Original title: Comparison of frequency of Radial Artery Oclusion Alter 4Fr Versus 6Fr Transradial Coronary intervention (from the Novel Angioplasty Using Coronary Accessor Trial). Reference: Satoshi Takesita, et al. Am J Cardiol 2014;113:1986-89)
Since Andreas Gruentzig performed the first angioplasty, technological development has improved devices and radial access becomes more common. This procedure reduces complications, mainly bleeding. However, although is clinically not relevant, there is a chance of radial artery occlusion in between 3% and 10%.
In this multicenter, randomized, prospective study, 160 patients who received angioplasty by radial access with Allen test (+), were included, 80 with 4 Fr introducer and 80 with 6 Fr. We excluded those who required secondary branch protection by kissing balloon, cutting balloon, rotational atherectomy or IVUS not compatible with 4 Fr. The Primary Endpoint was the occlusion of the radial artery a day after the procedure and secondary was the procedural success, MACE, vascular access complications, procedure time and contrast used. The characteristics of both groups were similar, the mean age was 68 years, most men and more than 70% of coronary lesions were single (A or B1). Three patients (4%) of group 6 Fr presented occlusion of the radial artery and none in the 4 Fr group (p = 0.08). There was no difference with respect to the secondary endpoint except for the shorter hemostasis and vascular complications related to access.
Conclusion:
The use of radial access with introducer and 4 Fr catheters can become a less invasive alternative in simple coronary angioplasty.
Editorial comment
The use of 4 Fr in coronary angioplasty marks an important advance in this technique, but can be used in non-complex procedures only, giving benefit especially to patients with thin gauge arteries and prone to spasm. Further technological development are needed in order to perform complex angioplasties using compatible devices with 4 Fr.
Courtesy of Carlos Fava
Cardiólogo Intervencionista
Fundación Favaloro
Buenos Aires
Dr. Carlos Fava