Traditional Versus Distal Radial Access for Coronary Diagnostic and Revascularization Procedures: Final Results of the TENDERA Multicenter, Randomized Controlled Study.

Background: Traditional transradial access (TRA) is widely used for coronary and non-coronary interventions with significant improvements in procedural outcomes; however, it is associated with RAO that precludes repeat use of the same artery for possible future TRI and other purposes. Distal radial access (DRA) has been proposed as an effective alternative to decrease RAO rates. Published literature describing the RAO rate after DRA versus TRA from various RCT and clinical registries has shown conflicting results.

Distal Radial Access: Is There a Clinical Benefit?

For decades, the femoral artery has been the most common vascular access for diagnostic and therapeutic endovascular procedures. However, over the past 20 years, radial access has been gaining popularity, as it is a safer and allows practical access with more benefits. Recently, the new distal radial access has proven to be an equal or perhaps even safer vascular access for diagnostic and therapeutic coronary and noncoronary interventions.

Distal Radiation Access as an Alternative to Conventional Radial Access for Coronary Angiography and Percutaneous Coronary Interventions (According to TENDERA Trial).

The aim of this study was to assess the immediate and medium-term (3 months) results of the safety and efficacy of distal radial access (DRA) in coronary interventions compared with conventional transradial radial access (TRA). TRA is the recommended access for coronary procedures because of increased safety: fewer local complications, large and small bleeding. Recently, DRA has emerged as a promising alternative access to minimize radial artery occlusion (RAO) risk, as well as other complications.

A narrative review of history, advantages, future developments of the distal radial access.

This article presents a historical excursus and a review of modern literature on distal radial access for interventional surgery, discussing the anatomical and physiological substantiation of the use of this access point in endovascular surgery, its advantages and disadvantages. The main considerations directly related to distal puncture, choice of instrumentation, hemostasis, possible complications, and prevention are analyzed. The major areas of interventional surgery (coronary, vascular, oncological, and neurointerventional), where the distal radial approach is actively used, are reflected and their characteristics are highlighted.

Distal Radial Artery Access in Noncoronary Procedures.

Since the beginning of interventional cardiology and for decades, the femoral artery has been the access of choice for both diagnostic and interventional endovascular procedures. Due to an extensive evidence base accumulated over the last 20 years, the majority of interventional cardiologists around the world prefer classical radial artery access for both elective and emergency procedures. A similar trend has been observed for distal radial artery access over the last 5 years.

Thrombus aspiration without stenting in a patient with anterior STEMI: Regression and healing of an unstable plaque assessed by OCT at 24 months of follow-up.

In selected cases, when STEMI caused by mild or moderate degree lesion with a large concomitant thrombus, additional OCT-guided PCI strategy after thrombus removal allows us to defer stenting with the follow-up natural healing of the vessel wall.

Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review.

The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration.

Distal Radial Access: Consensus Report of the First Korea-Europe Transradial Intervention Meeting.

Among patients undergoing percutaneous coronary procedures, transradial access, compared with transfemoral access, is associated with a reduced risk for complications including mortality, especially in higher risk patients. However, transradial access is limited by radial artery occlusion (RAO) that despite being mostly asymptomatic because of the extensive anastomoses between the forearm arteries restricts future use of the same radial artery. Distal radial access (DRA) in the anatomic snuffbox or on the dorsum of the hand has recently gained global popularity as an alternative access route for vascular procedures.

Best Practices for the Prevention of Radial Artery Occlusion After Transradial Diagnostic Angiography and Intervention: An International Consensus Paper.

Transradial access (TRA) is increasingly used worldwide for percutaneous interventional procedures and associated with lower bleeding and vascular complications than transfemoral artery access. Radial artery occlusion (RAO) is the most frequent post-procedural complication of TRA, restricting the use of the same radial artery for future procedures and as a conduit for coronary artery bypass graft. The authors review recent advances in the prevention of RAO following percutaneous TRA diagnostic or interventional procedures.

Anatomic Basis and Physiological Rationale of Distal Radial Artery Access for Percutaneous Coronary and Endovascular Procedures.

Transradial access offers important advantages over transfemoral access, including overall increased procedure comfort and better outcomes. Still, complications of transradial access exist, with radial artery occlusion being the most clinically relevant one. Puncture sites in the hand allowing distal radial artery access have initially been described for anterograde angioplasty of occluded radial arteries and could represent a valuable alternative to traditional wrist puncture for radial artery catheterization.

Interosseous artery as an access artery in case of late radial artery occlusion.

We report a new technique of arterial access through the ipsilateral interosseous artery in a case of late radial artery occlusion (RAO). RAO, although not frequent, is a limiting iatrogenic complication after transradial intervention (TRI) and precludes repeat use of the same radial artery for future procedures. Our technique involves obtaining access to the ipsilateral radial artery (RA) in the distal postocclusion segment and use of collateral channel between this segment and the interosseous artery (IOA) for advancing a guidewire and sheath in the IOA lumen and in brachial artery thereafter.

[Immediate and Long-term Results of the First in Russia of IntrocoronaryMetal Stent in the Coronary Artery].

The authors present immediate and long term results of the first in Russia implantation in coronary artery of Palmaz-Shatz metal stent. Indications for stenting were urgent after complicated dissection as a result of balloon dilation of discrete bifurcational stenosis of anterior interventricular artery (IVA). Immediate angiographic and clinical result was good.

[Coronary Angioplasty and Stenting in Patients Older Than 80 Years: Immediate and Long-Term Results].

Aim: to assess immediate and long-term results of coronary angioplasty and stenting in patients older than 80 years - a high risk group in view of the severity of concomitant pathology and extent of coronary atherosclerosis.

Material And Methods: We conducted retrospective analysis of data from 167 patients older than 80 years (mean age 81.43+/-2.

New technique for treatment of postcatheterization radial artery pseudoaneurysm.

We report a new technique for treatment of radial artery pseudoaneurysm (RAP) caused by transradial access (TRA) for coronary angiography. Traditional extrinsic compression with radial flow cessation leads to a local milieu likely associated with an increase in probability of radial artery occlusion (RAO). Our technique involves obtaining ipsilateral radial artery access distal to the neck of the RAP followed by a prolonged sheath dwell time covering the neck of the RAP which allows the RAP sac to thrombose and maintains radial artery lumen patency.

[Multistage endovascular treatment of multifocal atherosclerosis].

We present a report of a clinical case of multistage endovascular treatment of multifocal atherosclerosis with involvement of coronary arteries, left renal artery, and arteries of lower extremities. A 54 year old patient with type 2 diabetes, impaired renal function, vasorenal hypertension, and lowered left ventricular contractility had history of stroke and myocardial infarction. Endovascular treatment was carried out in 6 stages with sequential angioplasty and stenting of coronary arteries, arteries of lower extremities, and left renal artery.

Recanalization and reuse of early occluded radial artery within 6 days after previous transradial diagnostic procedure.

Late radial artery (RA) thrombosis occurs in 3-9% after transradial interventions. RA occlusion has made this approach unsuitable for repeat interventions and obviated the need for alternative vascular access for catheterization, e.g.

[A case of spontaneous closure of left main coronary artery false aneurysm and stent thrombosis 11 years after coronary artery stenting].

This is the presentation of a case of formation of traumatic iatrogenic false aneurysm of left main coronary artery and its spontaneous closure combined with acute thrombosis of the stented segment of anterior interventricular artery (AIA) 11 years after initial procedure. False aneurysm was a consequence of dissection of arterial wall due to mechanical trauma by relatively stiff tip of guide wire and arterial wall hematoma extending to adventitia. Hematoma formation could be facilitated by thrombolytic therapy with streptokinase urgently carried out for acute AIA thrombosis after balloon angioplasty.

[Retrograde recanalization of coronary artery occlusions: novel method for increase of the rate of successful interventions].

First results of the use of a novel method of percutaneous coronary angioplasty of chronic occlusions of coronary arteries are presented. In 8 patients (men aged 54 - 75 years, mean age 60,4 +/- 7.1 years, mean duration of occlusion 45.

[Efficacy of the use of sirolimus covered stents in the treatment of diffuse atherosclerotic lesions of coronary arteries].

Aim of the study was to compare efficacy of sirolimus covered (116 patients, group 1) and bare (117 patients, group 2) stents. Groups were comparable according to main characteristics. Proportion of patients with diabetes was 19 and 13.

[13-year result after implantation of intracoronary stent (treatment of progressing atherosclerosis of coronary arteries with the help of endovascular methods)].

Clinical case of implantation in anterior interventricular artery (AIA ) of the first coronary stent in Russia is presented. Control angiogram obtained 7 years after stenting showed stent patency without restenosis with maximal 15.68% in-stent stenosis.

[The treatment of coronary atherosclerosis: effect of the use of stents on immediate and long term results of coronary angioplasty].

Immediate and long term results of 2 methods of coronary angioplasty (balloon dilatation and stenting) were analyzed retrospectively. During 10 years proportion of stent implantations increased 30-fold reaching 95-97% of coronary interventions. This was associated with improvement of immediate results of angioplasty: lowered rates of myocardial infarctions, urgent coronary artery bypass graftings and acute coronary artery occlusions (from 2.