Jahanzeb Ali, Asim Javed, Sohail Aziz, Azhar Mahmood Kayani.
Transradial access for PCI: a novel approach / changing trends of vascular access.
Pak Heart J Jan ;43(2):64-9.

Objective: Vascular complications associated with femoral artery access for interventional cardiological procedures may increase morbidity especially in patients receiving anticoagulants, aspirin, clopidogrel and platelet glycoprotein IIb/ IIIa receptor inhibitors. The use of radial arterial access reduces the incidence of access site bleeding complications. The purpose of the present study was to assess the feasibility, success, and safety of the transradial approach (TRA) for PCI. Design: Single-centre, Prospective observational study. Place and Duration of Study: The study was carried out in Armed Forces Institute of Cardiology – National Institute of Heart Diseases (AFIC-NIHD) over a period of six months from july 2009 to december 2009. Patients and Methods: We collected data of 100 consecutive patients who underwent PCI by the transradial approach. Transradial access was performed only if the Allen’s test was normal (positive), suggesting the presence of an adequate collateral circulation from the ulnar artery. Patients with previous CABG with LIMA grafting, ACS with cardiogenic shock or requiring TPM placement were excluded from this study. Study endpoints included procedure success rate, vascular complications at access site, and major adverse cardiac and cerebrovascular events during hospitalization. Results: Mean age of the patients was 53 years (range 31-79 yrs). Procedural success was achieved in 100% cases. Right TR approach was used in 99% cases. Number of target lesions treated was 239 with multivessel PCI done in 61% cases. DES was used in 72%cases and BMS was used in 28% cases. Maximum no of target lesions treated included LAD 114(47.6%), followed by RCA 50 (20.9%),LCX 41(17.1%),OM branch 25(10.4%),Diagonal branch 9(10.4%). No case of vascular complications such as major access site bleeding, vascular pe64rforation, radial artery occlusion, forearm ischemia or compartment syndrome was observed. There were no procedural myocardial infarctions or deaths, and no patient was referred for emergency bypass surgery. Conclusions: We conclude that the transradial access for PCI is a safe and effective alternative to transfemoral access. It adds to patients comfort and convenience and offers coronary intervention with the potential of less vascular complications.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com