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The Journal of Invasive Cardiology Apr 2020The aim of this study was to compare two hemostatic techniques, minimum pressure technique and patent hemostasis, on radial artery occlusion (RAO) after transradial... (Comparative Study)
Comparative Study
OBJECTIVES
The aim of this study was to compare two hemostatic techniques, minimum pressure technique and patent hemostasis, on radial artery occlusion (RAO) after transradial catheterization.
BACKGROUND
RAO is an infrequent complication of transradial procedures. One of the strategies used to reduce this complication is the patent hemostasis technique. Use of minimum pressure in hemostatic wristband, without monitoring patency, might have the same efficacy for preventing RAO.
METHODS
This is a multicenter study encompassing patients submitted to transradial catheterization. After pneumatic wristband application, the band was deflated to the lowest allowable volume while preserving hemostasis. Radial artery patency was subsequently evaluated. The group with no return of plethysmographic curve was labeled "minimum pressure," and the group in which the signal returned was labeled "patent hemostasis." RAO was verified by Doppler evaluation within the first 24 hours of the procedure.
RESULTS
A total of 1082 patients were enrolled, with mean age of 61.4 ± 10.4 years. The majority (61.0%) were male and 34.5% had diabetes. Patent hemostasis was achieved in only 213 cases (20%). Early RAO occurred in 16 patients (1.8%) in the minimum pressure group and in 4 patients (1.9%) in the patent hemostasis group (P=.97). No major bleeding was observed among the entire cohort. EASY scale for hematoma grade was similar between the cohorts (EASY grades 1-3: 7.0% in the minimum pressure group vs 7.5% in the patent hemostasis group; P=.96).
CONCLUSION
Checking radial patency during hemostatic compression may not be necessary after the procedure when adopting a mild and short hemostatic compression.
Topics: Aged; Arterial Occlusive Diseases; Cardiac Catheterization; Catheterization, Peripheral; Female; Hemostasis; Hemostatic Techniques; Humans; Male; Middle Aged; Punctures; Radial Artery; Vascular Patency
PubMed: 32160152
DOI: No ID Found -
Journal of Interventional Cardiology Dec 2018Radial artery occlusions (RAOs) impose an important problem that limit transradial interventions. In this study, we represent that it is possible to perform...
It is both possible and safe to perform coronary angiography through the same radial artery, after retrograde recanalization of radial artery occlusion, following a previous coronary angiography.
INTRODUCTION
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.
METHOD
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.
RESULTS
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.
DISCUSSION AND CONCLUSION
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.
Topics: Aged; Arterial Occlusive Diseases; Coronary Angiography; Female; Humans; Male; Middle Aged; Postoperative Complications; Punctures; Radial Artery; Vascular Surgical Procedures
PubMed: 29855079
DOI: 10.1111/joic.12524 -
Medicine Dec 2021Although their effectiveness and safety have not yet been established, endovascular treatments have recently been applied in the treatment of acute basilar artery...
INTRODUCTION
Although their effectiveness and safety have not yet been established, endovascular treatments have recently been applied in the treatment of acute basilar artery occlusion. If not identified, persistent primitive hypoglossal artery, a rare variant of the posterior circulation, could be a barrier to the successful treatment of basilar artery occlusion.
PATIENT CONCERNS
An 83-year-old woman, who had been undergoing treatment for hypertension for 20 years, visited our hospital 3 hours after the onset of acute unresponsive mental deterioration. The patient was unresponsive to painful stimuli, and the pupils were equal and miotic.
DIAGNOSIS
Brain computed tomography angiography confirmed complete occlusion of the distal basilar artery and revealed a dilated branch arising from the right internal carotid artery at the C2 vertebral level.
INTERVENTIONS
Endovascular thrombectomy was performed directly via the right femoral artery. Complete recanalization was achieved via manual aspiration thrombectomy.
OUTCOMES
Brain magnetic resonance imaging revealed multifocal cerebral infarctions in the bilateral thalamus, midbrain, and cerebellar vermis. The patient's neurological symptoms gradually improved.
CONCLUSIONS
This is a rare case of basilar artery occlusion that was successfully treated with mechanical thrombectomy through persistent primitive hypoglossal artery. It is important to consider the potential clinical implications of this rare vascular variant.
Topics: Aged, 80 and over; Arterial Occlusive Diseases; Basilar Artery; Carotid Artery, Internal; Cerebral Infarction; Endovascular Procedures; Female; Humans; Magnetic Resonance Imaging; Thrombectomy
PubMed: 35049208
DOI: 10.1097/MD.0000000000027998 -
The Kobe Journal of Medical Sciences 2006Using monochromatic synchrotron radiation, we performed microangiography in C57BL/6J mice and investigated their vasculature after unilateral and bilateral carotid...
Using monochromatic synchrotron radiation, we performed microangiography in C57BL/6J mice and investigated their vasculature after unilateral and bilateral carotid artery occlusion. Bilateral occlusion of the carotid artery was made by a ligation of the left common carotid artery followed by a ligation of the right internal carotid artery (ICA) two days later (n=12). Five days after the second surgery, angiography was performed. Unilateral occlusion was made by clipping the right ICA and then angiography was performed immediately (n=5). The control mice did not undergo any occlusion (n=5). We removed the brain of the bilateral occlusion mice after angiography and examined the infarction area. The cerebral microvessels in all animals were clearly visualized. In the control mice, the posterior communicating artery (Pcom) was not visualized. In the unilateral occlusion mice, the anastomosis of the pterygopalatine artery (PPA) and the external carotid artery (ECA) were recognized. The PPA is thus considered to play a role in the collateral vessel between the ICA and the ECA. The Pcom was not visualized. In the bilateral occlusion mice, the Pcom was observed either unilaterally (n=5) or bilaterally (n=5). The Pcom supplied blood flow to the anterior circulation from the vertebrobasilar arteries. The bilateral occlusion mice that had at least one visualized Pcom did not have any infarction. We could successfully visualize the cerebral vasculature of normal mice and carotid artery occluded mice in an in vivo study. Microangiography can demonstrate the development of vasculature and the blood flow dynamics in mice.
Topics: Angiography; Animals; Arterial Occlusive Diseases; Carotid Arteries; Carotid Stenosis; Collateral Circulation; Male; Mice; Mice, Inbred C57BL; Microcirculation; Neovascularization, Pathologic; Pilot Projects; Synchrotrons
PubMed: 17006051
DOI: No ID Found -
Interventional Neuroradiology : Journal... Feb 2020
Topics: Arterial Occlusive Diseases; Basilar Artery; Humans; Vertebrobasilar Insufficiency
PubMed: 31480889
DOI: 10.1177/1591019919872402 -
Pediatrics and Neonatology Aug 2014Acute basilar artery occlusion (ABAO) is an infrequent but potentially fatal complication that can cause strokes in both adults and children. Traumatic vertebral artery...
Acute basilar artery occlusion (ABAO) is an infrequent but potentially fatal complication that can cause strokes in both adults and children. Traumatic vertebral artery dissection (VAD) is one of the most common causes of ABAO in young patients. We present a case of an 11-year-old boy with VAD complicated by basilar artery occlusion 2 days after a fight with classmates that caused severe neurological deficits. He did not have any direct head trauma or concomitant risk factors. Clinical symptoms included nausea, vomiting, and rapid alteration of consciousness. Magnetic resonance imaging showed total occlusion of the basilar artery, and angiography confirmed VAD from the third to the fourth segments. A history of such subtle precipitating events should be noted when diagnosing young patients with brainstem strokes. A delay in the diagnosis of ABAO is frequently due to misleading symptoms and signs and the lack of awareness of this rare condition.
Topics: Arterial Occlusive Diseases; Basilar Artery; Child; Craniocerebral Trauma; Humans; Magnetic Resonance Angiography; Male; Vertebral Artery Dissection
PubMed: 23597537
DOI: 10.1016/j.pedneo.2012.12.014 -
Journal of Vascular Surgery Dec 2009Occlusion of the ulnar artery is found in a substantial proportion of elderly patients. The aim of this study was to estimate the prevalence of ulnar artery occlusion in...
BACKGROUND
Occlusion of the ulnar artery is found in a substantial proportion of elderly patients. The aim of this study was to estimate the prevalence of ulnar artery occlusion in a sample of the general population of France, look for its risk factors, and evaluate its clinical correlates.
METHODS
This study was an offshoot of a cross-sectional epidemiologic study in the general population of four locations in France (Tarentaise, Grenoble, Nyons, and Toulon). In phase I, random samples of 2000 individuals per location aged >or=18 years old were interviewed by phone for screening of Raynaud phenomenon. In phase II, subsamples of individuals were invited to a medical interview and physical examination where the presence of Raynaud phenomenon and occupational risk factors were recorded and a bilateral clinical Allen test was performed for the detection of ulnar artery occlusion. Phase II comprised 688 women and 335 men.
RESULTS
In 36 men and seven women, at least one occluded ulnar artery was found. The estimated prevalence was 9.6% in men and 1.0% in women (P < .001). The occluded artery was more often in the dominant hand of both men (8.1% vs 2.4%; P < .001) and women (0.9% vs 0.4%; P = .34). Ulnar artery occlusion was found more often in men aged >50 years (16.4%) than in younger men (1.4%; P < .001). Besides age, male sex, and dominant side, the only independent risk factor was an occupational exposure in men to repeated palmar trauma, with a significant quantitative relationship in the frequency of the impacts (P < .001) and the duration of the exposure (P < .001). Exposures to hand-held vibrating tools and cigarette smoking did not show a significant relationship in the multivariate analysis. Most individuals with ulnar artery occlusion did not have associated complaints; however, the diagnostic criteria for Raynaud phenomenon was validated in 13 of the 36 affected men. The association remained significant after adjusting for occupational exposure to vibrating tools. One individual reported a previous episode consistent with an attack of permanent digital ischemia.
CONCLUSION
This study confirms a substantial prevalence of ulnar artery occlusions in the general population, mostly in middle-aged and elderly men, which appears to be principally related to an occupational exposure to repeated occupational palmar trauma. Although there is a significant association with Raynaud phenomenon, most often the consequences of this occlusion remain subclinical.
Topics: Adult; Age Distribution; Age Factors; Aged; Aged, 80 and over; Arterial Occlusive Diseases; Constriction, Pathologic; Cross-Sectional Studies; Female; France; Functional Laterality; Humans; Logistic Models; Male; Middle Aged; Occupational Diseases; Occupational Exposure; Odds Ratio; Population Surveillance; Prevalence; Raynaud Disease; Regional Blood Flow; Risk Assessment; Risk Factors; Sex Distribution; Sex Factors; Ulnar Artery; Vibration
PubMed: 19837535
DOI: 10.1016/j.jvs.2009.07.076 -
Interventional Neuroradiology : Journal... Jun 2016The objective of this study was to add more evidence about the efficacy and safety of mechanical thrombectomy in patients with basilar artery occlusion and secondarily...
OBJECTIVES
The objective of this study was to add more evidence about the efficacy and safety of mechanical thrombectomy in patients with basilar artery occlusion and secondarily to identify prognostic factors.
METHODS
Twenty-two consecutive patients (mean age 60.5 years, 15 men) with basilar artery occlusion treated with mechanical thrombectomy were included. Clinical, procedure and radiological data were collected. Primary outcomes were the modified Rankin scale score with a good outcome defined by a modified Rankin scale score of 0-2 and mortality rate at three months.
RESULTS
The median National Institutes of Health stroke scale at admission was 24 (interquartile range 11.5-31.25). Twelve patients (54.5%) required tracheal intubation due to a decreased level of consciousness. Successful recanalisation (modified treatment in cerebral ischaemia scale 2b-3) was achieved in 20 patients (90.9%). A favourable clinical outcome (modified Rankin scale score 0-2) was observed in nine patients (40.9%) and the overall mortality rate was 40.9% (nine patients). Haemorrhagic events were observed in three patients (13.63%). A decreased level of consciousness requiring intubation in the acute setting was more frequent in patients with poor outcomes (84.6%) than in patients with favourable outcomes (11.1%), and in patients who died (100%) compared with those who survived (23.1%), with a statistically significant difference (P = 0.002 and P = 0.001, respectively).
CONCLUSION
Mechanical thrombectomy is feasible and effective in patients with acute basilar artery occlusion. A decreased level of consciousness requiring tracheal intubation seems to be a prognostic factor and is associated with a poor clinical outcome and higher mortality rate. These initial results must be confirmed by further prospective studies with a larger number of patients.
Topics: Arterial Occlusive Diseases; Basilar Artery; Female; Humans; Male; Mechanical Thrombolysis; Middle Aged; Prognosis; Treatment Outcome
PubMed: 26908588
DOI: 10.1177/1591019916631145 -
Therapeutic Advances in Cardiovascular... Mar 2018We sought to investigate the rate of radial artery occlusion (RAO) after same-day dual radial artery puncture. The trans-radial arterial approach (TRA) for diagnostic...
BACKGROUND
We sought to investigate the rate of radial artery occlusion (RAO) after same-day dual radial artery puncture. The trans-radial arterial approach (TRA) for diagnostic and interventional procedures has risen significantly in the United States. Although becoming more commonly performed, TRA is not without risk, and a potential complication is RAO. The rate of RAO after same-day dual artery puncture is unknown.
METHODS
A retrospective analysis of 27 patients who underwent same-day dual radial artery puncture for percutaneous coronary intervention (PCI) at our institution (Providence Heart Institute in Southfield, MI, USA) from November 2011 to December 2013 were included after initially presenting for cardiac catheterization at a non-PCI-capable facility. The study patients were asked to follow up for evaluation of the radial artery, including obtaining a duplex ultrasound evaluation.
RESULTS
The mean age of the patients was 65 years old with 66% of the patients being male. Of the 27 study participants, there were no symptoms reported that were related to RAO. Overall, one (3.7%) patient had an absent radial pulse. The modified Allen's test was normal in all of the patients with a mean return of palmar flush time of 4 seconds. Duplex ultrasound revealed subtotal RAO in four (14.8%) patients and no patients experienced total occlusion following the intervention.
CONCLUSION
Dual radial artery puncture appears to be a well-tolerated and viable strategy in patients that are transferred to a PCI-capable hospital for coronary interventions.
Topics: Aged; Aged, 80 and over; Arterial Occlusive Diseases; Catheterization, Peripheral; Coronary Angiography; Coronary Artery Disease; Female; Humans; Incidence; Male; Michigan; Middle Aged; Patient Transfer; Percutaneous Coronary Intervention; Punctures; Radial Artery; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex
PubMed: 29307269
DOI: 10.1177/1753944717749738 -
JACC. Cardiovascular Interventions Jan 2022This study aimed to compare the efficacy and safety of the distal transradial approach (dTRA) versus the conventional transradial approach (TRA) for coronary angiography... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
This study aimed to compare the efficacy and safety of the distal transradial approach (dTRA) versus the conventional transradial approach (TRA) for coronary angiography and percutaneous coronary interventions.
BACKGROUND
The recommended approach for coronary procedures is TRA. However, it is associated with radial artery occlusion (RAO). The dTRA could potentially decrease the incidence of RAO.
METHODS
One thousand forty-two consecutive patients were randomized (1:1) to right dTRA or TRA. The primary endpoint was the rate of RAO, which was evaluated by Doppler ultrasound at 60 days after randomization.
RESULTS
Five hundred eighteen and 524 patients were randomized to dTRA and TRA, respectively. Follow-up Doppler evaluation of the radial artery was accomplished in 404 (78.0%) patients in the dTRA group and 392 (74.8%) in the TRA group. The rate of RAO was significantly reduced in the dTRA group compared with TRA group (3.7% vs 7.9%, respectively; P = 0.014). The rate of successful sheath insertion was lower in the dTRA group compared with the TRA group (78.7% vs 94.8%, respectively; P < 0.001). More punctures (median = 2 [IQR: 1-3] vs median = 1 [IQR: 1-2]; P < 0.001) and a longer time (120 vs 75 seconds; P < 0.001) were required for sheath insertion in the dTRA group compared with the TRA group. The hemostasis time was shorter in the dTRA group compared with the TRA group (60 vs 120 minutes; P < 0.001). The dose area product was higher in the dTRA group (median = 32,729 in the dTRA vs 28,909 cGy/cm in the TRA group; P = 0.02). No significant differences were observed in the secondary safety endpoints (bleeding [Bleeding Academic Research Consortium ≥2] and severe radial artery spasm).
CONCLUSIONS
According to our study, dTRA was associated with a lower rate of forearm RAO, a shorter time of hemostasis, a higher crossover rate and dose area product, and a longer procedural time compared with TRA.
Topics: Arterial Occlusive Diseases; Coronary Angiography; Humans; Percutaneous Coronary Intervention; Radial Artery; Treatment Outcome
PubMed: 34922888
DOI: 10.1016/j.jcin.2021.09.037