DISTAL TRANSRADIAL APPROACH IN HIGH-RISK PATIENT WITH STEMI AND CARDIOGENIC SHOCK – A CASE REPORT
Keywords:
distal transradial access, efficacy, advantagesAbstract
Conventional transradial access has been considered as a recommended choice in PCI and myocardial revascularization.The vascular complications such as radial artery occlusion, perforation and spasm have led to the development of a new approach, which was proposed to overcome these limitations. This was a distal transradial approach (snuffbox approach).
A 74-year-old woman presented to the emergency department with oppressive chest pain and dyspnea formore than 3 hours.On clinical examination, the patient appeared pale and diaphoretic, with weak and rapidpulsation and systolic blood pressure below 70mmHg. A 12 lead ECG lead was performed, whichshowed ST segment elevation of 4 mm in inferior lead.She was admitted to the catheterization laboratory with blood pressure 70/40mmhg andnorepinephrine vasopressor support. A 6Fr introducer sheath was placed in distal radial (anatomical snuffbox). The coronary angiography revealed RCA with acute total occlusion and high thrombotic burden TIMI 5 in proximal segment,normal LMCA, LAD and Circumflex. RCA was engaged with a guide catheter and advanced distally a floppy guidewire, then the occlusion site was predilated with a balloon and advanced stent from proximal segment with TIMI3 final flow. 2D transthoracic echocardiography was performed, and it showed heart failure with mildly reduced ejection fraction and hypokinesia of the inferior wall.
Distal transradial access is a new approach which might offer several advantages over conventional radial access such as reduction of the risk of radial artery occlusion, short hemostasis andsaving the radial artery for possible future coronary artery graft.
References
Babunashvili A, Dundua D. Recanalization and reuse of early occluded radial artery within 6 days after previous transradial diagnostic procedure. Catheterization Cardiovasc Interventions. 2011;77(4):530–536.
Kiemeneij F Left distal transradial access in the anatomical snuffbox for coronary angiography (ldTRA) and interventions (ldTRI) [Internet]. EuroIntervention. [citéd 2019. October 12]. Disponible sur: https://eurointervention.pcronline.com/article/left-distal-transradial-access-in-the-anatomical-snuffbox-for-coronary-angiography-ldtra-and-interventions-ldtri.
Anastasia Hadjivassiliou1, MBBS, BSc; Ferdinand Kiemeneij2, MD, PhD; Sandeep Nathan3, MD, MSc; Darren Klass1, MD, PhD ultrasound-guided access to the distal radial artery at the anatomical snuffbox for catheter-based vascular interventions : a techical guide. EuroIntervention 2021;16:1342-1348. DOI: 10.4244/EIJ-D-19-00555.
Ultrasound-guided access of the distal radial artery at the anatomical snuffbox for catheter-based vascular interventions: a technical guide. Hadjivassiliou A, Kiemeneij F, Nathan S, et al. https://eurointervention.pcronline.com/article/ultrasound-guided-access-of-the-distal-radial-artery-at-the-anatomical-snuffbox-for-catheter-based-vascular-interventions-a-technical-guide EuroIntervention. 2019:0.
Zaid Nairoukg, Saira Jahangir: Dennis Adjepong; Distal Radial Artery Acces: The Fututre of Cardiovasclar Intervention Cures 2020 Mar; 12(3) e7201 DOI : 107759/cureus.7201.
Elton Soydan and Mustafa Akın Applicability of left distal radial artery access site in ST-segment elevation myocardial infarction; A comparative evaluation with the conventional transfemoral approach. The Journal of Vascular Access 1–7 © The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1129729820983138 journals.sagepub.com/home/jva.
Rania Hamai, Fatma Zouari et al. Distal radial approach verss conventional radial approach: a comparative study of feasibility study and safety. Libyan J med 2020 Nov 4. doi : 10.1080/1932820.2020.1830600.
Kim Y, Lee J-W, Lee SY, et al. Feasibility of primary percutaneous coronary intervention via the distal radial approach in patients with ST-elevation myocardial infarction. Korean J Intern Med. Epub ahead of print March 2020. DOI: 10.3904/kjim.2019.420.
Wretowski D, Krakowian M, Łabyk A, et al. Very distal transradial approach (VITRO) for coronary interventions. Postepy Kardiol Interwencyjnej. 2019;15(1):42–45.
