Abstract

ANATOMICAL OBSTACLES AND SHEATH TO BALLOON TIME WHILE INTERVENING THROUGH TRANSRADIAL APPROACH IN PATIENTS UNDERGOING PRIMARY PCI.

*Dr. Syed Abdul Bari, Dr. Dileep Kumar, Dr. Tahir Saghir, Dr. Nasir Khan, Dr. Romana Awan, Dr. Vickee Kumar, Dr. Shahzeb and Dr. Nadeem Qamar

.

Abstract

Background: Transradial approach has been considered a safe and useful vascular access site for cardiac catheterization in comparison with the conventional transfemoral approach. However, radial access has many challenges, such as access difficulty related to anatomical variations, radial artery spasm, occlusion, loops, tortuosities, and aberrant origin of radial and subclavian arteries. These factors were ignored in the large randomized trials that might have a significant impact on the outcome. Purpose: To determine the predictors of anatomical obstacles and the sheath to balloon time while intervening through a trans-radial approach in patients undergoing primary percutaneous coronary intervention. Methods & Results: This was a case-control study comprised of 466 patients who underwent primary percutaneous coronary intervention to determine the predictors of anatomical obstacles Sheath to balloon time was determined in both the groups with and without anatomical obstacles.Patients with and without anatomical obstacles were recruited in a 1:3 ratio. Mean age was 56.45 ± 9.42 years. 78.5% (366) were male and 21.5% (100) were females. Out of them 64.2% (299) were hypertensive. 42.7% (199) were diabetics. Among the anatomical obstacle radial artery spasm was included in 25.9%, Subclavian tortuosity in 40.2%, tortuous configuration in 17%, Radioulnar loop in 12.5% and abnormal loop in 4.5% study population. (Fig 1). Mean sheath to balloon time was 22.19 ± 9.76 minutes. Mean sheath to balloon time was 19.42 ± 6.2 in trans-radial route without anatomical obstacle and 30.92 ± 13.25 minutes in patients with anatomical obstacle. Contrast induced nephropathy was more pronounced in patients with anatomical obstacles (4.5%) as compared to patients without obstacles (0.6%). Conclusion: Older age, female gender, and diabetes were found to be the major predictors for anatomical obstacles and hence significantly increasing the sheath to balloon time.

Keywords: radial artery spasm, occlusion, loops, tortuosities.