Gaining a New Skill With the Risk of Losing One: The Effect of Radial Catheterization

Outcomes of Percutaneous Antegrade Intraluminal Coronary Intervention of Chronic Total Occlusion With Remote Surgical Backup

Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) is not favored in facilities without on-site surgical backup. We reviewed outcomes of patients who had CTO intervention with remote surgical backup in our institution. All patients who underwent attempted antegrade intraluminal CTO PCI from January 2013 to July 2017 were analyzed. Twenty cases (18 patients, 58.1 ± 7.0 years, 70% males) were identified. Procedure was successful in 85% (17 of 20). There were 2 nonflow limiting dissections and 1 wire perforation. Two patients had post-PCI myocardial infarction. There was no cardiac death, myocardial infarction, target vessel revascularization, or stroke at 30 days and at mean follow-up of 19.5 ± 13.7 months. There were 4 rehospitalizations for angina requiring repeat angiogram in 3 cases: 2 without intervention, and 1 referred for coronary artery bypass grafting. Careful attempt at antegrade intraluminal CTO intervention done at a center with remote surgical backup is feasible in selected patients.

Radial Artery Occlusion After Cardiac Catheterization: Significance, Risk Factors, and Management

Multiple modifiable risk factors have been proposed to decrease the likelihood of developing radial artery occlusion (RAO) in patients who undergo transradial (TR) catheterization. RAO, the most significant complication for these patients, however, remains poorly identified and under diagnosed owing to its clinical quiescence and lack of clinical guidelines for systematic evaluation of radial artery patency. Currently, only best practices are available. As TR catheterization is becoming more widely adopted across the United States it has become more important to develop concrete strategies for identifying modifiable risk factors, high-risk patients, and better understanding the mechanisms to adequately approach treatment of RAO. We reviewed the contemporary literature regarding RAO and TR catheterization to provide a simplified method for discerning identifiable risk factors, high-risk groups, and management of RAO after TR catheterization.