Journal of Invasive Cardiology

Abstract: Anatomic variations during transradial (TR) procedures are relatively common and represent a significant cause of technical failure, even for experienced radial operators. In this study, we present an interesting alternative technique to overcome these anatomical anomalies. A significant amount of TR procedures in various and challenging anatomical conditions were successfully completed with the use of a 0.014˝ hydrophilic coronary guidewire.

J INVASIVE CARDIOL 2012;24(6):290-293

Key words: transradial access, radial approach, coronary wire

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In recent years, the transradial (TR) approach has gained popularity and is increasingly used by many operators as the preferred access route for percutaneous coronary intervention (PCI). Compared to a transfemoral (TF) approach, the TR approach has been shown to reduce vascular complications,^1-3 to promote early ambulation4 and to shorten hospital stay.⁵ However, in 1%-5% of TR procedures, technical failure occurs.^6-10 This is mainly caused by the presence of upper-limb arterial anatomic variations.^9,10 After successful radial sheath insertion, these variations can cause difficult advancement of a standard (non-hydrophilic) guidewire or catheter, and a retrograde arteriography is recommended to detect underlying anatomical anomalies. Generally, a hydrophilic-coated 0.035˝ guidewire is then used to attempt to cross the anatomical anomaly. If this conventional approach fails, most operators will change to another access route, such as the contralateral radial artery, femoral arteries, or even the homolateral ulnar artery,¹¹ increasing procedural time and patient discomfort. Compared to a 0.035˝ hydrophilic guidewire, a 0.014˝ coronary guidewire is thinner and more steerable. In this study, we demonstrate the advantage of a hydrophilic coronary guidewire in various and challenging anatomical conditions during TR procedures.

Methods

Patient selection. All TR cases, performed by the authors between January 2010 and July 2011, were analyzed retrospectively. In this study, a case was used if anatomical variations of the radial artery were confirmed by angiography, and the following two conditions were met: (1) failure to overcome this variation with the use of a 0.035˝ hydrophylic-coated guidewire; and (2) subsequent attempt with a 0.014˝ hydrophilic coronary guidewire.