3
Results
From 30,848 consecutive transradial procedures procedural success through primarily chosen transradial access site was achieved in 94% of patients.
Patient population was predominantly male (68%). Most common risk factors were hypertension (55%), diabetes (18%) and smoking (25%) ( Table 1 ).
Table 1
Baseline characteristics of study population.
Age (years) |
62 (18–93) |
Male |
21,204 (68%) |
BMI (kg/m 2 ) |
25 (19–47) |
CAD risk factor |
|
Hypertension |
16,978 (55%) |
Diabetes mellitus |
5595 (18%) |
Dyslipidemia |
6439 (21%) |
Smoking |
7703 (25%) |
Positive family history for CAD |
3477 (11%) |
Prior TRA |
6523 (21%) |
Prior stroke |
895 (2,9%) |
CAD (coronary artery disease), TRA (transradial access).
Percutaneous coronary intervention was done in 14,315 (46%) with PPCI in 13,5% (3659). PCI in LMN was done in 284 (0,9%) and CAS in 730 (2,3%) patients. Most common sheath size used was 6F with 96% of all interventions ( Table 2 ).
Table 2
Procedural characteristics of study population.
Procedure |
Diagnostic coronary angiography |
16,533 (53%) |
PCI |
14,315 (46,4%) |
PPCI |
3659 (13,5%) |
PCI in LM |
284 (0,9%) |
CAS |
730 (2,3%) |
ILIAC/SFA artery PTA |
167 (0,5%) |
Subclavian artery PTA |
62 (0,2%) |
RAO (on RA angiography) |
608 (2%) |
Sheath size |
5F |
917 (3%) |
6F |
24,730 (96%) |
7F |
96 (0, 3%) |
7.5F Asahi Sheathless |
79 (0,25%) |
8F |
52 (0,17%) |
Fluoroscopy time (minute) |
12 (1–98) |
Procedural time (minute) |
32 ± 20 |
Access site bleeding complications |
1579 (5,1%) |
Hematoma grade 4/5 |
23 (0,007%) |
Clinical RA spasm |
1197 (3,9%) |
RA anomalies |
2220 (7,2%) |
High take off RA |
1554 (5%) |
RA 360 degree loop |
291 (1%) |
Tortuous RA |
338 (1,1%) |
Small “hypoplastic” RA |
37 (0,1%) |
Length of stay <2 days |
20,387 (66%) |
Same day discharged |
8990 (29%) |
PCI (percutaneous coronary intervention), LM (left main), CAS (carotid artery stenting), SFA (superficial femoral artery), RAO (radial artery occlusion), RA (radial artery).
Crossover was done in 1860 (6%) of patients. Most common reason for crossover was inability to puncture the right radial artery in 4,1% and direct TUA crossover due to lack of RA pulsations in 1,2%. Operators decided to crossover due to RA angiogram alone in certain cases with presence of complex 360 degree RA loop (n = 65), small RA (n = 7) or other RA anomalies as very tortuous RA (n = 11) and high take off RA with high degree spasm (n = 21) ( Fig. 1 ).
The analysis of crossover rate (from 6.9% in 2010 to 5% in 2015 and in STEMI patients from 4.6% to 2.1%) showed a trend toward lower crossover rate after implementing routine RA angiography ( Fig. 2 ).
Crossover direction was primarily done to ipsilateral TUA 3,8%, left radial access 1,5% with only 0,6% of patients transferred to TFA.
Separately we accessed the reasons for crossover to all other access sites. Main cause for TUA transfer was inability to puncture the RA with 63% (746 patients) and direct transfer in 32% due to lack of RA pulsations (operator decision). Crossover to TFA was made mainly due to inability to puncture in 62% (n 117) (presence of AV fistula in chronic kidney disease, occluded UA) and procedural demand 34% (n 65) in SFA PTA and procedures as TAVI, TEVAR or EVAR (that require TFA access). Crossover to LRA was made mainly due to inability to puncture the RRA in 82% (n 383) of cases ( Fig. 3 ).
Some crossovers due to inability to puncture can be related to the presence of chronic RAO (with palpable RA distal to the occlusion). Consequently, numbers of detected chronic RAO on RA angiography (2%) might be underestimated.
Procedure time was 32 ± 20 (10−300) min, and fluoroscopy time was 12 (1–98) min.
Significant number of patients were discharged the same day (29%, n = 8990) and most of them had a length of stay under 2 days (66%, n = 20,387).
Clinical radial artery spasm was present in 3,9% of patients. Access site bleeding complications (EASY score for hematoma type 1 to 5) were present in 5,1% (n 1579) of patients [ ]. Hematoma type 4 was present in 21 patients (0,006%). Two patients (0,0006%) needed vascular repair of the forearm due to compartment syndrome (hematoma type 5), without further clinical consequences. There were no signs of hand ischemia at discharge or follow up in any patient ( Table 3 ).
Table 3
Access site complications.
Clinical radial artery spasm |
1197 (3,9%) |
Grade I |
961 (3,1%) |
Grade II |
188 (0,6%) |
Grade III |
47 (0,1%) |
Grade IV |
1 (0%) |
Access site bleeding complications |
1579 (5,1%) |
Hematoma grade 1 |
1015 (3,2%) |
Hematoma grade 2 |
466 (1,5%) |
Hematoma grade 3 |
75 (0,2%) |
Hematoma grade 4 |
21 (0,006%) |
Hematoma grade 5 |
2 (0,0006%) |
Major vascular complications |
2 (0,0006%) |
Sign of hand ischemia |
0 (0%) |
In-hospital MACE and mortality rates were 856 (2,7%) and 368 (1,1%) accordingly.