Transradial Approach in Patients With Coronary Bypass Grafts

1. Transradial Approach in
Patients With Coronary
Bypass Grafts
Carlos Cafri, MD
Soroka Medical Center
Beer Sheva, Israel

2. The Case
n 69 years old men
n Hypertension, Dyslipidemia
n CABG (2000): LIMA to LAD, Free RIMA “T” graft to OM,
SVG to PDA
n 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. Urgent Transradial Angiography

4. After Aspiration
SVG occlusion
Manual
Aspiration
Injection
through
aspiration
catheter

5. Ulcerated Plaque
Residual Thrombus

6. Final Result

7. Mechanism and Predictors of Failed Transradial
Approach for Percutaneous Coronary
Interventions
n 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. Mechanism and Predictors of Failed Transradial
Approach for Percutaneous Coronary
Interventions
aortic root dilation, calcification, Diffuse atherosclerosis of both great vessels
J Am Coll Cardiol Intv, 2009; 2:1057-1064,

9. Patient Evaluation
n Number and the type of graft
n Forearm Circulation
n Allen’stest
n Reverse Allen’s test

10. Homolateral IMA Graft
n Reduction* of
n Time for IMA cannulation
n Time for IMA assessment
n Number of projections needed for visualization
Burzotta F. J Cardiov.Medic 2008*

11. Homolateral IMA Graft

12. Contralateral IMA graft
n Bilateral radial arterial access
n Single radial approach with contra lateral
crossing

13. Aorto-Coronary Saphenous Vein
Grafts

14. Efficacy and Safety of the
Transradial Approach for
SaphenousVein Graft PCI
Cafri C. et al.
Soroka Medical Center
Faculty of Health Sciences. Ben Gurion University
Beer Sheva. Israel

15. Aims
To compare the efficacy and
safety of transradial and
transfemoral approaches for
PCI to saphenous vein grafts.

16. Methods
Retrospective observational trial, single center
n 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: None
n Data: Demographics, clinical & angiographic
n End point :
n Angiographic success
n Bleeding complication rate

17. Characteristics
Transradial Transfemoral p value
Unstable Angina (%) 34 24 <0.01
NSTEMI (%) 31 23 <0.01
Pulmonary Edema (%) 0 3 <0.05
Decreased 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. Characteristics
Transradial Transfemoral
6F (%) 100 100
Right Radial (%) 9
Left Radial (%) 91
Right Judkins (%) 41 22
MP (%) 20 40
Coronary Bypass (%) 14 18
Others (%) 25 20

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. Conclusions
n 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. Radial is not perfect, however..

22. The radial approach is safe

23. The radial approach is successful

25. THANK YOU!!!

26. Characteristics
Transradial Transfemoral p value
GP IIB/IIIA inhibitors 31 27 ns
(%)
Distal Protection Device 14 11 ns
(%)
Aspiration Device (%) 4 7 ns
Angiographic Success (%) 90 81 ns
No Reflow (%) 6 9 ns
Bleeding Complications 7 21 <0.01
(%)