Balaban Yakup, Elevli Murat G
VM Medical Park Kocaeli Hospital, Department of Cardiology, Başiskele, Kocaeli, Turkey.
Sakarya Özel Adatıp Hastanesi, Kalp-Damar Cerrahisi Kliniği, Serdivan, Sakarya, Turkey.
J Interv Cardiol. 2018 Dec;31(6):957-963. doi: 10.1111/joic.12524. Epub 2018 May 31.
Radial artery occlusions (RAOs) impose an important problem that limit transradial interventions. In this study, we represent that it is possible to perform interventions through occluded radial arteries.
Twenty-five patients with RAO who had retrograde flow shown by doppler ultrasonography were enrolled into our study. After preparing the radial region, the radial artery was accessed with a puncture needle. A 0.014″ guidewire was introduced into the brachial artery via the radial artery with the aid of balloon back up. Lesion was predilated with a drug coated peripheral balloon, and a sheath was placed at the end.
Radial artery recanalization could be established in 22 of 25 cases and coronary angiography could be performed from those occluded radial arteries. Neither the occlusion duration nor the caliber of the radial artery had any effect on the success rate of recanalization attempts. Two patients had a hematoma because of the intervention and there were no other complications.The patency rates at 1 month follow up have been only 33.4%, too much lower than we expected.
In patients with RAO because of a previous angiographic intervention via their radial arteries may be reintervened from their occluded radial artery safely and effectively. So, our procedure is not intended for neither the recanalization nor keeping the patency of the radial artery, but suitable for those patients in whom other routes of intervention are not wanted.
桡动脉闭塞(RAO)是限制经桡动脉介入治疗的一个重要问题。在本研究中,我们表明通过闭塞的桡动脉进行介入治疗是可行的。
25例经多普勒超声显示有逆向血流的桡动脉闭塞患者纳入本研究。准备好桡动脉区域后,用穿刺针进入桡动脉。在球囊支撑的辅助下,将一根0.014英寸的导丝经桡动脉引入肱动脉。用药物涂层外周球囊对病变进行预扩张,并在最后置入鞘管。
25例患者中有22例成功实现桡动脉再通,且可从闭塞的桡动脉进行冠状动脉造影。桡动脉的闭塞持续时间和管径对再通尝试的成功率均无影响。2例患者因介入治疗出现血肿,无其他并发症。1个月随访时的通畅率仅为33.4%,远低于我们的预期。
对于因既往经桡动脉造影介入导致桡动脉闭塞的患者,可安全有效地从其闭塞的桡动脉进行再次介入治疗。因此,我们的操作并非旨在实现桡动脉再通或保持其通畅,而是适用于那些不希望采用其他介入途径的患者。