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class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Radial access in cardiac catheterization: Can we do even better?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "415" "paginaFinal" => "416" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Marco Costa" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Marco" "apellidos" => "Costa" "email" => array:1 [ 0 => "marcocostacard@sapo.pt" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Cardiologia, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Acesso radial no cateterismo cardíaco: podemos ainda fazer melhor" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Radial access for cardiac catheterization was first described by Radner in 1948,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> but it was not until 1989 that Campeau published the first series of 100 patients who underwent coronary angiography by a radial approach,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a> while in 1993 Kiemeneij and Laarman reported the first three cases in which stents were placed by this route.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> At that time there was little confidence in the radial approach, due to the high failure rate and frequent need for crossover to femoral access, and so the femoral approach continued to be preferred in most centers. One of the main reasons for the poor results of radial access was the inappropriate way in which operators accustomed to the femoral approach handled radial puncture and catheterization. Another important factor was the lack of material such as puncture needles, hydrophilic introducers and diagnostic and interventional catheters designed specifically for radial access, which only came on to the market some years later.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the last 10 years there has been a considerable increase in the volume of percutaneous interventions using the transradial route, and it is now the first choice for coronary angiography and percutaneous coronary interventions in Europe and in many other countries. In Portugal, radial access went from 4.1% of procedures in 2004 to 57.9% in 2013,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> and according to the National Registry of Interventional Cardiology (RNCI) the figure was 75.5% in 2016.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The main advantage of the radial route is its safety, particularly in frail patients and those under aggressive antithrombotic therapy, such as in acute coronary syndromes.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">7,8</span></a> An additional benefit is shorter hospital stay and early mobilization, raising the possibility of performing interventions on an outpatient basis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Several studies have shown the advantages of radial access in ST-elevation myocardial infarction, reporting fewer bleeding complications and lower mortality, and this approach is therefore recommended in the current European Society of Cardiology guidelines.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">However, catheterization by the radial route presents certain challenges, even for experienced operators, including the tortuosity of the right subclavian artery (which can lead to excessive manipulation and even twisting of the catheter), poor support in the right coronary artery for conventional catheters designed for femoral access, and radial artery spasm during puncture or the procedure.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The recent development of “7-in-6” sheaths (a 6F sheath with an internal lumen equivalent to 7F) enables more complex angioplasties to be performed, including use of the Rotablator, treatment of chronic occlusions, and simultaneous implantation of two stents to treat bifurcations.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The success rate of radial puncture is directly related to the experience of the operator and of the center, but is also affected by the type of patient and clinical presentation. All these factors can help increase the number of patients who can be treated by the radial approach and thereby potentially reduce the number of adverse events.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The article by Ünal et al.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> published in this issue of the <span class="elsevierStyleItalic">Journal</span> reports a randomized trial comparing two strategies for reducing radial artery spasm during arterial puncture for catheterization via this artery. A total of 90 patients referred for radial artery catheterization were randomized to low-dose subcutaneous nitroglycerin plus diltiazem or to manual heating, in which the temperature of the puncture site was raised by direct contact with the operator's hand for 3 min. The study endpoint was puncture score (between 1 and 4, corresponding to ease of puncture), which was lower in the patients undergoing local heating before puncture. Although this was not an objective of the study, it would be interesting to know whether this strategy helped prevent arterial spasm after puncture, during catheterization.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Low temperatures stimulate the adrenergic nervous system, leading to vasoconstriction, which is exacerbated by the administration of lidocaine. It is logical to assume that this process could be counteracted by increasing local temperature. Improving the effectiveness of the initial puncture shortens the procedure and is less traumatic for the patient, as well as probably reducing arterial spasm during the rest of the exam or intervention. No direct relation has yet been proven between arterial spasm and radial occlusion, but it is plausible that an artery whose caliber has been reduced by spasm should be more liable to damage by sheaths and catheters than one without spasm and that has been easily punctured at the first attempt. The administration of heparin, the use of smaller sheaths, and shorter compression time have been shown to be associated with a reduction in radial occlusion in follow-up.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> This would be an important endpoint in future studies, since a significant number of patients could benefit from a range of procedures using radial access.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Finally, it should be noted that this is the first trial on the Balbay maneuver, which should ideally be validated in a larger sample, preferably in multiple centers.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Costa M. Acesso radial no cateterismo cardíaco: podemos ainda fazer melhor. Rev Port Cardiol. 2017;36:415–416.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thoracal aortography by catheterization from the radial artery; preliminary report of a new technique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. 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Year/Month | Html | Total | |
---|---|---|---|
2024 November | 11 | 5 | 16 |
2024 October | 44 | 28 | 72 |
2024 September | 54 | 23 | 77 |
2024 August | 47 | 27 | 74 |
2024 July | 44 | 32 | 76 |
2024 June | 42 | 26 | 68 |
2024 May | 30 | 28 | 58 |
2024 April | 38 | 21 | 59 |
2024 March | 27 | 20 | 47 |
2024 February | 24 | 17 | 41 |
2024 January | 21 | 31 | 52 |
2023 December | 21 | 28 | 49 |
2023 November | 26 | 17 | 43 |
2023 October | 21 | 13 | 34 |
2023 September | 21 | 23 | 44 |
2023 August | 19 | 14 | 33 |
2023 July | 12 | 11 | 23 |
2023 June | 21 | 14 | 35 |
2023 May | 44 | 22 | 66 |
2023 April | 25 | 3 | 28 |
2023 March | 38 | 27 | 65 |
2023 February | 28 | 16 | 44 |
2023 January | 23 | 15 | 38 |
2022 December | 34 | 20 | 54 |
2022 November | 49 | 23 | 72 |
2022 October | 33 | 15 | 48 |
2022 September | 28 | 25 | 53 |
2022 August | 28 | 32 | 60 |
2022 July | 40 | 34 | 74 |
2022 June | 23 | 25 | 48 |
2022 May | 18 | 31 | 49 |
2022 April | 23 | 25 | 48 |
2022 March | 26 | 32 | 58 |
2022 February | 23 | 23 | 46 |
2022 January | 27 | 27 | 54 |
2021 December | 17 | 35 | 52 |
2021 November | 37 | 36 | 73 |
2021 October | 29 | 35 | 64 |
2021 September | 22 | 23 | 45 |
2021 August | 30 | 31 | 61 |
2021 July | 22 | 15 | 37 |
2021 June | 23 | 20 | 43 |
2021 May | 23 | 46 | 69 |
2021 April | 40 | 21 | 61 |
2021 March | 63 | 25 | 88 |
2021 February | 52 | 14 | 66 |
2021 January | 25 | 10 | 35 |
2020 December | 33 | 9 | 42 |
2020 November | 25 | 13 | 38 |
2020 October | 17 | 13 | 30 |
2020 September | 59 | 12 | 71 |
2020 August | 20 | 9 | 29 |
2020 July | 42 | 10 | 52 |
2020 June | 26 | 3 | 29 |
2020 May | 40 | 6 | 46 |
2020 April | 31 | 10 | 41 |
2020 March | 44 | 10 | 54 |
2020 February | 41 | 18 | 59 |
2020 January | 23 | 5 | 28 |
2019 December | 32 | 4 | 36 |
2019 November | 27 | 6 | 33 |
2019 October | 51 | 4 | 55 |
2019 September | 21 | 10 | 31 |
2019 August | 30 | 5 | 35 |
2019 July | 39 | 9 | 48 |
2019 June | 20 | 5 | 25 |
2019 May | 33 | 3 | 36 |
2019 April | 19 | 15 | 34 |
2019 March | 70 | 11 | 81 |
2019 February | 57 | 9 | 66 |
2019 January | 82 | 5 | 87 |
2018 December | 84 | 10 | 94 |
2018 November | 105 | 9 | 114 |
2018 October | 233 | 13 | 246 |
2018 September | 56 | 16 | 72 |
2018 August | 32 | 7 | 39 |
2018 July | 28 | 8 | 36 |
2018 June | 39 | 8 | 47 |
2018 May | 79 | 16 | 95 |
2018 April | 70 | 12 | 82 |
2018 March | 98 | 13 | 111 |
2018 February | 88 | 3 | 91 |
2018 January | 52 | 15 | 67 |
2017 December | 110 | 12 | 122 |
2017 November | 72 | 18 | 90 |
2017 October | 28 | 19 | 47 |
2017 September | 44 | 23 | 67 |
2017 August | 63 | 23 | 86 |
2017 July | 86 | 33 | 119 |
2017 June | 28 | 13 | 41 |