Author + information
- Received April 18, 2013
- Accepted May 9, 2013
- Published online November 1, 2013.
- Eltigani Abdelaal, MD,
- Cynthia Brousseau-Provencher, MD,
- Sarah Montminy, MS,
- Guillaume Plourde, MS,
- Jimmy MacHaalany, MD,
- Yoann Bataille, MD,
- Pierre Molin, MD,
- Jean-Pierre Déry, MD,
- Gérald Barbeau, MD,
- Louis Roy, MD,
- Éric Larose, MD,
- Robert De Larochellière, MD,
- Can M. Nguyen, MD,
- Guy Proulx, MD,
- Olivier Costerousse, PhD,
- Olivier F. Bertrand, MD, PhD∗ (, )
- Interventional Cardiologists at Quebec Heart-Lung Institute
- ↵∗Reprint requests and correspondence:
Dr. Olivier F. Bertrand, Interventional Cardiology Laboratory, Quebec Heart-Lung Institute, 2725, Chemin Ste Foy, Quebec City, Quebec, Canada G1V 4G5.
Objectives To study the causes of and to develop a risk score for failure of transradial approach (TRA) for percutaneous coronary intervention (PCI).
Background TRA-PCI failure has been reported in 5% to 10% of cases.
Methods TRA-PCI failure was categorized as primary (clinical reasons) or crossover failure. Multivariate analysis was performed to determine independent predictors of TRA-PCI failure, and an integer risk score was developed.
Results From January to June 2010, TRA-PCI was attempted in 1,609 (97.3%) consecutive patients, whereas 45 (2.7%) had primary TRA-PCI failure. Crossover TRA-PCI failure occurred in 30 (1.8%) patients. Causes of primary TRA-PCI failure included chronic radial artery occlusion (11%), previous coronary artery bypass graft (27%), and cardiogenic shock (20%). Causes for crossover TRA-PCI failure included: inadequate puncture in 17 patients (57%); radial artery spasm in 5 (17%); radial loop in 4 (13%); subclavian tortuosity in 2 (7%); and inadequate guide catheter support in 2 (7%) patients. Female sex (odds ratio [OR]: 3.2; 95% confidence interval [CI]: 1.95 to 5.26, p < 0.0001), previous coronary artery bypass graft (OR: 6.1; 95% CI: 3.63 to 10.05, p < 0.0001), and cardiogenic shock (OR: 11.2; 95% CI: 2.78 to 41.2, p = 0.0011) were independent predictors of TRA-PCI failure. Risk score values from 0 to 7 predicted a TRA-PCI failure rate from 2% to 80%.
Conclusions In a high-volume radial center, 2.7% of patients undergoing PCI are excluded from initial TRA on clinical grounds, whereas crossover to femoral approach is required in only 1.8% of the cases. A new simple clinical risk score is developed to predict TRA-PCI failure.
This study was conducted with internal funds and did not receive external sources of funding. Dr. Abdelaal is supported by the Laval University International Chair on Interventional Cardiology and Transradial Approach. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 18, 2013.
- Accepted May 9, 2013.
- American College of Cardiology Foundation