Radial artery acute injury after PCI assessed by optical coherence tomography

1. RADIAL ARTERY ACUTE INJURY
AFTER PCI ASSESSED BY OPTICAL
COHERENCE TOMOGRAPHY
Kanovsky J., Poloczek M., Bocek O., Miklik R., Jerabek P., Ondrus T., Spinar J., Kala
P.
Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech
Republic

AimRADIAL2013, New York

2. Disclosure: Jan Kanovsky, MD, PhD

Dr. Jan Kanovsky has no relevant financial interests to disclose
AimRADIAL2013, New York

3. Background
Importance of RA condition

The number of transradial coronary catheterizations and
interventions is increasing

The quality of the radial artery (RA) is crucial if used for the
coronary artery bypass graft (CABG)

The number of patients with more than one arterial conduit used
for the CABG is increasing

RA native disease is a predictor of coronary thin-cap
fibroatheroma (TCFA)1
1
Di Vito, 2013
AimRADIAL2013, New York

4. Background
OCT
 Optical coherence
tomography (OCT) is
intravascular imaging
method with the highest
resolution available (up to
10um)
 OCT of RA can provide
detailed information about
acute injury or chronic
changes of the vessel after
transradial catheterization1
1
Yonetsu, 2010
AimRADIAL2013, New York

5. TD-OCT study (Yonetsu, 2009)
 High number of
intimal tears and
medial dissections
 Using 16cm sheath,
for imaging pulled
14cm out
 Most of the injuries
in the distal segment
1
Yonetsu, 2010
AimRADIAL2013, New York

6. Methods

40 consecutive patients admitted for coronary angiography (CAG)
due to non-STEMI diagnosis

First myocardial lesion in patients’s history

First transradial CAG

Informed consent
Exclusion: STEMI, previous MI, acute heart failure, left main
disease, renal insufficiency
AimRADIAL2013, New York

7. Methods

6F 7cm sheath

Pulled back of 3cm, guiding
catheter moved back into the
sheath

FD-OCT recording of RA,
starting 8cm from the sheath tip
(using X-ray contrast ruler)

Manual injection of the 100%
contrast fluid
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8. Results
 Only two minor injuries found (5%)
 Few patients with abnormal vessel wall structure (5pts,
12,5%, intimal thickening, calcifications, qualitative
assessment)
 No thrombotic mass found
 All patient asymptomatic
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9. Injuries
 Intimal tear
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10. Injuries
 Dissection
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11. Discussion

In most of the patients
(95%), we found no acute
injury and normal vessel
structure

Major difference in results
comparing to the Yonetsu
study from 2010

Two main differences –
sheath length, TD vs FD
OCT imaging
AimRADIAL2013, New York

12. Conclusion
 Transradial CAG and intervention is a safe access route,
with minor incidence of acute injuries
 The length of sheath is likely important for the incidence of
RA injury
 Chronic changes are the subject of further research in the
project (all patients scheduled for 9 months follow-up CAG
and OCT).
AimRADIAL2013, New York

13. Thank you for your attention.

Supported by the Grant of the IGA Ministry of Health of the Czech
Republic no. NT/13830.
AimRADIAL2013, New York