Guiding Catheters for Transradial Approach: New Designs and Summary of Experiences with VDL/VDR Catheters. A Novel Score for PCI Technical Complexity.

In one multicenter and several single-center studies involving 202 cases, new shapes of transradial access PCI guide catheters were tested following a standardized original protocol. The evaluation included a newly designed score for PCI complexity. Three operators successfully performed the 40 cases of the multicenter study, scoring intermediate to difficult 66% of the cases.

Early prognosis and predictor analysis for positive coronary angiography after out-of-hospital cardiac arrest (OHCA).

Background: Key predictors of survival after OHCA have been described in the literature. Current guidelines recommend emergency angiography in patients without an obvious extra-cardiac cause of arrest. However, the value of this strategy is debated.

Double guide double wrist 5F left coronary artery transradial percutaneous coronary intervention and the X-Kiss technique.

Percutaneous coronary intervention for bifurcated anatomy, particularly at the proximal left coronary artery site, requires guide catheters (GC) of at least 6 french and preferably larger in diameter. We describe a new trans-radial approach more suitable for small artery size: the simultaneous use of both radial arteries for double cannulation of the LMCA with 5F GC: each GC will target either the LM/LAD or the LM/CX artery (or LM-LAD/LM-LAD-1st diagonal branch) stenoses. The technique successfully was applied to 5 cases.

Usefulness of a Gentle and Short Hemostasis Using the Transradial Band Device after Transradial Access for Percutaneous Coronary Angiography and Interventions to Reduce the Radial Artery Occlusion Rate (from the Prospective and Randomized CRASOC I, II, and III Studies).

The study sought to evaluate the benefit of the reduction in intensity and duration of the hemostasis obtained with the transradial (TR) Band compression device on the radial artery occlusion (RAO) rate. RAO is the most frequent complication of TR access for cardiac catheterization and limits future use of this safe route. Its occurrence must be minimized.

Elevation of biomarkers and long-term outcome after percutaneous coronary intervention.

Background/objectives: The impact of an elevation of cardiac biomarkers occurring after percutaneous coronary intervention (PCI) on long-term outcome remains controversial. Most available data are based on observational registries using multivariable analysis. In this study, a case-control approach was used to assess separately the impact of post-PCI elevation of CK-MB on the short-term in-hospital outcome and on the long-term outcome after hospital discharge.

Distal 'buddy-in-jail' technique: a complementary 'Jail with stent' method for stent delivery.

Delivery of coronary stents can be challenging, but the use of a second or 'buddy' wire helps the progression of equipment through tortuous and rigid vessels. We successfully positioned a coronary stent in a distal lesion, intentionally jailing the buddy wire during stent delivery. The jailed wire was then used to proceed further with proximal coronary stenting.

Full conversion from transfemoral to transradial approach for percutaneous coronary interventions results in a similar success rate and a rapid reduction of in-hospital cardiac and vascular major events.

Aims: The transradial approach (TRA) for percutaneous coronary intervention (PCI) recently emerged as a safer vascular access with a similar rate of MACE but a lower success rate requiring crossover to another approach when compared to the transfemoral approach (TFA).

Methods And Results: In our hospital the introduction of the TRA in November 2003 resulted in a progressive decline of TFA use. Over the five years of conversion to TRA, from 2002 (100% TFA) to 2007 (98% TRA), major adverse cardiac events (MACE) and all in-hospital vascular and bleeding events, related or not to vascular access, were prospectively collected to assess performances of each approach in the specific setting of PCI (percutaneous coronary interventions).

The different mechanisms of periprocedural myocardial infarction and their impact on in-hospital outcome.

Background: CK-MB levels exceeding 3 times the upper limit of normal (ULN) following percutaneous coronary intervention (PCI), defining periprocedural myocardial infarction (PMI), are associated with worse outcomes. This study assessed the incidence and mechanisms of PMI and their impact on in-hospital stay.

Methods And Results: Over a 12-year period (1996-2007), 272 cases of PMI (overall incidence, 3.

Gentleman, rebel and believer: the radial way.

The manuscript highlights some historic milestones of the universal trans-radial approach (TRA) and describes some characteristics that "radialists" share (at least in the author's opinion). The author argues against common misconceptions about the TRA, like the use of more iodine contrast, more X-ray exposition, a lower rate of successful angioplasty. Data illustrating the conversion from a trans-femoral approach catheterization laboratory to a complete TRA laboratory are presented, showing the speed of the switch and the rapid clinical benefit observed.

Low rate of conversion to transfemoral approach when attempting both radial arteries for coronary angiography and percutaneous coronary intervention: a study of 1,826 consecutive procedures.

Aims: Despite a proven safety profile, the transradial approach (TRA) for coronary procedures is regarded by many as complicated and the second-choice arterial access, with a high conversion rate to transfemoral access (TFA). This study reports causes of failure and the contemporary success rate of TRA when both radial arteries are attempted first before converting to TFA.

Methods: This prospective, single-center study included 1,826 consecutive patients referred for cardiac catheterization, which was performed by two trained operators between January 2005 and June 2007.