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ABS20191023_0001
| Vascular Access (transradial) | |
| Optical Coherent Tomographic Assessment of Radial Artery After Transradial Coronary Intervention via Distal Radial Access at Anatomical Snuffbox | |
| Sang Yeub Lee1, Yongcheol Kim2, Sangmin Kim3, Jang-Whan Bae4, Myeong-Chan Cho3 | |
| Chung-Ang University Gwangmyeong Hospital, Korea (Republic of)1, Yongin Severance Hospital, Korea (Republic of)2, Chungbuk National University Hospital, Korea (Republic of)3, Good Samsun Hospital, Korea (Republic of)4 | |
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Background:
Transradial coronary intervention (TRI) introduces a trauma to the radial artery (RA), possibly influencing quality as a bypass conduit or arterio-venous fistulae for hemodialysis. Distal radial access at anatomical snuffbox may reduce the chance of radial artery occlusion at the site of the distal forearm. The aim of study is to demonstrate safety of distal transradial access (dTRA)immediately after distal transradial intervention (dTRA) by optical coherence tomography (OCT).
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Methods:
Immediately after distal TRI, 46 RAs in 46 patients were evaluated. Distal radial arteries were punctured at anatomical snuffbox with conventional radial sheath. OCT imaging was performed through radial artery via distal radial access. Acute injury of RA after snuffbox approach was composite of intimal tear, intraluminal thrombus, medial dissection, totalo cclusion.
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Results:
Patients with acute coronary syndrome were 30 (65.2%) and All TRIs were performed with6F guiding catheter (XB3.5 18 (62%), AL1 7 (24%) and JR4 2 (7%)). The sheath was pulled back at distal end of head of radius bone. OCT examination through the distal part of radial artery including conventional puncture site of transradial access. Meandiameter of conventional RA was2.89 mm and mean lumen area of conventional RA was 6.68 mm2. Patients who underwent CAG or PCI via conventional radial arterial access previously were excluded. Acute Intimal tears were observed in 3 RAs (10.3%). Only a medial dissection was detected in 1 RA(3.4%). Thrombus in 6 RAs(20.7%) and spasm in 6 RAs(20.7%) were observed. Acute injuries of RA after snuffbox approach were 5 (10.9%). Intimal tear was found only 1 (2.2%), intraluminal thrombus 4 (8.7%) and no medical dissection and no total occlusion.
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Conclusion:
Optical coherence tomography via distal transradial access(dTRA) at anatomical snuffbox clearly demonstrated intact radial arteries immediately after TRI via TRA. Further study should evaluate the impact of these effects in radial artery which are subsequently used as conduits and access for hemodialysis.
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