Conversion of dorsopalmar (modified distal) radial approach in primary percutaneous coronary intervention

• Akhramovich R.V.
• Semitko S.P.
• Azarov A.V.
• Azarov A.V.
• Melnichenko I.S.
• Chernysheva I.E.
• Tretyakov A.A.
• Ioseliani D.G.

Abstract

Objective. To study the incidence, causes and peculiarities of conversion of dorsopalmar (modified distal) radial approach in primary percutaneous coronary interventions in patients with acute coronary syndrome.

Patients and methods. The study included a total of 75 patients subjected to primary endovascular interventions using dorsopalmar (modified distal) radial approach. The operators’ experience performing these interventions was more than 100 punctures of the radial artery in distal portions. On POD 5–7, we assessed the diameter of the radial artery of the arm and dorsal surface of the palm.

Results. 4 (5.3%) patients required conversion due to radial artery spasm at the stage of puncture or guidewire insertion. The patients were subjected to the “traditional” radial approach through the proximal portion of the artery of the ipsilateral limb. There were no conversions to the femoral approach. The artery diameter in patients with approach conversion, measured on POD 5–7 was below the average value. The diameter of the radial artery on the forearm turned out to be significantly higher than that on the dorsal surface of the palm in all patients.

Conclusion. The dorsopalmar radial approach performed by experienced operators demonstrated compared with the classical transradial approach frequency of conversion. The main cause of conversion was radial artery spasm developing during puncture or guidewire insertion. The first-choice approach is conversion in the “classical” transradial approach on the ipsilateral limb. Ultrasonography of distal portions of the radial artery prior to endovascular intervention contributes to decreasing the frequency of conversions. The diameter of the artery at the site of the envisaged access less than 2 mm should be considered as a contraindication to the use of dorsopalmar distal radial approach.

Keywords:acute coronary syndrome; distal radial approach; modified distal radial approach; dorsopalmar radial approach; conversion of approach; radial artery; femoral approach

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