HOW CAN WE MANAGE RADIAL ARTERY
LATE OCCLUSION: RECANALIZATION OF
OCCLUSION OR PROXIMAL “HIGH”
PUNCTURE OF RADIAL ARTERY

...
Disclosure: Avtandil M. Babunashvili, MD

I have no relevant financial interests to disclose
Background:
_______________________________________________
Transradial interventions (TRI) are associated
with certain ri...
Study population
Occlusion of the RA/UA was detected in 72 cases (3.7%)
of the 1972 repeat transradial or transulnar inter...
1
2

Schematic image and angiogram of previous (1) and repeat (2)
puncture for recanalization of RA
Radial artery late occlusion recanalization

Instruments

Same as used for CTO coronary
or tibial arteries
(Fielder, Mirac...
Combined (Dotter+balloon) technique for
RA recanalization
various grade Dissections are common after procedure …
Long balloon (220cm) for tibial angioplasty for
dissection sealing
Sheath as a temporary stent . . .
PROCEDURAL AND DEMOGRAPHIC DATA OF 72 PATIENTS WITH
RADIAL ARTERY LATE OCCLUSION
Patient or procedure related factors

Num...
Immediate results of RA/UA recanalization
Type of occlusion

artery

Subacute
(<2 week)

radial
ulnar

CTO
(> 3 months)

r...
RECANALIZATION TECHNIQUES USED IN OCCLUDED
RADIAL/ULNAR ARTERIES
Type of
occlusion

artery

Balloon
angioplasty

“Dotter”t...
Ulnar artery subacute (6 days) thrombosis recanalization
Thrombus dislocation during subacute
Radial artery recanalization
RA perforation after successful puncture of distal stump
Factors influencing on immediate success of recanalization

Factors

OR

p

Duration of occlusion

OR = 0.97
(95% CI 0.94-...
DEPENDENCE OF DOSE AND DURATION OF RECANALIZATION
RADIAL / ULNAR ARTERY FROM TYPE OF CORONARY INTERVENTION

Mean ±
SD

CAG...
Follow-up (1 week-3 year) results of RA/UA
recanalization
Type of occlusion

Subacute
(<2 week)

artery

radial
ulnar

CTO...
Immediate and follow-up (8 months) result of
Right RA recanalization
Proximal (“high”) puncture of
occluded radial artery
Proximal Radial artery puncture under US guidance

Bifurcation point

Previous Puncture site
Proximal RA puncture and 7F sheath inserted before PCI
Proximal puncture of high take-off Radial artery
► “High” puncture sucessfully performed in 5
patients (3 –control angio, 2 – PCI);
► in one case proximal punction was per...
CONCLUSIONS
► Recanalization of late radial/ulnar artery occlusion for repeat arterial
access is technically feasible and ...
Babunashvili AM - AIMRADIAL 2013 - Radial recanalization
Babunashvili AM - AIMRADIAL 2013 - Radial recanalization
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Babunashvili AM - AIMRADIAL 2013 - Radial recanalization

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How can we manage radial artery late occlusion: recanalization of occlusion or proximal 'high' puncture of radial artery

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Babunashvili AM - AIMRADIAL 2013 - Radial recanalization

  1. 1. HOW CAN WE MANAGE RADIAL ARTERY LATE OCCLUSION: RECANALIZATION OF OCCLUSION OR PROXIMAL “HIGH” PUNCTURE OF RADIAL ARTERY Avtandil M. Babunashvili Center of Endosurgery, Moscow, Russia
  2. 2. Disclosure: Avtandil M. Babunashvili, MD I have no relevant financial interests to disclose
  3. 3. Background: _______________________________________________ Transradial interventions (TRI) are associated with certain risk of radial artery (RA) occlusion, limiting The possibility of re-intervention through the same access site.
  4. 4. Study population Occlusion of the RA/UA was detected in 72 cases (3.7%) of the 1972 repeat transradial or transulnar interventions for diagnostic and interventional procedures from January 2005 to November 2012. Methods In case of late RA/UA occlusion if the distal stump was palpable pulse, puncture and cannulation of the postocclusion segment, retrograde RA/UA recanalization and angioplasty was performed using the "Dottertechnique” or plain balloon dilatation or mixed technique.
  5. 5. 1 2 Schematic image and angiogram of previous (1) and repeat (2) puncture for recanalization of RA
  6. 6. Radial artery late occlusion recanalization Instruments Same as used for CTO coronary or tibial arteries (Fielder, Miracle series etc) Wire strategy ● escalation ● penetration Recanalization technique ● True lumen ● Subintimal (Bolia technique) Final lumen formation ● “Dotter” technique ● Balloon angioplasty ● Mixed
  7. 7. Combined (Dotter+balloon) technique for RA recanalization
  8. 8. various grade Dissections are common after procedure …
  9. 9. Long balloon (220cm) for tibial angioplasty for dissection sealing
  10. 10. Sheath as a temporary stent . . .
  11. 11. PROCEDURAL AND DEMOGRAPHIC DATA OF 72 PATIENTS WITH RADIAL ARTERY LATE OCCLUSION Patient or procedure related factors Number of patients, (%) woman 10 (13,9%) 22 (36,1%) Age > 65 5 Previous TRI 6 48 (66,7%) 7 Sheath used, F 18 (25%) 6 (8,3%) <15 Duration of TRI, min 9 (12,5%) 15-60 40 (55,6%) >60 23 (31,9%) Multiple previous punctions (2 or more TRI through the same RA) CAG Type of procedure 24 (33,3%) 34 (65,4%) Procedure details 9 (17,3%) PCI bifurcation (including LM) Present TRI* PCI CTO 7 (13,5%) PCI as a second stage 6 (11,5%) Ad-hoc PCI after control CAG 12 (23%) Control CAG 24 (46,2%)
  12. 12. Immediate results of RA/UA recanalization Type of occlusion artery Subacute (<2 week) radial ulnar CTO (> 3 months) radial ulnar success Technical failure Complication 10 1 1 1 40 6 2 1 52 7 3 (85,2%) (11,5%) (4,9%) 12 49 61
  13. 13. RECANALIZATION TECHNIQUES USED IN OCCLUDED RADIAL/ULNAR ARTERIES Type of occlusion artery Balloon angioplasty “Dotter”technique combined technique thrombus aspiration+ Balloon Subacute (<2 week) radial 4 3 3 - ulnar - - - 1 CTO (> 3 months) radial 17 13 10 - ulnar 1 - - - 22 (42,3%) 16 (30,8%) 13 (25%) 1 (1,9%) 11 41 52
  14. 14. Ulnar artery subacute (6 days) thrombosis recanalization
  15. 15. Thrombus dislocation during subacute Radial artery recanalization
  16. 16. RA perforation after successful puncture of distal stump
  17. 17. Factors influencing on immediate success of recanalization Factors OR p Duration of occlusion OR = 0.97 (95% CI 0.94-1.01) 0,269 Length of stump OR = 1.94 (95% CI 1.17-3.21) 0.010 OR = 0.98 95% CI 0.97-1.02 0.039 Length of occlusion
  18. 18. DEPENDENCE OF DOSE AND DURATION OF RECANALIZATION RADIAL / ULNAR ARTERY FROM TYPE OF CORONARY INTERVENTION Mean ± SD CAG (n= 34) Control CAG+ad hoc Planned PCI (n= 6) PCI (n=12) Total RA/UA recanaliza tion Total RA/UA recanaliza tion Total RA/UA recanali zation Radiation Dose, µGy/m2 2705.6 ± 2160.1 21.8 ± 32.3 12014.1 ± 8932.6 122.7 ± 265.7 5274 ± 4052.9 70.1 ± 48.3 Time, min 26 ± 15.8 15.2 ± 9.7 69.9 ±29.1 19.1 ± 10.8 68.7 ± 30.2 18 ± 10.1
  19. 19. Follow-up (1 week-3 year) results of RA/UA recanalization Type of occlusion Subacute (<2 week) artery radial ulnar CTO (> 3 months) radial ulnar Patent (angio or US) reocclusion 6 4 1 20 20 1 28 24 (53,8%) (46,2%) Successfully reopened 2 2 11 41 52
  20. 20. Immediate and follow-up (8 months) result of Right RA recanalization
  21. 21. Proximal (“high”) puncture of occluded radial artery
  22. 22. Proximal Radial artery puncture under US guidance Bifurcation point Previous Puncture site
  23. 23. Proximal RA puncture and 7F sheath inserted before PCI
  24. 24. Proximal puncture of high take-off Radial artery
  25. 25. ► “High” puncture sucessfully performed in 5 patients (3 –control angio, 2 – PCI); ► in one case proximal punction was performed in RA with high take-off from brachial artery; ► Only one small haematoma (< 5X5cm) was occured
  26. 26. CONCLUSIONS ► Recanalization of late radial/ulnar artery occlusion for repeat arterial access is technically feasible and safe with acceptable success rate; ► There is more benefit than harm in this technique taking in consideration the difficulties of puncture and catheterization of distal postocclusion segment; ► Despite the high risk of reocclusion this technique allows to solve the problem of access in Patients with challenging approach; ► Proximal RA catheterization under US control is feasible and safe in certain case of retrograde recanalization failure.

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