2. The Case
n 69 years old men
n Hypertension, Dyslipidemia
n CABG (2000): LIMA to LAD, Free RIMA “T” graft to OM,
SVG to PDA
n On Admission:
n STEMI - Inferior wall.
n Ischemic time: 10 hours
n Ongoing chest pain (2/10)
n ECG: Q waves & minimal ST elevation
n Killip I
7. Mechanism and Predictors of Failed Transradial
Approach for Percutaneous Coronary
Interventions
n Transradial Failure: 4.7% (98/2100)
n Inabilityto advance guide catheter to ascending
aorta in 50 (51%).
n Inadequate guide catheter support in 35 (36%)
n Unsuccessful radial artery puncture in 13
(13%) patients
J Am Coll Cardiol Intv, 2009; 2:1057-1064,
8. Mechanism and Predictors of Failed Transradial
Approach for Percutaneous Coronary
Interventions
aortic root dilation, calcification, Diffuse atherosclerosis of both great vessels
J Am Coll Cardiol Intv, 2009; 2:1057-1064,
9. Patient Evaluation
n Number and the type of graft
n Forearm Circulation
n Allen’stest
n Reverse Allen’s test
10. Homolateral IMA Graft
n Reduction* of
n Time for IMA cannulation
n Time for IMA assessment
n Number of projections needed for visualization
Burzotta F. J Cardiov.Medic 2008*
14. Efficacy and Safety of the
Transradial Approach for
SaphenousVein Graft PCI
Cafri C. et al.
Soroka Medical Center
Faculty of Health Sciences. Ben Gurion University
Beer Sheva. Israel
15. Aims
To compare the efficacy and
safety of transradial and
transfemoral approaches for
PCI to saphenous vein grafts.
16. Methods
Retrospective observational trial, single center
n Population:
n Inclusion criteria: patients undergoing PCI to SVG
(2005-2009)
n 140 transradial pts (75 ± 12) vs. 70 transfemoral pts (69 ± 12)
n Exclusion criteria: None
n Data: Demographics, clinical & angiographic
n End point :
n Angiographic success
n Bleeding complication rate
19. Efficacy and Safety of the Transradial
Approach for Saphenous Vein Graft
intervention.
90% 81% Soroka Medical Center
Radial (*140)
Femoral(*70 )
21%
14%11%
6% 9% 7%
Distal No reflow Success Bleeding
Protection
20. Conclusions
n Transradial PCI of SVGs is as effective as
the transfemoral approach and is associated
with fewer bleeding complications.
n Our data supports a broader utilization of
the transradial approach for SVG
intervention.