TRANSRADIAL ARTERY CORONARY ANGIOPLASTY

This study explored the feasibility and safety of percutaneous coronar y balloon angioplasty (PTCA) with miniaturized PTCA equipment via the radial artery. Coronary angioplasty (PTCA) via the femoral or brachial arteries may be associated with rare vascular complications such as b leeding and damage to the artery and adjacent structures. It was postu lated that PTCA via the radial artery with miniaturized angioplasty eq uipment is feasible and that no major puncture site-related complicati ons occur because hemostasis is obtained easily and because no major s tructures are near the radial artery. With double blood supply to the hand, radial artery occlusion is well tolerated. In 100 patients with collateral blood supply to the right hand, PTCA was attempted with 6F guiding catheters and rapid-exchange balloon catheters for exertional angina (87 patients) or nonexertional angina (13 patients). Angioplast y was attempted in 122 lesions (type A n = 67 [55%], Type a n = 37 [30 %], and type C n = 18 [15%]). Pre- and post-PTCA computerized quantita tive coronary analysis was performed. Radial artery function and struc ture were assessed clinically and with Doppler and two-dimensional ult rasound on the day of discharge. Coronary catheterization via the radi al artery was successful in 94 patients (94%). The 6 remaining patient s had successful PTCA via the femoral artery (n = 5) or the brachial a rtery (n = 1). Procedural success (120 of 122 lesions) was achieved in 92 patients (98%) via the radial artery and in 98 patients of the tot al study population. Minimal luminal diameter increased from 0.9 +/- 0 .3 (0 to 1.8) to 2.0 +/- 0.5 (0.6 +/- 3.6) mm, and diameter stenosis w as reduced from 74% +/- 11% to 24% +/- 11%. In 3 patients a coronary s tent was implanted via the radial artery because PTCA results were sub optimal. Of 98 patients with a successful PTCA, four (4%) had acute my ocardial ischemia 1 to 24 hours after the procedure. In these patients an emergency second PTCA procedure via the femoral artery was perform ed successfully, but in 2 patients a myocardial infarction could not b e prevented. No other major cardiac complications were encountered. No major entry site-related complications were seen, and no patient requ ired vascular surgery or blood transfusions, In 10 patients radial art ery pulsations were absent at discharge, and all 10 were asymptomatic. Of these 10 patients, late recanalization was evident in 5, and in 3 patients pulsations remained absent. PTCA via the radial artery is eff ective and safe and minimizes major puncture site-related complication s.