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Published online: 2022-06-20
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Subclavian angioplasty during coronary interventions using radial approach

Ahmed Mahmoud El Amrawy12, Santiago Camacho-Freire2, Antonio Gomez-Menchero2, Rosa Cardenal-Piris2, Jose Francisco Diaz-Fernandez2
DOI: 10.33963/KP.a2022.0151
·
Pubmed: 35724334
Affiliations
  1. Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
  2. Department of Interventional Cardiology, Juan Ramon Jimenez University Hospital, Huelva, Spain

open access

Online first
Original article
Published online: 2022-06-20

Abstract

BACKGROUND: In the past years, the percentage of percutaneous coronary angiography and interventions using the radial access had significantly increased due to its higher safety, lower risk of major bleeding and hence lower cardiovascular mortality. Subclavian artery stenosis is one of the challenges that may be met during transradial coronary interventions, which may necessitate femoral access crossover or conversion.

AIMS: To evaluate the feasibility and safety of performing subclavian angioplasty via the radial access, during complex coronary interventions using forearm approach.

METHODS: A series of patients with complex radial approach due to subclavian stenosis, for which subclavian angioplasty was performed during the procedure. Forty-eight patients out of 22 500 procedures performed, from February 2009 to February 2020, were included. All patients did not have alternative vascular access due to extensive peripheral arterial disease (previous history of iliac stenting or distal aortic occlusion which makes femoral access crossover difficult, also the contralateral radial/ulnar artery was very faint or not felt at all).

RESULTS: Mean age was 72 (10) years and 67% were males. Subclavian angioplasty was successfully done in all patients via the ipsilateral radial access; 91.7% (44 patients) required subclavian stenting and 4 patients were treated by subclavian angioplasty without stenting. Coronary angiography or intervention was perfectly done through the revascularized subclavian artery; coronary stenting was successfully done in 36 patients as indicated.

CONCLUSIONS: It can be concluded that percutaneous subclavian artery angioplasty can be done safely and effectively to facilitate complex transradial coronary procedures, with an acceptable immediate technical success, especially in patients without alternative vascular access. Also, we may conclude that subclavian angioplasty may be successfully performed in patients with symptomatic upper limb ischemia, via the radial approach

Abstract

BACKGROUND: In the past years, the percentage of percutaneous coronary angiography and interventions using the radial access had significantly increased due to its higher safety, lower risk of major bleeding and hence lower cardiovascular mortality. Subclavian artery stenosis is one of the challenges that may be met during transradial coronary interventions, which may necessitate femoral access crossover or conversion.

AIMS: To evaluate the feasibility and safety of performing subclavian angioplasty via the radial access, during complex coronary interventions using forearm approach.

METHODS: A series of patients with complex radial approach due to subclavian stenosis, for which subclavian angioplasty was performed during the procedure. Forty-eight patients out of 22 500 procedures performed, from February 2009 to February 2020, were included. All patients did not have alternative vascular access due to extensive peripheral arterial disease (previous history of iliac stenting or distal aortic occlusion which makes femoral access crossover difficult, also the contralateral radial/ulnar artery was very faint or not felt at all).

RESULTS: Mean age was 72 (10) years and 67% were males. Subclavian angioplasty was successfully done in all patients via the ipsilateral radial access; 91.7% (44 patients) required subclavian stenting and 4 patients were treated by subclavian angioplasty without stenting. Coronary angiography or intervention was perfectly done through the revascularized subclavian artery; coronary stenting was successfully done in 36 patients as indicated.

CONCLUSIONS: It can be concluded that percutaneous subclavian artery angioplasty can be done safely and effectively to facilitate complex transradial coronary procedures, with an acceptable immediate technical success, especially in patients without alternative vascular access. Also, we may conclude that subclavian angioplasty may be successfully performed in patients with symptomatic upper limb ischemia, via the radial approach

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Keywords

transradial approach, percutaneous coronary intervention, peripheral intervention

About this article
Title

Subclavian angioplasty during coronary interventions using radial approach

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2022-06-20

Page views

24

Article views/downloads

21

DOI

10.33963/KP.a2022.0151

Pubmed

35724334

Keywords

transradial approach
percutaneous coronary intervention
peripheral intervention

Authors

Ahmed Mahmoud El Amrawy
Santiago Camacho-Freire
Antonio Gomez-Menchero
Rosa Cardenal-Piris
Jose Francisco Diaz-Fernandez

References (13)
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  2. Ferrante G, Rao SV, Jüni P, et al. Radial versus femoral access for coronary interventions across the entire spectrum of patients with coronary artery disease: a meta-analysis of randomized trials. JACC Cardiovasc Interv. 2016; 9(14): 1419–1434.
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