Transradial diagnostic and percutaneous coronary intervention

Objective: To describe the technique and rationale of coronary diagnostic and intervention procedures via radial artery. Design: A descriptive study. Place and Duration of Study: From January, 2000 to August, 2001 at National Institute of Cardiovascular Diseases (NICVD), Karachi. Subjects and Methods: A total of 167 (3.6%) patients underwent TR approach for both diagnostic and intervention procedures. The minimum age of the patients was 20 years whereas maximum age was 75 years. All patients with positive Allen's Test were included in the study. All the procedures were done by using the right radial artery approach. Results: Out of 167 cases 76% were diagnostic and 24% were in Percutaneous Coronary Intervention (PCI) group. In 3% the radial artery approach was not successful. In PCI group disease, pattern was single vessel (58%) with mostly left anterior descending artery(LAD) involvement (44%). Lesions were mostly low to moderate risk. In PCI group 51 stents both pre-mounted and un-mounted (bare) were used. In 19% cases, direct stenting was done while 12.5% patients received Abciximab and 7.5% patients underwent IVUS for lesion quantification. In PCI group, procedure was unsuccesful in 2.4% cases due to inability to cannulate and negotiate the lesion. In our limited local experience of 167 cases of TR approach, there were no major complications like major bleed, limb ischemia etc. Conclusion: The TR approach for invasive procedures yields comparable results to femoral approach. It has a major benefit of reduction in puncture site related complications vis-a-vis intensive use of anticoagulants, antiplatelet, and fibrinolytics required for PCI. Additionally, the approach also increases patient comfort through early mobilization and reduction in cost.