decision is something that produces impotence, from that impotence the idea of this project was born. The project focuses on developing a prosthetic device for transradial amputees focused on cycling and thus ensuring that people who want to practice cycling and cannot due to their disability can do it without impediments. To execute the project, objectives will be established, which will be achieved through two completely compatible design methodologies, these are Design thinking and the double diamond methodology, through the combination of these two methodologies, various points are developed, among the most outstanding are They find the Briefing with which they get more information about the product, user, etc and the identification of the problem where up to 9 tools are used to identify it. Thanks to all the information collected in the aforementioned points, the product is designed and subsequently a 3D modeling is carried out, through this modeling a series of simulations and stress calculations are carried out to verify that the designed prosthetic device is safe. Finally, the final product is defined by means of 2D plans and 3D renderings, thanks to the renderings the client can get an approximate idea of what the product will be like, but to facilitate the work a model is made with which they can see different aspects such as shape, size, proportions, etc. Once the project is finished, a series of conclusions are made of all the work carried out and the result of the project is positively valued.

In this randomized, single-center, clinical study we aimed to compare the oxidative stress response in patients undergoing diagnostic transradial or transfemoral elective coronary angiography. Sixty patients with stable angina pectoris undergoing elective coronary angiography to either transradial ( n = 30) or transfemoral ( n = 30) approach were included. The levels of plasma total oxidative status (TOS) were measured and compared just before and immediately after the procedure in both groups. The clinical and laboratory findings were compatible between the two groups. Although the levels of plasma total oxidative status after coronary angiography were increased in both groups (TF pTOS 20. ± :3; 34 ± 3 vs TR pTOS 18 ± 2; 23 ± 4), this was more pronounced in the transfemoral group as compared with the transradial group (ΔpTOS: 11 ± 4 vs 4 ± 3, p

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Objective We aim to demonstrate the safety and effectiveness of extra-femoral endovascular access for mechanical thrombectomy for acute ischemic stroke patients whose vascular anatomy precludes safe or maneuverable trans-femoral access. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to conduct a systematic review and meta-analysis with articles published until March 2018. The search protocol, including research questions and inclusion and exclusion criteria, were developed a priori. Our own institutional retrospective data were included in the cohort of case series. Results Eleven studies including 51 patients were included. Age ranged from 4th to 10th decade of life (average: 9.3rd decade) and 40.1% received IV tissue plasminogen activator. Initial National Institutes of Health Stroke Scale (NIHSS) score ranged from 1 to 36, (average: 17.6). Of the 51 patients, 39 (76%) patients suffered from anterior circulation large vessel occlusions versus 12 (24%) from posterior circulation occlusions. Site of access included 26 (51%) radial artery punctures, 23 (45%) direct percutaneous cervical carotid punctures, 1 brachial artery puncture, and 1 direct extradural vertebral artery puncture. Technical success was achieved in 43/51 (84%) of patients. The average modified Rankin Scale at discharge was 2.93 (n=26). There were no complications in 25 patients who underwent radial arterial access. Two (7.4%) of 27 cervical access patients developed hematoma. Conclusions Trans-carotid and trans-radial access for intervention in acute ischemic stroke is safe and effective. There may be instances in which these approaches should be considered first line before standard femoral approaches.

Objective To compare 5 French (Fr) and 6 Fr guiding catheters regarding the volume of contrast administered, fluoroscopy time, and total procedure time during transradial percutaneous coronary intervention (PCI). Background Previous studies had compared 5 Fr and 6 Fr catheters and deemed 5 Fr catheters safe and effective. In this study, we retrospectively compared the 5 Fr catheter to 6 Fr catheter with an attempt to eliminate the effect of inter-operator skill level variability. Methods In a single-center, retrospective cohort study, we randomly selected patients who had received PCI through transradial access using 5 Fr or 6 Fr catheters. The study involved two groups of 100 patients each. These groups were comprised of an equal number of cases from each operator. The primary endpoint was contrast medium volume. Secondary endpoints were fluoroscopy time and procedure time. Results Less contrast was used in the 5 Fr group vs. 6 Fr catheter group (140.2 ± 45.7 mL vs. 158.2 ± 66.7 mL, p=0.004). PCI using 5 Fr catheters was associated with shorter fluoroscopy time (13.7 ± 7.3 mins vs. 15.2 ± 8.2 mins, p=0.584) and shorter procedure time (43.7 ± 22.2 mins vs. 46.5 ± 19.7 mins, p=0.890), but this was not statistically significant. Conclusion Transradial PCI using 5 Fr guiding catheters was associated with less contrast medium usage, but there was no advantage regarding procedure time or fluoroscopy time when compared to 6 Fr catheters. Similar to 6 Fr catheters, 5 Fr catheters achieved high PCI success rates through radial access when compared in the treatment of coronary lesions with the same level of complexity.

Background Transradial approach for percutaneous coronary intervention (PCI) is gaining popularity due to lesser bleeding and other access site related complications. This study aims to determine the in-hospital outcomes of primary PCI through a transradial approach in a tertiary care cardiac center. Methods Consecutive patients with ST-segment elevation myocardial infarction presenting within 12 hours with symptoms without a previous history of thrombolytic therapy, coronary angioplasty, or cardiac surgery were included in the study. All patients underwent a diagnostic angiogram followed by primary PCI of the infarct-related artery through a radial route and were kept under observation during the hospital stay for forearm hematoma or mortality. Results A total of 180 patients were included in this study, with a mean age of 52.04±7.31 years. Majority (87.2%) of the patients were male, and diabetes (72.8%) was the most commonly observed co-morbid condition followed by hypertension (67.2%). Hospital mortality rate was 3.9% (7 patients), and post-procedure forearm hematoma was noted in 5.6% (10 patients). An increased mortality rate was found to be associated with age above 50 years (7.1% vs. 0.0%; p=0.012) and non-hypertension (8.5% vs. 1.7%; p=0.026). An increased incidence of forearm hematoma was found to be associated with age above 50 years (10.2% vs. 0.0%; p=0.002), diabetic mellitus (7.6% vs. 0.0%; p=0.047), hyperlipidemia (11% vs. 0.0%; p=0.001), and non-smoking (10.2% vs. 0.0%; p=0.003). Conclusion Our study showed that primary PCI through a transradial approach is a safe option with excellent success rates in terms of both mortality rates and morbidity such as forearm hematoma.

The adoption of transradial access in the United States and internationally has been growing over the past few years. In the population of patients presenting with acute coronary syndromes, particularly ST-elevation myocardial infarction, transradial access has the benefit of fewer vascular and bleeding complications and lower mortality rates over transfemoral access. We will examine the current evidence supporting transradial access for several patient populations, including those patients presenting with acute coronary syndromes. We will review the literature regarding the learning curve for transradial access with new operators, as well as experienced transfemoral operators new to transradial access. Finally, we will investigate the role of transradial access in same-day discharge for stable patients undergoing percutaneous coronary intervention.

Key Clinical Message The use of alternative arterial access and advanced imaging is not only applicable to mainstream adult cardiology, but helpful and sometimes necessary in taking care of adult patients with complex congenital heart disease.

The purpose of this research is to conduct cost minimisation analysis of coronary angiography interventions with Transradial (TRA) and Transfemoral (TFA) approach. Thus, operators will be guided in relation with intervention selection and cardiovascular area on the subject matter will be enriched which is quite inadequate with a cost analysis sample. The research has been conducted by evaluating and examining of data of the patients who had coronary angiography. Population of the research consists of angiography interventions in the scope of the research carried out within the year of 2013 in a Cardiology Clinic of a tertiary hospital. Patient records were randomly selected. At the end of the research, the findings have revealed that the costs of TRA and TFA have been respectively Turkish Liras (TRY)746,214 and TRY 710,040. The cost of TRA approach is higher than TFA approach. On the other hand, experts’ opinion is that TRA approach is a more reliable alternative compared to TFA approach. In the selection process of the approach to be used by the operators, it would be beneficial for the patients when both the cost and results of the intervention are considered simultaneously.

We are reporting a case of a 80-year-old lady with effort angina who underwent coronary angiography through the right radial artery, using a dedicated radial multipurpose 5 French Optitorque Tiger catheter. The catheter was advanced into the left ventricle and a left ventriculogram was obtained, while the catheter appeared optimally placed at the centre of the ventricle and the pressure waveform was normal. A large posterior interventricular vein draining into the right atrium was opacified, presumably because the catheter's end hole inadvertently cannulated an endocardial opening of a small thebesian vein, with subsequent retrograde filling of the epicardial vein. Our case suggests that caution is needed when a dedicated radial catheter with both an end-hole and a side hole is used for a ventriculogram, as a normal left ventricular pressure waveform does not exclude malposition of the end-hole against the ventricular wall.

Background The transradial approach (TRA) has already become popular worldwide, but only recently has gained acceptance among Iraqi interventional cardiologists. The aim of this study is to document single operator experience with TRA and to test the benefit of assessing dual hand circulation before the TRA. It was an observational prospective study. Over a 2-year period (Jan 1, 2015, to Dec 31, 2016), 1561 patients underwent transradial coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) by a single operator. Patients were divided into two groups: A (the first 450 patients), in which dual hand circulation was assessed by Allen’s test or plethysmography/oximetry test before TRA, and B (1111 patients) in which TRA was done without assessing dual hand circulation. Results A total of 1561 patients were included, 69.1% males and 30.9% females. The mean age was (57 ± 10.0) years. We performed 1684 procedures (1005 CAG and 679 PCIs). The total transradial success rate was 95.6%, and PCI procedural success rate was 96.5%. The crossover rate from radial to femoral access was 4.4%. The primary causes for crossover were severe tortuosity of the aorta and brachiocephalic trunk, radial artery spasm, puncture failure, and radial loop. The main complication was radial artery occlusion (RAO) (3.7%). There were no cases of hand ischemia or complications that need surgical repair or blood transfusion. No statistically significant difference between groups A and B was observed regarding hand ischemia, the incidence of RAO, or the crossover rate. Conclusions TRA is safe and can be applied in the majority of cases. The routine assessment of dual hand circulation before TRA might not be necessary.

Background: The aim of this study was to compare transradial access (TRA) approach with transfemoral access (TFA) approach in patients undergoing hepatic interventions. Methods: We conducted a comprehensive search of the PubMed, Embase, and the Cochrane Library database to identify relevant available articles. Patients’ preference, success rate, intra- and postoperative outcomes were analyzed. The risk difference (RD), relative risk (RR), and weighted mean difference (WMD) values were reported with 95% confidence intervals (CIs). We used RevMan 5.3 to perform the pooled analyses. Results: Nine cohort studies were included. A total of 1096 procedures were performed in 877 patients. Of those, 545 procedures (49.7%) were performed by TRA, and 551 procedures (50.3%) were performed by TFA. Patients were significantly prefer the TRA (86.5%) to the TFA (13.5%) (RD = 0.88, P

INTRODUCTION Myoelectric hands progressed from single grip hands (traditional myoelectric devices (TH)) to be multi-grip hands (MGH) which are hypothesized to bring more degrees of freedom, greater range of motion and improved grasping capabilities1,2. Their impact on patients’ lives has been documented in only a few case studies. The Strategic Consortium for Upper Limb Prosthetic Technologies (SCULPT) aims to assess the potential benefits MGH with respect to function and patient satisfaction compared to TH systems. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32049/24463 How to cite: Popovic I, Cutti A, Ryan T, Schaefer M, Andres E, Wuestefeld D, Winkler C, Baun K, Bischof B, Braatz F, Miguelez J, Conyers D, Hahn A. DO MULTI-GRIP HANDS INCREASE FUNCTION AND PATIENT SATISFACTION WHEN COMPARED TO TRADITIONAL MYOELECTRIC HANDS? CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32049 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/

INTRODUCTION Upper limb prosthetic acceptance seems to be relatively unchanged from 1958 where it was measured to be 75% for transradial, 61% for transhumeral, and 35% for shoulder disarticulation levels. A practitioner survey from 2013 by the author found this to be largely unchanged at 79.6%, 57.8%, and 32.8% respectively. An upper limb meta-analysis showed that the most significant factors affecting prosthetic rejection using a median rating were function, comfort, ease of use, weight, heat, lack of sensory feedback, inconvenience, lifestyle, dissatisfaction with technology, irritation, and availability of services. An earlier survey by the author condensed these factors of rejection to amputation level, functional advantage, and comfort, and included confidence of the prosthetist, availability of therapy, and support of the patient context. Also it was speculated that the value of factors influencing rejection of prostheses may not be simply the converse of those accepting the prosthesis but different scales. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32045/24459 How to cite: Stark G E. FACTOR ANALYSIS OF UPPER LIMB PROSTHETIC ACCEPTANCE FROM RETROSPECTIVE PROSTHETIC CLINICIAN SURVEY. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32045

AIMS Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) collecting the opinion of the cardiology community on the invasive management of acute coronary syndrome (ACS), before and after the MATRIX trial presentation at the American College of Cardiology (ACC) 2015 Scientific Sessions. METHODS AND RESULTS A web-based survey was distributed to all individuals registered on the EuroIntervention mailing list (n=15,200). A total of 572 and 763 physicians responded to the pre- and post-ACC survey, respectively. The radial approach emerged as the preferable access site for ACS patients undergoing invasive management with roughly every other responder interpreting the evidence for mortality benefit as definitive and calling for a guidelines upgrade to class I. The most frequently preferred anticoagulant in ACS patients remains unfractionated heparin (UFH), due to higher costs and greater perceived thrombotic risks associated with bivalirudin. However, more than a quarter of participants declared the use of bivalirudin would increase after MATRIX. CONCLUSIONS The MATRIX trial reinforced the evidence for a causal association between bleeding and mortality and triggered consensus on the superiority of the radial versus femoral approach. The belief that bivalirudin mitigates bleeding risk is common, but UFH still remains the preferred anticoagulant based on lower costs and thrombotic risks.

Background and aim Experience gained in transradial approach for cardiac catheterization resulted in many advantages including less bleeding complications, more patient comfort, and decreased costs with immediate ambulation. We described our initial experience with transradial approach for transarterial chemo-embolization (TACE) in Egyptian patients with HCC. Materials and methods In this prospective study, transradial TACE procedures were performed in 20 patients with HCC. Barbeau test was performed using a pulse oximeter to confirm the patency of the palmar arch. A 6F sheath was placed in the left radial artery using US guidance. A solution of 5000 U heparin, 10 mg verapamil, and 100 μg nitroglycerin was administered intra arterially. Technical success, early (30-day) complications, and patient acceptance were evaluated. Results Technical success was achieved in all cases (100%). No major complications were encountered in the first 30 days. Mild pain was observed in 1 case (5%) and managed by analgesics. No radial artery thrombosis was found with an asymptomatic small hematoma in one patient (5%) which resolved spontaneously. 5/20 patients (25%) had prior transfemoral artery TACE and all 5 patients (100%) preferred the radial approach. Conclusion Transradial approach for TACE is feasible, safe, well-accepted and preferred in patients with previous femoral approaches.

Despite the increasing worldwide adoption of the transradial access site, the ulnar artery (UA) only very infrequently serves as a primary option for coronary procedures. In contrast to the uncertainty surrounding previous reports regarding the feasibility and safety, recent data from larger registries and randomized trials provide more conclusive evidence that the transulnar route may be safely selected as an alternative arterial access approach. However, a default transulnar strategy appears time-consuming and is associated with higher crossover rates compared with the radial artery (RA). Once arterial access is obtained, the likelihood of a successful coronary procedure is high and similar between the two forearm arteries. The UA has similar flow-mediating vasodilating properties with and seems at least as vulnerable as the RA with regard to incident occlusion, with UA occlusion (UAO) rates being probably higher than previously anticipated. A learning curve effect may not be apparent for crossover rates among experienced radialists, but increasing experience is associated with reduction in the fluoroscopy time, contrast volume and frequency of large hematoma formation. The UA may represents an important alternative access site for coronary procedures, and experienced radial operators should obtain additional skills to perform the transulnar approach. Nevertheless, in view of this method's lower feasibility compared to the RA, an initial ulnar access strategy should be reserved for carefully selected patients to ensure satisfactory cannulation rates.

BACKGROUND The use of adjunctive protective drapes placed on the patient protects the operating physician from scatter radiation during percutaneous coronary procedures (PCP). No data are available on the effect of these drapes for staff members' radio-protection. PURPOSE To evaluate staff radiation exposure during PCP and the effect of adjunctive protective drapes on dose reduction. METHODS The RADIANT study (NCT01974453) is a prospective, observational study evaluating operator radiation exposure during PCP using electronic dosimeter. In a sub-group of procedures all the staff members (II operator, nurse circulator and technologist) were also equipped with a dedicated electronic dosimeter. RESULTS From a total of 2028 procedures included in the RADIANT study, staff members' doses were available for 122 procedures (67 coronarography and 55 percutaneous coronary interventions). Median fluoroscopy time was 306 s (Interquartile range 155-526 s) and the dose area product (DAP) was 18.0 Gy*cm2 (10-35.5 Gy*cm2). The radiation exposure was highest for the operating physician (6.7 μSv) and progressively lower for the nurse circulator (1.8 μSv), the II operator (1 μSv) and the technologist (0.7 μSv, p

Background Same‐day discharge ( SDD ) after elective percutaneous coronary intervention is safe, less costly, and preferred by patients, but it is usually performed in low‐risk patients, if at all. To increase the appropriate use of SDD in more complex patients, we implemented a “patient‐centered” protocol based on risk of complications at Barnes‐Jewish Hospital. Methods and Results Our objectives were as follows: (1) to evaluate time trends in SDD ; (2) to compare (a) mortality, bleeding, and acute kidney injury, (b) patient satisfaction, and (c) hospital costs by SDD versus no SDD ( NSDD ); and (3) to compare SDD eligibility by our patient‐centered approach versus Society for Cardiovascular Angiography and Interventions guidelines. Our patient‐centered approach was based on prospectively identifying personalized bleeding, mortality, and acute kidney injury risks, with a personalized safe contrast limit and mitigating those risks. We analyzed Barnes‐Jewish Hospital's National Cardiovascular Data Registry Cath PCI Registry data from July 1, 2009 to September 30, 2015 (N=1752). SDD increased rapidly from 0% to 77% ( P SDD patients were comparable to NSDD patients, SDD was not associated with adverse outcomes (0% mortality, 0% bleeds, and 0.4% acute kidney injury). Patient satisfaction was high with SDD . Propensity score–adjusted costs were $7331 lower/ SDD patient ( P SDD by Society for Cardiovascular Angiography and Interventions guidelines, implying our patient‐centered approach markedly increased SDD eligibility. Conclusions With a patient‐centered approach, SDD rapidly increased and was safe in 75% of patients undergoing elective percutaneous coronary intervention, despite patient complexity. Patient satisfaction was high, and hospital costs were lower. Patient‐centered decision making to facilitate SDD is an important opportunity to improve the value of percutaneous coronary intervention.

Background: Percutaneous coronary intervention (PCI) through transradial approach (TRA) has shown to be safe and effective as transfemoral approach (TFA) among unselected patients. However, very few studies have compared the outcomes between TRA and TFA specifically in patients with a history of coronary artery bypass grafting surgery (CABG). Methods: A total of 404 post-CABG patients who had undergone angiography or PCI were included in the study. The primary endpoint was defined as angiographic success and procedure success. The secondary endpoint was defined as in-hospital net adverse clinical events (NACEs), which included all cause of death, myocardial infarction (MI), stroke, repeat revascularization, and major bleeding. Patients were followed-up for 1-year. Major adverse cardiovascular events (MACEs), which included death, MI, and repeat revascularization, at 1-year follow-up were also compared. Results: The angiographic success was reached by 97.4% in the TRA group compared with 100% in the TFA group ( P = 0.02). The procedure success was achieved in 99.1% in the TRA group and 97.9% in the TFA group ( P = 0.68). The incidence rates of in-hospital NACE (2.7% vs. 2.7%, P = 1.00) and 1-year MACE (11.5% vs. 12.0%, P = 0.88) were similar between TRA and TFA. Meanwhile, TRA was associated with a lower rate of Bleeding Academic Research Consortium ≥2 bleeding ( P = 0.02). In patients undergoing graft PCI, the procedure success was similar between TRA and TFA (100.0% vs. 98.7%, P = 1.00). The procedure time (25.0 min vs. 27.5 min, P = 0.53) was also similar. No significant difference was detected between TRA and TFA in terms of in-hospital NACE (0 vs. 0, P = 1.00) and 1-year MACE (21.4% vs. 10.3%, P = 0.19). Conclusions: Compared with TFA, TRA had lower angiographic success but had a similar procedure success in post-CABG patients. TRA was also associated with decreased bleeding and shortened hospital stay.

OBJECTIVES The aim of this study was to analyze the change of upper limb function when percutaneous coronary procedures were performed through the radial artery. BACKGROUND It is currently unknown if upper limb function is affected by transradial (TR) catheterization. METHODS Between January 2013 and February 2014, upper limb function was assessed in a total of 338 patients undergoing coronary catheterization in an ambulatory setting (85% radial approach, 15% femoral approach). Upper limb function was assessed with the self-reported shortened version of the Disabilities of Arm, Shoulder, and Hand questionnaire. The presence and severity of upper extremity cold intolerance was assessed with the self-reported Cold Intolerance Symptom Severity questionnaire. Both questionnaires were completed before the catheterization and at 30-day follow-up. Higher scores represent worse upper limb functionality or symptoms. The nonparametric Wilcoxon signed-rank test was used to assess the change of upper limb function and symptoms over time. RESULTS Upper limb function did not change significantly over time when catheterization was performed through the radial artery (p = 0.06). The number of procedure-related extremity complaints that persisted during 30-day follow-up were not different between both access groups (TR access 10.5%, transfemoral access 11.5%; p = 0.82). The upper extremity was not affected by cold intolerance after TR access at 30-day follow-up (p = 0.91). CONCLUSIONS Upper limb function was not affected when coronary catheterizations and interventions were performed through the radial artery. (C) 2015 by the American College of Cardiology Foundation.

Background Incidence of radial artery occclusions (RAO) and ulnar artery occclusions (UAO) in coronary procedures, factors predisposing to forearm arteries occlusion, and the benefit of anticoaggulation vary significantly in existing literature. We sought to determine the incidence of RAO/UAO and the impact of anticoagulation intensity. Methods and Results Meta‐analysis of 112 studies assessing RAO and/or UAO (N=46 631) were included. Overall, there was no difference between crude RAO and UAO rates (5.2%; 95% confidence interval [CI], 4.4–6.0 versus 4.0%; 95% CI, 2.8–5.8; P=0.171). The early occlusion rate (in‐hospital or within 7 days after procedure) was higher than the late occlusion rate. The detection rate of occlusion was higher with vascular ultrasonography compared with clinical evaluation only. Low‐dose heparin was associated with a significantly higher RAO rate compared with high‐dose heparin (7.2%; 95% CI, 5.5–9.4 versus 4.3%; 95% CI, 3.5–5.3; Q=8.81; P=0.003). Early occlusions in low‐dose heparin cohorts mounted at 8.0% (95% CI, 6.1–10.6). The RAO rate was higher after diagnostic angiographies compared with coronary interventions, presumably attributed to the higher intensity of anticoagulation in the latter group. Hemostatic techniques (patent versus nonpatent hemostasis), geography (US versus non‐US cohorts) and sheath size did not impact on vessel patency. Conclusions RAO and UAO occur with similar frequency and in the order of 7% to 8% when evaluated early by vascular ultrasonography following coronary procedures. More‐intensive anticoagulation is protective. Late recanalization occurs in a substantial minority of patients.

Introduction Superior outcomes with transradial (TRPCI) versus transfemoral coronary intervention (TFPCI) in the setting of acute ST-segment elevation myocardial infarction (STEMI) have been suggested by earlier studies. However, this effect was not evident in randomized controlled trials (RCTs), suggesting a possible allocation bias in observational studies. Since important studies with heterogeneous results regarding mortality have been published recently, we aimed to perform an updated review and meta-analysis on the safety and efficacy of TRPCI compared to TFPCI in the setting of STEMI. Material and methods Electronic databases were searched for relevant studies from January 1993 to November 2012. Outcome parameters of RCTs were pooled with the DerSimonian-Laird random-effects model. Results Twelve RCTs involving 5,124 patients were identified. According to the pooled analysis, TRPCI was associated with a significant reduction in major bleeding (odds ratio (OR): 0.52 (95% confidence interval (CI) 0.38–0.71, p < 0.0001)). The risk of mortality and major adverse events was significantly lower after TRPCI (OR = 0.58 (95% CI: 0.43–0.79), p = 0.0005 and OR = 0.67 (95% CI: 0.52–0.86), p = 0.002 respectively). Conclusions Robust data from randomized clinical studies indicate that TRPCI reduces both ischemic and bleeding complications in STEMI. These findings support the preferential use of radial access for primary PCI.

ObjectivesThis study sought to determine the efficacy of low rate fluoroscopy at 7.5 frames/s (FPS) versus conventional 15 FPS for reduction of operator and patient radiation dose during diagnostic coronary angiography (DCA) and percutaneous coronary intervention (PCI) via the transradial approach (TRA).BackgroundTRA for cardiac catheterization is potentially associated with increased radiation exposure. Low rate fluoroscopy has the potential to reduce radiation exposure.MethodsPatients undergoing TRA diagnostic angiography ± ad-hoc PCI were randomized to fluoroscopy at 7.5 FPS versus 15 FPS prior to the procedure. Both 7.5 and 15 FPS fluoroscopy protocols were configured with a fixed dose per pulse of 40 nGy. Primary endpoints were operator radiation dose (measured with dosimeter attached to the left side of the thyroid shield in μSievert [μSv]), patient radiation dose (expressed as dose-area product in Gy·cm2), and fluoroscopy time.ResultsFrom October 1, 2012 to August 30, 2013, from a total of 363 patients, 184 underwent DCA and 179 underwent PCI. Overall, fluoroscopy at 7.5 FPS compared with 15 FPS was associated with a significant reduction in operator dose (30% relative reduction [RR], p < 0.0001); and in patient's dose-area product (19% RR; p = 0.022). When stratified by procedure type, 7.5 FPS compared with 15 FPS was associated with significant reduction in operator dose during both DCA (40% RR; p < 0.0001) and PCI (28% RR; p = 0.0011). Fluoroscopy at 7.5 FPS, compared with 15 FPS, was also associated with substantial reduction in patients' dose-area product during DCA (26% RR; p = 0.0018) and during PCI (19% RR; p = 0.13). Fluoroscopy time was similar in 7.5 FPS and 15 FPS groups for DCA (3.4 ± 2.0 min vs. 4.0 ± 4.7 min; p = 0.42) and PCI (11.9 ± 8.4 min vs. 13.3 ± 9.7 min; p = 0.57), respectively.ConclusionsFluoroscopy at 7.5 FPS, compared with 15 FPS, is a simple and effective method in reducing operator and patient radiation dose during TRA DCA and PCI.

Background During transradial (TR) access, it remains unclear whether differences in baseline patients characteristics and hemostasis care impact the rate of radial artery occlusion (RAO). We sought to compare the rate of RAO after TR access with the 6 French(Fr) Glidesheath Slender (GSS6Fr, Terumo, Japan) or a standard 5 Fr sheath in Japanese and non‐Japanese patients. Methods and Results The Radial Artery Patency and Bleeding, Efficacy, Adverse evenT (RAP and BEAT) trial randomized 1,836 patients undergoing TR coronary angiography and/or interventions to receive the GSS6Fr or the standard 5 Fr Glidesheath (GS5Fr, Terumo, Japan). Out of this study population, 1,087 were Japanese patients and 751 non‐Japanese patients. The overall incidence of RAO was significantly higher in Japanese patients (3.6% vs. 1.2%, P = 0.002). Use of GSS6Fr was associated with higher rates of RAO than GS5Fr in Japanese patients (5% vs. 2.2%, P = 0.02) and with similar RAO rates in non‐Japanese patients (1.3 vs. 1.1%, P = 1). The mean hemostasis time was significantly longer in Japanese patients (378 ± 253 vs. 159 ± 136 min, P

Background: With the increasing prevalence of coronary artery disease, percutaneous coronary artery procedures have become even more important. Our study has compared transradial to transfemoral artery approach for coronary procedures in Indian population. Aims and objective: Comparison of transradial and transfemoral artery approach for percutaneous coronary procedures. Material & methods: 26,238 patients, who underwent percutaneous coronary artery procedures, were divided into two groups depending upon transradial and transfemoral artery approach and compared for the various demographic and clinical characteristics, risk factors profile, vascular access and procedural details. Results: 26,238 patients underwent percutaneous coronary procedures at our center. 81% were male and 19% were female. 55.65% and 44.35% procedures were done through transfemoral and transradial approach, respectively. 17,417 (66.38%) coronary angiographies were done, out of which 53.92% were transradial and 46.08% were transfemoral procedures. 8821 (33.62%) Percutaneous Transluminal Coronary Angioplasty (PTCA) were done, out of which 25.46% and 74.54% were done through transradial and transfemoral approach, respectively. Mean fluoroscopy time was 4.40 ± 3.55 min for transradial and 3.30 ± 3.66 min for transfemoral CAG (p

Background The adoption of the transradial ( TR ) approach over the traditional transfemoral ( TF ) approach has been hampered by concerns of increased radiation exposure—a subject of considerable debate within the field. We performed a patient‐level, multi‐center analysis to definitively address the impact of TR access on radiation exposure. Methods and Results Overall, 10 centers were included from 6 countries—Canada (2 centers), United Kingdom (2), Germany (2), Sweden (2), Hungary (1), and The Netherlands (1). We compared the radiation exposure of TR versus TF access using measured dose‐area product ( DAP ). To account for local variations in equipment and exposure, standardized TR : TF DAP ratios were constructed per center with procedures separated by coronary angiography ( CA ) and percutaneous coronary intervention ( PCI ). Among 57 326 procedures, we demonstrated increased radiation exposure with the TR versus TF approach, particularly in the CA cohort across all centers (weighted‐average ratios: CA , 1.15; PCI , 1.05). However, this was mitigated by increasing TR experience in the PCI cohort across all centers ( r =−0.8; P =0.005). Over time, as a center transitioned to increasing TR experience ( r =0.9; P =0.001), a concomitant decrease in radiation exposure occurred ( r =−0.8; P =0.006). Ultimately, when a center's balance of TR to TF procedures approaches 50%, the resultant radiation exposure was equivalent. Conclusions The TR approach is associated with a modest increase in patient radiation exposure. However, this increase is eliminated when the TR and TF approaches are used with equal frequency—a guiding principle for centers adopting the TR approach.

ObjectivesThis study sought to estimate the economic impact of same-day home discharge compared with overnight hospitalization after transradial percutaneous coronary intervention (PCI).BackgroundSame-day home discharge after transradial PCI and a bolus-only abciximab regimen was found to be clinically noninferior to the abciximab standard therapy and overnight hospitalization in patients with various forms of acute coronary syndromes.MethodsIn the EASY (Early Discharge After Transradial Stenting of Coronary Arteries) trial, 1,005 patients were randomized after a bolus of abciximab and uncomplicated transradial coronary stenting, either to same-day home discharge and no infusion (outpatient group) or to overnight hospitalization and 12-h abciximab infusion (overnight-stay group). We estimated post-PCI health care cost (in Canadian dollars) of trial subjects and short-term economic impact of same-day home discharge. As randomization was done after the procedure, outcomes were similar, and PCI resource use showed minimal and nonsignificant differences, a post-PCI cost-minimization analysis was conducted. Detailed per-patient information of health care resources used immediately after PCI up to 30 days was collected.ResultsMean post-PCI hospital stay was 8.9 h for outpatients versus 26.5 h for overnight-stay patients (p < 0.001). At 30-day follow-up, the mean cumulative medical cost per outpatient was $1,117 ± $1,554 versus $2,258 ± $1,328 for overnight-stay patients. The mean difference of $1,141 (95% confidence interval: $962 to $1,320) was mainly due to the extra night for overnight hospital stay.ConclusionsIn a real-world setting, same-day home discharge after uncomplicated transradial PCI and a bolus-only abciximab regimen resulted in a 50% relative reduction in medical costs. Extension of this outpatient strategy would be welcomed by the hospitals and reimbursement systems in a context of increasing demand for health care cost reduction. (Early Discharge After Transradial Stenting of Coronary Arteries [EASY]; NCT00169819)

Objectives This study intended to compare outcomes between transradial (TR) and transfemoral (TF) percutaneous revascularization in high-risk coronary anatomy. Background The feasibility, efficacy and safety between TR and TF methods of percutaneous coronary revascularization for unprotected left main coronary artery (UPLM]) disease have not been compared. Methods Among 821 consecutive patients with UPLM disease treated with percutaneous revascularization by either TR (n = 353) or TF (n = 468) vascular access, procedural outcomes, resource use, in-hospital bleeding, and late clinical events were compared according to vascular access method. Results Clinical and angiographic characteristics were similar between groups, except that TR patients less commonly presented with unstable angina and had less UPLM bifurcation disease requiring treatment with 2 stents. No significant differences were observed between TR and TF methods for procedural success (97% TF vs. 96% TR, p = 0.57) or total procedural time. However, duration of hospital stay and in-hospital occurrence of Thrombosis In Myocardial Infarction (TIMI) major or minor bleeding (0.6% vs. 2.8%, p = 0.02) were significantly lower with TR access. Using propensity score modeling (254 matched pairs), over a mean follow-up period of 17 months, rates of cardiovascular death (1.2% vs. 2.0%, p = 0.48), nonfatal myocardial infarction (4.7% vs. 2.4%, p = 0.16), stent thrombosis (0.8% vs. 2.8%, p = 0.10) and any target vessel revascularization (6.0% vs. 6.7%, p = 0.72) did not statistically differ among TR and TF groups, respectively. Conclusions In contrast to TF vascular access, TR percutaneous coronary revascularization for UPLM disease is feasible and associated with similar procedural success, abbreviated hospitalization, reduced bleeding, and comparable late-term clinical safety and efficacy.