Author + information
- Rajendra Kumar Gokhroo,
- Shashi Kant Pandey,
- Ramsagar Roy,
- Avinash Anantharaj and
- Kailash Garhwal
Background: Transulnar access (TUA) percutaneous coronary intervention (PCI) has been proposed as a feasible and non inferior alternate access in patients not suitable for trans radial approach in terms of vascular and major adverse cardiac event (MACE). The hardware used for both routes are similar. We aimed to study whether TUA, as a preferred route, is non inferior to Transradial access(TRA) for PCI.
Methods: This prospective single centre observational study involved 1,092 patients. TRA and TUA were used in 827 (right radial -816, left radial 11) and 265(right ulnar-263, left ulnar-2) patients respectively. Experienced operators with experience of at least 100 ulnar artery cannulations, did all the cannulations. Primary end points were composed of MACE and major vascular events(large hematoma-defined as hematoma extending above elbow, vascular occlusion at 7 days and failed attempts-defined as need of >3 puncture attempts). Secondary end points included cannulation and procedure time, angiographic success, radiation hazards and contrast volume.
Results: TRA and TUA were used in 827 (right radial -816, left radial- 11) and 265 (right ulnar -263, left ulnar -2) patients respectively. The composite primary end points occurred in 10 patients (3.77%) in TUA and 41 patients(4.95%) in TRA arm (RR .73; 95% confidence interval [CI] .37- 1.44; P = 0.37 at α = .05). Cannulation time (from first skin puncture to the effective placement of arterial sheath) and procedure time (insertion of catheter to exit of catheter) were similar in either group (5.9 ± 2.89 vs 6.2 ± 3.03 minutes, P =0.15) and (32 ±17 vs 34 ± 20 minutes, P =0.14). Radiation dose was similar in either arm (55± 31 vs 54±32 Gy-cm square for kerma area product, P =.65). Angiographic success rate was comparable in both the groups. At 6 month follow up, 261(98.49%) and 820 (99.15%) patients in TRA and TUA groups respectively, were free from recurrent ischemic events (P = .35). Access crossover and major access site bleeding were similar in both groups.
Conclusions: With an experienced operator, TUA is non inferior to TRA for elective PCI. TUA increase the chance of success with forearm access and reduces the need for crossover to femoral route
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Interventional Complexity and Complications
Abstract Category: 26. Interventional Cardiology: Vascular Access and Complications
Presentation Number: 1285-162
- 2017 American College of Cardiology Foundation