P6370BUDA SNUFF-BOX study: Ultrasound guided distal transradial access for coronary angiography and angioplasty using 5F guiding or 6F sheathless guiding system

Abstract

Background: To demonstrate the feasibility and safety of the distal transradial approach (snuff box) for coronary angiography and interventions. Methods: The clinical, angiographic and ultrasonography data of 132 consec-utive patients with symptomatic coronary artery stenosis between 2017.01 and 2017.12 were evaluated in a pilot study. The distal radial artery was investigated with a Doppler ultrasound and the puncture was made by ultrasound guidance. At the first postoperative day, both radial arteries were examined by vascular ul-trasound. We have used 5F Terumo sheath for coronary angiography and af-ter diagnostic angiography we have used 5F or 6.5 sheathless guiding for the intervention. Sheathless guiding was used for rotational atherectomy, left main and complex bifurcation intervention and for CTO recanalisation. We have inves-tigated the technical success of the procedure, the rate of MACCEs and the rate of access site complications. Results: The ultrasound guided radial artery puncture and the procedure were successful in all cases (132/132). The cross-over rate to alternative access site was 0%. The diagnostic angiography was finished in all cases (100%). PCI was performed in 100 cases with a 6.5F sheathless guiding in 20 cases and through a 5F guiding in 80 cases. Procedural success was achieved in 99 cases (99%). Mean contrast consumption was 98.21 [86.1-110.3] ml, DAP was 32.89 [26.13-39.65] Gy cmsup2/sup, fluoroscopy time 7.7 [6.36-9] minutes for PCI. The size of the radial artery in the snuff box and conventional punture area was 2.1±0.5 vs. 2.27±0.6 mm (p<0.001). No radial artery occlusions at the site of the forearm were encountered. Minor forearm haematoma was found in two patients (1.5%). The incidence of MACCEs at two months follow up was 0.75%. Conclusion: Ultrasound guided distal transradial access in the snuff box area is safe and effective and the rate of radial artery occlusion is extremely low.