الفهرس 
Radial accessOnly 14 pages are availabe for public view
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Abstract
Coronary artery disease has had high morbidity and mortality for a long time. To date percutaneous coronary angiography and percutaneous trans-luminal coronary angioplasty are standard diagnostic and therapeutic strategy for coronary artery disease respectively. The common femoral artery has long been the access site for doing coronary angiography and angioplasty.
Femoral artery has been the preferred site of access because of the larger size and the larger diagnostic and angioplasty guiding catheters being used lately. The profile of balloons used is an additional factor for the same. The use of better coronary hardware and development of newer anticoagulants has significantly increased the spectrum for interventions. Vascular access site bleeding is one of the most feared complications particularly with the use of anticoagulants and platelet glycoprotein inhibitors.
Percutaneous coronary intervention can be performed by the following three routes: femoral, brachial or radial arteries. The vascular or bleeding risk associated with the femoral approach is reported upto 10% in some studies. Other complications include hematomas accompanied by significant blood loss, arterial pseudo aneurysms and arteriovenous fistulas. The trans-radial approach for coronary procedures is gaining fast acceptance. The interest in the trans-radial approach is increasing due to decreased associated vascular complications, convenience for the patients, earlier discharge, shorter stay in the hospital and early ambulation. Not only is it a safer technique, but it is also characterized by its high success rate, close to 90% in some populations.
Vascular complications are lesser in the trans-radial approach because of favorable anatomy, smaller size of the sheaths used and rapid hemostasis. The main complications for the approach are smaller radial artery that may not be accessed successfully and arterial occlusion post procedure. Radial artery is smaller in the Asian populations compared to West. Bleeding complications are lesser and easily controllable with the radial approach because of the easy compressibility of the radial artery. Another advantage is that no big nerves or veins are located in the vicinity of the artery making injury to such structures less likely. Also there are economic benefits to the approach as reflected by reduced hospital expenditures. Patients overwhelmingly prefer the trans-radial over the femoral approach.
Although trans-radial approach has a lot of benefits, it has a longer learning curve for the operator making it more challenging. It also limits the devices which are used in interventions like temporary pacemakers, intra-aortic balloon pumps and larger devices for coronary interventions. Also it may not always be the best choice in some patients who may have an anomalous palmer arch not providing sufficient blood supply to the hand in case of occlusion of radial artery.
Coronary catheterization is usually performed via the trans-femoral approach. Trans-radial access offers advantages in comparison with trans-femoral access, especially under conditions of aggressive anticoagulation and antiplatelet treatment in which bleeding complications at the femoral puncture site can result in increased morbidity and duration of hospitalization. Therefore, the rationale for the trans-radial approach is the intention to reduce access site bleeding complications, earlier ambulation, and improved patient comfort.
Trans-radial procedures have been demonstrated to be an effective and safe alternative to trans-femoral procedures. Safety of trans-radial coronary catheterization is mainly determined by the favorable anatomic relations of the radial artery to its surrounding structures, like no major veins or nerves located near the artery, hence minimizing the chance of injury of these structures. Superficial course of the radial artery gives the advantage of easy hemostasis by local compression. Thrombotic or traumatic arterial occlusion does not endanger the viability of the hand if adequate collateral blood supply from the ulnar artery is present. Multiple studies have demonstrated that bleeding complications after PTCA can be substantially reduced with trans-radial access. Furthermore, trans-radial primary success rates, even in high-risk groups, are similar to those from the femoral approach.
The aim of the study was to compare 30 days outcome between radial and femoral approaches in patients presenting with ST-segment elevation myocardial infarction and undergoing primary percutaneous coronary intervention.
This was a Prospective, randomized, open-label, double-arm, single center study, that was conducted on 120 STEMI patients; subdivided randomly into 2 groups. group A (60 patients) had Primary PCI through femoral access; group B (60 patients) had Primary PCI through radial access.
The main results of the study revealed that:
There was non-statistical significant difference between groups as regard each of age, sex, risk factors, previous myocardial infarction and previous PCI.
Total length of stents used in group (I) was ranged between 15–66 mm with mean± S.D. 40.78±15.476 mm while in group (II) was ranged between 21–67 mm with mean± S.D. 46.52±14.979 mm. There were statistically significant differences between groups
There was no statistically significant difference between groups as regard target lesion and No. of vessels treated.
There were no statistically significant differences between groups as regard Total fluoroscopy time.
Total contrast volume in group (I) was ranged between 210–717 ml with mean± S.D. 475.85±141.983 ml while in group (II) was ranged between 321–874 ml with mean± S.D. 612.52±156.767 ml. There were statistically significant differences between groups where P<0.001
Total procedure time in group (I) was ranged between 30–90 min with mean± S.D. 61.00±18.199 min while in group (II) was ranged between 45–90 min with mean± S.D. 72.58±13.639 min. There were statistically significant differences between groups where P<0.001.
Procedural success in group (I) show that 50(83.3%) had Procedural success while in group (II) 48(80.0%) had Procedural success. There was no statistically significant difference between groups.
Hospitalization time in group (I) was ranged between 3–8 days with mean±S.D. 5.35±1.686 days while in group (II) was ranged between 5–10 days with mean±S.D. 7.32±1.751 days. There were statistically significant differences between groups.
In-hospital mortality in group (I) show that all patients were survive while in group (II) only one patients were died. There was no statistically significant difference between groups
Urgent CABG in group (I) show that 2(3.3%) need Urgent CABG while in group (II) 4(6.7%) need Urgent CABG. There was no statistically significant difference between groups.
Complications in group (I) show that 9(15.0%) had Access site complication, 4(6.7%) had hematoma, 2(3.3%) had Pseudoaneurysm and 7(11.7%) had Radial artery spasm while in group (II) 6(10.0%) had Access site complication. There was no statistically significant difference between groups.
Based on our findings, we recommend that more emphasis should be put on rapid spread of expertise in trans-radial approach.