PDF
ePub
Citation
Print
Abstract
The transradial approach for coronary angiography (CAG) is known to be associated with fewer vascular complications and shorter hospital stay than the transfemoral approach. In the transradial approach, the insertion of a guiding catheter can be affected by the shape and vascular tortuosity of the brachiocephalic and subclavian arteries. In this study, we compared the left transradial with the right transradial approach in elderly patients. From 1 July 2008 to 30 April 2009, we performed CAG and angioplasty in 143 cases via the left transradial approach (Group I) and in 219 cases via the right approach (Group II). Among elderly patients over the age of 65 years, Group I consisted of 63 cases (71.8±5.17 years, male: 55.6%) and Group II consisted of 97 cases (72.7±5.16 years, male: 52.6%). We evaluated the degree of axillary tortuosity, the angle of the aorta to the subclavian artery, the procedural success rate, the fluoroscopic times, the size of the radial artery, and the procedure-related complications of both groups. The degree of axillary artery tortuosity and the angle of the aorta to the subclavian artery increased with age. In elderly patients, the degree of axillary tortuosity in Group I tended to be less severe than that in Group II (good: 82% vs 67.7%, mild: 11.5% vs 17.2%, moderate: 3.3% vs 8.6%, severe: 3.3% vs 6.5%, p=0.059), and the angle of the aorta to the subclavian artery was smaller in Group I (small: 95.1% vs 83.9%, moderate: 3.3% vs. 5.4%, severe: 1.6% vs 10.8%, p=0.024). There was no statistical difference in the procedural success rate (96.8% vs. 89.7%, p=0.094), but the fluoroscopy time was significantly shorter in Group I (Group I: 46.8±26.4 sec, Group II: 58.2±36.6 sec, p=0.037). In elderly patients, the angle of the aorta to the subclavian artery was smaller and the fluoroscopy time was shorter via the left transradial approach compared with the right approach. We conclude that the left transradial approach is more effective and acceptable for elderly patients than the right approach.
Figures and Tables
Fig. 1
(A) Relation of degree of axillary artery tortuosity with age. (B) Relation of angle of subclavian artery to brachiocephalic artery with age.
Table 1
Clinical and angiographic characteristics in all patients
Lt, left; Rt, right; LDL, low densily lipoprotein; CAD, coronary artery disease; LAD, left anterior descending artery; LCx, left circumflex artery; RCA, right coronary artery; PCI, percutaneous coronary intervention; STEMI, ST segment elevation myocardial infarction; other chest pain, no lesion on coronary angiography.
References
1. Louvard Y, Benamer H, Garot P, Hildick-Smith D, Loubeyre C, Rigattieri S, et al. Comparison of transradial and transfemoral approaches for coronary angiography and angioplasty in octogenarians (the OCTOPLUS Study). Am J Cardiol. 2004. 94:1177–1180.
2. Archbold RA, Robinson NM, Schilling RJ. Radial artery access for coronary angiography and percutaneous coronary intervention. BMJ. 2004. 329:443–446.
3. Agostoni P, Biondi-Zoccai GG, de Benedictis ML, Rigattieri S, Turri M, Anselmi M, et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; systematic overview and meta-analysis of randomized trials. J Am Coll Cardiol. 2004. 44:349–356.
4. Brueck M, Bandorski D, Kramer W, Wieczorek M, Höltgen R, Tillmanns H. A randomized comparison of transradial versus transfemoral approach for coronary angiography and angioplasty. JACC Cardiovasc Interv. 2009. 2:1047–1054.
5. Oh HL, Gwon HC, Lee SM, Kim YH, Cheon IS, Cheon WJ, et al. Safety of one-day admission transradial coronary intervention. Korean Circ J. 2004. 34:647–654.
6. Park SJ, Park JH, Lee JH, No SP, Park HS, Park YK, et al. The clinical feasibility of transradial primary percutaneous coronary intervention with an ST elevation acute myocardial infarction. Korean Circ J. 2007. 37:72–77.
7. Chun KJ, Kim JH, Hong TJ, Chun TH, Shin YW. The safety and feasibility of transradial coronary angiography over 70-year-old patients. Korean Circ J. 2004. 34:376–380.
8. Kawashima O, Endoh N, Terashima M, Ito Y, Abe S, Ootomo T, et al. Effectiveness of right or left radial approach for coronary angiography. Catheter Cardiovasc Interv. 2004. 61:333–337.
9. Yoo BS, Lee HH, Yoon J, Lee SH, Kim JY, Lee BK, et al. The study of branching anomaly and tortuosity of radial artery for trans-radial coronary procedure. Korean Circ J. 2000. 30:82–89.
10. Yoo BS, Yoon JH, Ko JY, Kim JY, Lee SH, Hwang SO, et al. Anatomical consideration of the radial artery for transradial coronary procedures: arterial diameter, branching anomaly and vessel tortuosity. Int J Cardiol. 2005. 101:421–427.
11. Cha KS, Kim MH, Kim HJ. Prevalence and clinical predictors of severe tortuosity of right subclavian artery in patients undergoing transradial coronary angiography. Am J Cardiol. 2003. 92:1220–1222.
12. Kim JY, Yoon J, Jung IH, Wang HS, Jung HS, Yoo BS, et al. Transradial coronary intervention: comparison of the left and right radial artery approach. Korean Circ J. 2006. 36:780–785.
13. Santas E, Bodi V, Sanchis J, Núñez J, Mainar L, Miñana G, et al. The left radial approach in daily practice. A randomized study comparing femoral and right and left radial approaches. Rev Esp Cardiol. 2009. 62:482–490.
14. Fernández-Portales J, Valdesuso R, Carreras R, Jiménez-Candil J, Serrador A, Romaní S. Right versus left radial artery approach for coronary angiography. Difference observed and the learning curve. Rev Esp Cardiol. 2006. 59:1071–1074.
15. Wu CJ, Lo PH, Chang KC, Fu M, Lau KW, Hung JS. Transradial coronary angiography and angioplasty in Chinese patients. Catherter Cardiovasc Diagn. 1997. 40:159–163.
16. Vavalle JP, Rao SV. The association between the transradial approach for percutaneous coronary interventions and bleeding. J Invasive Cardiol. 2009. 21:8 Suppl A. 21A–24A.
17. Hamon M, Coutance G. Transradial intervention for minimizing bleeding complications in percutaneous coronary intervention. Am J Cardiol. 2009. 104:5 Suppl. 55C–59C.
18. Rao SV, Ou FS, Wang TY, Roe MT, Brindis R, Rumsfeld JS, et al. Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention: a report from the National Cardiovascular Data Registry. JACC Cardiovasc Interv. 2008. 1:379–386.
19. De Carlo M, Borelli G, Gistri R, Ciabatti N, Mazzoni A, Arena M, et al. effectiveness of the transradial approach to reduce bleedings in patients undergoing urgent coronary angioplasty with GPIIb/IIIa inhibitors for acute coronary syndromes. Catheter Cardiovasc Interv. 2009. 74:408–415.
20. Eichhöfer J, Horlick E, Ivanov J, Seidelin PH, Ross JR, Ing D, et al. Decreased complication rates using the transradial comprared to the transfemoral approach in percutaneous coronary intervention in the era of routine stenting and glycoprotein platelet IIb/IIIa inhibitor use: a large single-center experience. Am Heart J. 2008. 156:864–870.
XML Download