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Feasibility of Percutaneous Coronary Intervention Via Transulnar Artery Approach in Selected Patients with Coronary Hear

Feasibility of Percutaneous Coronary Intervention Via Transulnar Artery Approach in Selected Patients with Coronary Heart Disease. Xianghua Fu, MD, PhD et al. Center of Interventional Cardiology, the 2 nd Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei,China.

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Feasibility of Percutaneous Coronary Intervention Via Transulnar Artery Approach in Selected Patients with Coronary Hear

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  1. Feasibility of Percutaneous Coronary Intervention Via Transulnar Artery Approach in Selected Patients with Coronary Heart Disease Xianghua Fu, MD, PhD et al Center of Interventional Cardiology, the 2nd Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei,China

  2. Background • Advantages of transradial intervention : -earlier ambulation -less complications -shorter hospital stay and lower cost • Unfeasible for TRI(10-30%) : -anatomic variation -malformation -puncture trouble : spasm, tortuous, thin,calcification, etc. -used for other purpose (graft, etc.)

  3. Dr. Terashima et al (2000): 7/9 cases of ulnar artery for angiography How about PCI via ulnar artery access? Feasibility? Easy or difficult? Safety? Complication?

  4. Objective • To explore the clinical feasibility of percutaneous coronary intervention via transulnar artery approach (TUI)

  5. Enrolled Patients • Total patients(2001-2003): 40 (Male 34;Female,6) from 482 PCI patients with CHD. • Age : 41-79 years old • Clinical diagnosis: • AMI(7-14d): 12 patients • OMI: 7 patients • UAP: 21 patients (Including 2 cases of restenosis after stent) • All of them gave written informed consent approved by the academic committee of The 2nd hospital of HBMU

  6. Reason of transulnar PCI • Tortuous/thin radial artery or failured radial artery puncture : 30 patients • Radial artery was used previously (angiography/PCI) : 8 patients • Abnormality of radial artery : 2 patients

  7. Ulnar Artery v.s Radial Artery - Diameter: UA >RA - Allen’s test time: UA<RA, both sides positive - Pulsation: UA>RA - Puncture feeling: ulnar access may be easier.

  8. Echo/Doppler : diameter of ulnar artery is larger than that of radial artery, UA/RA Ratio is 1.35

  9. Devices • All same as with transradial PCI • 21G（8#）naked needle（Cordis，USA） • 0.019 inch hydrophilic guidewire（Cordis，USA） • 6F radial special sheath（Cordis，USA） • 4F angiograph catheter (Cordis, USA) • 6F guiding catheter: -LCA ：XB-LAD3.5 EBU3.5 XB3.5 JL3.5 -RCA ：ART JR4.0 ZUMA

  10. Procedure • Puncture site: 3 cm up the right wrist with the most powerful pulsation of ulnar artery • Puncture angle: 45º along the axis of vessel • Prevention of ulnar artery spasm: nitroglycerin, verapamil , lidocaine and dilthiazem ,or combinted dual agents by intra-sheath for some patients • Removal artery sheath: without ceasing heparin infusion • Management of puncture site: 6 hrs compression with gradual release of pressure • Ambulate immediately if patients condition permit

  11. TRU-PCI

  12. Clinical Outcome • First time success rate for puncture : 87.5% (35 patients),the rest ( 5 patients) : 2-4 times • Forty-eight lesions of 42 vessels were angioplasticied successfully • The average procedure duration of manipulation : 56.6 min • Ulnar artery hemodynamics (flow velocity, ulnar blood pressure) : no difference before and after the procedure • One month follow-up : no significant difference before and after transulnar PCI

  13. UA BP (mmHg) Vs max (cm/s) RI Pao2 (mmHg) So2 % Pre-PCI 136±33/60 ±5 51.4±7.03 0.80±0.05 99.1±1.83 95.5±1.70 Post-PCI 131±28/59 ±4 48.6±7.14 0.82±0.03 97.6±1.12 95.0±1.51 Comparison of UA hemodynamic parameterbefore and after PCI operation UA: ulnar artery BP: blood pressure Vs: blood velosity RI: resistance index Pao2: oxygen pressure So2: oxygen saturation

  14. vessel comparison of UA and RA before and after PCI * p<0.05 UA vs RA before PCI # p<0.05 UA vs RA after PCI

  15. Complications -No serious complication -No ulnar nerve damage -No ulnar artery occlusion -No A-V fistula -No pseudoaneurism -Mild complications -Slight haematoma: 2 patients

  16. Summary 1.PCI by ulnar artery approach has been successfully performed in forty patients with difficulty to perform TRI • Possible consideration for transulnar artery PCI: • Transradial access PCI with difficulty but dual sides Allen’s test positive • The pulsation of ulnar artery is stronger than that of radial artery c. The diameter of ulnar artery is larger than that of radial artery (≥2.5mm and ≥4.5mm2 )

  17. Conclusions and Clinical Experience • The outcome of our clinical practice demonstrated that transulnar PCI is practical, safe and beneficial for the patients with TRI difficulty, but more clinic practice will be need • More patients to reach threshold for trans-forearm artery approach PCI • More practice for skill performance

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