Cafri C

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Transradial Approach in Patients With Coronary Bypass Grafts

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Cafri C

  1. 1. Transradial Approach inPatients With Coronary Bypass Grafts Carlos Cafri, MD Soroka Medical Center Beer Sheva, Israel
  2. 2. The Casen  69 years old menn  Hypertension, Dyslipidemian  CABG (2000): LIMA to LAD, Free RIMA “T” graft to OM, SVG to PDAn  On Admission: n  STEMI - Inferior wall. n  Ischemic time: 10 hours n  Ongoing chest pain (2/10) n  ECG: Q waves & minimal ST elevation n  Killip I
  3. 3. Urgent Transradial Angiography
  4. 4. After AspirationSVG occlusion Manual Aspiration Injection through aspiration catheter
  5. 5. Ulcerated Plaque Residual Thrombus
  6. 6. Final Result
  7. 7. Mechanism and Predictors of Failed Transradial Approach for Percutaneous Coronary Interventionsn  Transradial Failure: 4.7% (98/2100) n  Inabilityto advance guide catheter to ascending aorta in 50 (51%). n  Inadequate guide catheter support in 35 (36%) n  Unsuccessful radial artery puncture in 13 (13%) patients J Am Coll Cardiol Intv, 2009; 2:1057-1064,
  8. 8. Mechanism and Predictors of Failed Transradial Approach for Percutaneous Coronary Interventionsaortic root dilation, calcification, Diffuse atherosclerosis of both great vessels J Am Coll Cardiol Intv, 2009; 2:1057-1064,
  9. 9. Patient Evaluationn  Number and the type of graftn  Forearm Circulation n  Allen’stest n  Reverse Allen’s test
  10. 10. Homolateral IMA Graft n  Reduction* of n  Time for IMA cannulation n  Time for IMA assessment n  Number of projections needed for visualizationBurzotta F. J Cardiov.Medic 2008*
  11. 11. Homolateral IMA Graft
  12. 12. Contralateral IMA graftn  Bilateral radial arterial accessn  Single radial approach with contra lateral crossing
  13. 13. Aorto-Coronary Saphenous Vein Grafts
  14. 14. Efficacy and Safety of theTransradial Approach forSaphenousVein Graft PCI Cafri C. et al. Soroka Medical Center Faculty of Health Sciences. Ben Gurion University Beer Sheva. Israel
  15. 15. AimsTo compare the efficacy and safety of transradial and transfemoral approaches forPCI to saphenous vein grafts.
  16. 16. MethodsRetrospective observational trial, single centern  Population: n  Inclusion criteria: patients undergoing PCI to SVG (2005-2009) n  140 transradial pts (75 ± 12) vs. 70 transfemoral pts (69 ± 12) n  Exclusion criteria: Nonen  Data: Demographics, clinical & angiographicn  End point : n  Angiographic success n  Bleeding complication rate
  17. 17. Characteristics Transradial Transfemoral p value Unstable Angina (%) 34 24 <0.01 NSTEMI (%) 31 23 <0.01 Pulmonary Edema (%) 0 3 <0.05Decreased LV function (%) 27 33 <0.05 Ad-Hoc PCI (%) 86 68 <0.01 Fluoro Time (min) 17± 9 19±9 ns Dye Volume (cc) 183 ±77 182±85 ns
  18. 18. Characteristics Transradial Transfemoral 6F (%) 100 100 Right Radial (%) 9 Left Radial (%) 91 Right Judkins (%) 41 22 MP (%) 20 40Coronary Bypass (%) 14 18 Others (%) 25 20
  19. 19. Efficacy and Safety of the Transradial Approach for Saphenous Vein Graft intervention. 90% 81% Soroka Medical Center Radial (*140) Femoral(*70 ) 21% 14%11% 6% 9% 7% Distal No reflow Success Bleeding Protection
  20. 20. Conclusionsn  Transradial PCI of SVGs is as effective as the transfemoral approach and is associated with fewer bleeding complications.n  Our data supports a broader utilization of the transradial approach for SVG intervention.
  21. 21. Radial is not perfect, however..
  22. 22. The radial approach is safe
  23. 23. The radial approach is successful
  24. 24. THANK YOU!!!
  25. 25. Characteristics Transradial Transfemoral p value GP IIB/IIIA inhibitors 31 27 ns (%)Distal Protection Device 14 11 ns (%) Aspiration Device (%) 4 7 nsAngiographic Success (%) 90 81 ns No Reflow (%) 6 9 nsBleeding Complications 7 21 <0.01 (%)

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