Ryan Dimentberg, Svetlana Kvint, Peter Madsen, Gregory Glauser, Omar Choudhri
This case video demonstrates a microsurgical technique for the clipping and obliteration of a Cognard V tentorial dural fistula. The patient was a 49-year-old male who presented with progressive upper and lower extremity weakness over 12 months, with associated cervical spinal cord edema. The patient was initially misdiagnosed with transverse myelitis, however abnormal flow voids on the MRI led to a cerebral angiogram being performed. The pre-operative angiogram demonstrated the Cognard V right tentorial dural arteriovenous fistula with drainage into the dorsal and ventral medullary veins...
October 17, 2020: World Neurosurgery
Takeshi Kinkori, Kenichi Watanabe
We report the initial experience of the distal radial approach(DRA)via the anatomical snuffbox for various neuroendovascular procedures. DRA was attempted in 16 patients and catheterization of the targeted vessel was successfully performed in 15. In one patient, the puncture was successful, but the wire could not be advanced into the radial artery and a switch to the conventional transradial approach was needed. Among the 15 patients who underwent successful DRA, five patients underwent diagnostic cerebral angiography, five underwent coil embolization of a cerebral aneurysm, three underwent carotid artery stenting, one underwent liquid embolization of an arteriovenous malformation, and one underwent liquid embolization of a chronic subdural hematoma...
October 2020: No Shinkei Geka. Neurological Surgery
Manolo Rubio, Hamid A K Shirwany, Scott R Monnin, Rami N Khouzam
Coronary angiography is one of the most common procedures done in the United States and in other developed countries. For decades, the femoral artery has been the most common vascular access site utilized for this procedure. However, the radial access has been gaining popularity for being a safer and yet practical vascular access with substantial benefits. More recently, the novel distal transradial approach has proven to be an equally or perhaps safer vascular access for diagnostic and interventional coronary and noncoronary procedures...
September 25, 2020: Current Problems in Cardiology
Abdulla Shehab, Akshaya Srikanth Bhagavathula, Al Anee Kaes, Hany Ragy, Rajeev Gupta, Ibrahim Mahmoud El Mansour, Eman Eman Said Elkeshk
Background: In patients undergoing coronary intervention, different vasodilators are used to prevent the radial artery spasm (RAS). To date, no studies investigated the effect of these vasodilators in blood pressure (BP) reduction. Aim: The study aimed to investigate and compare the effect of vasodilatory medications on BP reduction in patients undergoing transradial coronary angiography procedure. Methods: We consecutively included 300 patients undergoing transradial coronary angiography procedures and randomly assigned them into three equal groups to compare the effect of verapamil (2...
April 2020: Heart Views: the Official Journal of the Gulf Heart Association
Angie S Lobo, Yader Sandoval, Jose P Henriques, Stavros G Drakos, Iosif Taleb, Jayant Bagai, Mauricio G Cohen, Yiannis S Chatzizisis, Benjamin Sun, Katarzyna Hryniewicz, Peter M Eckman, Holger Thiele, Emmanouil S Brilakis
BACKGROUND: Limited data exist on current cardiogenic shock (CS) management strategies. METHODS: A 48-item open- and closed-ended question survey on the diagnosis and management of CS. RESULTS: A total of 211 respondents (3.2%) completed the survey, including 64% interventional cardiologists, 14% general cardiologists, 11% advanced heart failure cardiologists, 5% intensivists, 3% cardiothoracic surgeons; the remainder were internists, emergency medicine, and other physicians...
October 2020: Journal of Invasive Cardiology
Shinsuke Mori, Keisuke Hirano, Masahiro Yamawaki, Norihiro Kobayashi, Yasunari Sakamoto, Masakazu Tsutsumi, Yohsuke Honda, Kenji Makino, Shigemitsu Shirai, Yoshiaki Ito
Objectives: To compare feasibility and safety between ultrasound-guided and conventional distal transradial access (dTRA). Background: Distal transradial access, a new technique for coronary angiography (CAG) and percutaneous coronary interventions (PCI), is safe and feasible and will become popular worldwide. Ultrasound-guided dTRA has been advocated to reduce failure rate and access-site complications. However, to date, the comparison of feasibility and safety between ultrasound-guided and conventional dTRA has not been reported...
2020: Journal of Interventional Cardiology
Aaqib H Malik, Srikanth Yandrapalli, Suchith S Shetty, Syed Zaid, Ammar Athar, Wilbert S Aronow, Robert J Timmermans, Hasan Ahmad, Howard A Cooper, Srihari S Naidu, Julio A Panza
BACKGROUND: We aimed to compare the safety and efficacy of transradial vs transfemoral access for coronary angiography and intervention in patients presenting with ST-segment elevation myocardial infarction (STEMI) without cardiogenic shock. METHODS: PubMed, Embase and Cochrane Central were searched for randomized controlled trials (RCTs) comparing outcomes of STEMI patients who underwent transradial angiography (TRA) compared to transfemoral angiography (TFA). Our outcomes of interest were major adverse cardiac events (MACE), all-cause mortality, severe bleeding, access site bleeding, myocardial infarction, stroke, and major vascular complications...
July 30, 2020: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Arun Maskey, Birat Krishna Timalsena, Sheikh Aslam, Rabindra Pandey, Madhu Roka, Shreya Bhandari, Himamshu Nepal
BACKGROUND: There is limited data on feasibility and safety of coronary interventions performed using radial artery at anatomical snuffbox as vascular access point in South Asian region. Our study attempts to evaluate the feasibility and safety of coronary angiography and percutaneous coronary intervention using transradial access at anatomical snuffbox. METHODS: Transradial access at anatomical snuffbox was attempted in 128 consecutive patients, who were planned for coronary angiography and/or percutaneous coronary intervention...
September 8, 2020: Journal of Nepal Health Research Council
Kuljit Singh, Rosanna Tavella, Tracy Air, Matthew Worthley, Ajay Sinhal, Margaret Arstall, Christopher Zeitz, John Beltrame
The differential impact of young age and female gender on transradial access (TRA) outcomes remains to be confirmed. The primary objective was to assess the impact of young age and female gender on in-hospital net adverse cardiovascular events (NACE). Among 12 346 patients from the Coronary Angiogram Database of South Australia (CADOSA) Registry, the impact of gender; men (transfemoral access [TFA] 1995, TRA 6168) and women (TFA 1249, TRA 2934), and a median split of age, ≤63 years (TFA 1617, TRA 4727) and >63 years (TFA 1627, TRA 4375) were analyzed on in-hospital outcomes by creating 5 separate propensity-matched cohorts (entire cohort, men, women, ≤63 and > 63 years)...
September 24, 2020: Angiology
Alejandra Blanco, Shahab Shayesteh, Linda Chi Hang Chu, Elliot K Fishman
Cardiac catheterization through the radial artery has reduced the percentage of complications seen previously in the femoral approach. Computed tomographic angiography is a noninvasive technique that can accurately diagnose pseudoaneurysms and other vascular pathologies. A 93-year-old female presented to the emergency department with pain and swelling of her right distal arm and wrist after a transradial cardiac catheterization procedure, as part of a transcatheter aortic valve replacement evaluation for severe aortic stenosis...
November 2020: Radiology Case Reports
Pierluigi Merella, Giovanni Lorenzoni, Laura Saderi, Giovanni Sotgiu, Gavino Casu
BACKGROUND: TRA is recommended as the preferred approach to perform coronary angiography and PCI. Despite this, TRA-PCI is burdened by a high access site crossover rate. Assisted-tracking techniques (balloon-assisted tracking and pigtail-assisted tracking) have showed to solve some of the issues related with challenging TRA procedures, but few data exist about procedural outcomes. Aim of the study was to evaluate the efficacy and safety of the assisted-tracking (AsTra) techniques during transradial (TRA) percutaneous coronary intervention (PCI)...
August 8, 2020: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Marcos Danillo P Oliveira, Adriano Caixeta
Distal TRA is a novel access site in the interventional cardiology field, with current data demonstrating high success and infrequent complication rates - global procedural metrics that are comparable with historical proximal TRA. Distal TRA may conversely provide important advantages over proximal TRA, including patient comfort, shorter hemostasis time, and lower radial artery occlusion rates.
September 2020: Journal of Invasive Cardiology
Caroline Birgy, Antonin Trimaille, Nathan Messas, Jessica Ristorto, Anas Kayali, Benjamin Marchandot, Thomas Cardi, Sébastien Hess, Marion Kibler, Laurence Jesel, Patrick Ohlmann, Olivier Morel
With respect to the transfemoral approach, transradial procedures enable a drastic reduction of bleeding events and are associated with a reduction of mortality. Radial artery spasm (RAS) is one of the most common complications and may lead to patient discomfort and procedural failure. Currently, there is no consensus on the optimal sedation protocol to avoid RAS. The aim of this study was to investigate the respective impact of opioids analgesia and inhalation sedation with a 50% nitrous oxide/oxygen premix (Kalinox) on pain and occurrence of RAS during transradial coronary procedures...
August 25, 2020: Journal of Clinical Medicine
Yingkai Xu, Yingkai Li, Hua Shen, Beibei Zhang, Qi Zhao, Yujing Cheng, Ziwei Zhao, Qianyun Guo, Jiaqi Yang, Yujie Zhou
Objective. To explore the clinical effect and radial remodeling of transradial slender 7Fr sheath for left main bifurcation disease (LM bifurcation). Methods. From January 2018 to September 2019, 236 patients with LM bifurcation undergoing transradial percutaneous coronary intervention (PCI) from two heart centers were divided into slender 7Fr sheath group (n = 127) and 6Fr sheath group (n = 109). Quantitative coronary angiography (QCA) and very high-frequency ultrasound/ultra biomicroscopy (VHFUBM) were used to assess the clinical effect and radial remodeling of transradial sheath...
August 27, 2020: Current Medical Research and Opinion
Evan Luther, Stephanie H Chen, David J McCarthy, Ahmed Nada, Rainya Heath, Katherine Berry, Allison Strickland, Joshua Burks, Michael Silva, Samir Sur, Dileep R Yavagal, Robert M Starke, Eric C Peterson
BACKGROUND: Many neurointerventionalists have transitioned to transradial access (TRA) as the preferred approach for neurointerventions as studies continue to demonstrate fewer access site complications than transfemoral access. However, radial artery spasm (RAS) remains one of the most commonly cited reasons for access site conversions. We discuss the benefits, techniques, and indications for using the long radial sheath in RAS and present our experience after implementing a protocol for routine use...
August 25, 2020: Journal of Neurointerventional Surgery
Peijian Wang, Qiulin Wang, Chen Bai, Peng Zhou
An aberrant right subclavian artery is a congenital aortic arch anomaly in which the right subclavian artery originates from the proximal descending aorta. The presence of an aberrant right subclavian artery can make right transradial coronary interventions more difficult and even lead to complications. Iatrogenic intramural hematomas and dissection of aberrant right subclavian arteries during transradial coronary angiography have been previously reported. We herein report a case of iatrogenic aortic dissection following attempts to perform right transradial coronary angiography in a patient with an aberrant right subclavian artery...
August 2020: Journal of International Medical Research
Julian Tay Cheong Kiat, Aaron Wong Sung Lung, Chin Chee Tang
The transradial approach for coronary angiography and intervention is the preferred approach because of its superior safety profile as compared to the transfemoral approach. However, like all procedures, transradial approach is not free from complications. In this case, we describe a unique case of a large symptomatic radial artery pseudoaneurysm requiring urgent surgical intervention. The pseudoaneurysm developed after treatment with a short duration of subcutaneous low molecular weight heparin for radial artery occlusion that occurred a day after transradial coronary catheterization...
August 2020: Journal of Cardiology Cases
Andrea Pacchioni, Michele Bellamoli, Antonio Mugnolo, Jayme Ferro, Gabriele Pesarini, Riccardo Turri, Flavio Ribichini, Salvatore Saccà, Francesco Versaci, Bernhard Reimers
OBJECTIVES: To assess the independent predictors of patent and occlusive hemostasis (PH and OH, respectively) during radial hemostasis after coronary procedures. BACKGROUND: Radial artery occlusion (RAO) is a thrombotic complication of transradial catheterization that can lead to permanent occlusion of the radial artery. Sheath-vessel diameter ratio, postprocedure compression time, occlusive hemostasis, inadequate, and excessive anticoagulation are all predictors of RAO...
June 17, 2020: Catheterization and Cardiovascular Interventions
Gaojun Cai, Haomin Huang, Feng Li, Ganwei Shi, Xiaolong Yu, Lei Yu
BACKGROUND: Transradial access (TRA) has been considered as the default choice in cardiac catheterization. Although infrequent, vascular complications of this approach remain. Recently, the distal transradial approach (dTRA) in cardiac catheterization was reported by interventionalists. METHODS: We retrieved the relevant literatures and reviewed the safety and feasibility of this novel approach in cardiac catheterization. RESULTS: The dTRA for cardiac intervention has superior safety and satisfaction...
August 5, 2020: BMC Cardiovascular Disorders
Behnam N Tehrani, Abdulla A Damluji, Matthew W Sherwood, Carolyn Rosner, Alexander G Truesdell, Kelly C Epps, Edward Howard, Scott D Barnett, Anika Raja, Christopher R deFilippi, Charles E Murphy, Christopher M O'Connor, Wayne B Batchelor
BACKGROUND: Transradial access (TRA) is associated with improved survival and reduced vascular complications in acute myocardial infarction (AMI). Limited data exist regarding TRA utilization and outcomes for AMI complicated by cardiogenic shock (CS). We sought to assess the safety, feasibility, and clinical outcomes of TRA in AMI-CS. METHODS: One-hundred and fifty-three patients with AMI-CS were stratified into tertiles of disease severity using the CardShock score...
August 3, 2020: Catheterization and Cardiovascular Interventions
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