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Purpose: Transradial approach (TRA) has become increasingly common for coronary angiography and intervention (CA/PCI) and a wealth of knowledge exists about its feasibility. Nevertheless radial injury and occlusion do occur and little is known about the success rate with its repeated use. Evidence of a long lasting use of the TRA might encourage a shift toward this access route. We aimed to evaluate the feasibility of a second TRA its predictors of failure. Methods: In a dual centre prospective registry, patients who underwent a first procedure by right TRA were identified. Whenever a second coronary angiography was necessary during follow-up, and the interventionalist's clinical assessment was favourable, the right TRA was again used. We compared the rates of crossover to another access and sought predictors of crossover. Results: From January 2009 to October 2012, 6392 patients (median age 66, interquartile range 16; 67% male; 37% due to ACS) who underwent a first procedure (36% PCI) by right TRA were identified; the crossover rate to another access was 5.8%. During the study period, a second TRA was performed in 686 of these patients in whom the interventionalist's clinical assessment was favourable; the crossover rate to another access was 6.9% and similar to the first TRA (Chi-square p=0.267). Three independent predictors of failure in the latter group were identified by binary logistic regression, with the following adjusted odds-ratio (95% confidence interval): female sex 3.67 (1.98-6.8), use of 10 cm (vs. 25 cm) introducer sheath 3.52 (1.73-7.16) and previous valvular surgery 3.02 (1.06-8.61). No differences with statistical significance were observed regarding advanced age, low body surface area, need for intervention or smaller sheath diameter. Conclusions: A second transradial approach is as feasible as the first. The use of shorter sheaths, female sex and previous valvular surgery patients reduce success in subsequent radial access.

Which are the possible causes for the cardiac dysfunction in this patient presenting for the first time with …