Author + information
- Andrea Santucci, MD and
- Marco Valgimigli, MD, PhD∗ ()
- ↵∗Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland
We enjoyed reading the case report by Singh et al. (1) reporting on a vascular complication following transradial access (TRA) in a middle-age woman requiring percutaneous coronary intervention after thrombolysis.
Notably, the transradial procedure was successfully completed and no site-access crossover was needed, thus minimizing the well-known access-site bleeding liability shortly after fibrinolytic administration, as previously shown in the context of the ASSENT-4 PCI (Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention) trial (2). This case emphasizes once more that evaluating ulnar patency prior to percutaneous coronary intervention with Allen’s test (AT) neither prevents nor reduces the risk of ischemic hand events, which, while extremely rare, can occur irrespective of whether ulnar collateral circulation is patent before the procedure.
In the RADAR (Should Intervention Through Radial Approach be Denied to Patients With Negative Allen’s Test Results) study we evaluated the safety and feasibility of TRA in patients with abnormal or intermediate AT results compared with those with normal AT results, measuring lactate levels, plethysmographic readings, and angiographic frame count to assess ulnar flow (3). No hand ischemic complication occurred in the 2 groups; likewise, lactate level, handgrip strength, and discomfort level reported by the patients were similar, with a decrease in post-test ulnar frame count among those with abnormal AT, indicating an enhanced ulnar flow.
We therefore believe that the assessment of ulnar circulation patency should not be evaluated prior to TRA as this may lead to avoid TRA in patients who could safely receive it. The MATRIX (Minimizing Adverse haemorrhagic events by TRansradial access site and systemic Implementation of AngioX) trial was the only randomized controlled study so far performed not mandating the performance of AT prior to TRA: importantly, no ischemic complication has been observed due to TRA catheterization in 8,404 patients (4).
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
- Singh K.,
- Abunassar J.,
- So D.Y.
- Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention (ASSENT-4 PCI) investigators
- Valgimigli M.,
- Campo G.,
- Penzo C.,
- et al.