Transradial cardiac catheterization: is femoral access obsolete?

Comparison of a safety strategy using transradial access and dual-axis rotational coronary angiography with transfemoral access and standard coronary angiography

OBJECTIVES

We sought to investigate the radiation exposure and contrast utilization associated with using a strategy of transradial access and rotational angiography (radial-DARCA) compared to the traditional approach of transfemoral access and standard angiography (femoral-SA).

BACKGROUND

There is an increased focus on optimizing patient safety during cardiac catheterization procedures. Professional guidelines have highlighted physician responsibility to minimize radiation doses and contrast volume. Dual axis rotational coronary angiography (DARCA) is the most recently investigated type of rotational angiography. This new technique permits complete visualization of the left or right coronary tree with a single injection, and is felt to reduce contrast and radiation exposure.

METHODS

A total of 56 consecutive patients who underwent radial-DARCA were identified. From the same time period, an age- and gender-matched group of 61 patients who had femoral-SA were selected for comparison. Total volume of contrast agent used, fluoroscopy time, and 2 measures of radiation dose (dose area product and air kerma) were recorded for each group.

RESULTS

Mean contrast agent use and patient radiation exposure of the radial-DARCA group were significantly less than that of the femoral-SA group. There was no significant difference in fluoroscopy time between the 2 groups.

CONCLUSIONS

Physicians can successfully employ an innovative safety strategy of transradial access combined with DARCA that is feasible and is associated with lower radiation doses and contrast volume than femoral artery access and traditional coronary angiography approach.

Left main artery dissection during 4 French coronary angiography in elderly patient with severe aortic stenosis: "speedy recovery" using emergency primary stenting

A 70-year-old woman was referred due to a symptomatic severe calcific aortic stenosis. An iatrogenic dissection of the left main artery with total occlusion and arrest (asystole) occurred during preoperative 4Fr coronography. "Speedy recovery" is achieved with a strategy of percutaneous primary stenting revascularization combined with cardiopulmonary maneuvers.