Abordagem transulnar para angioplastia coronária após tentativa de punção radial ipsilateral / Transulnar artery approach for coronary angioplasty after ipsilateral radial puncture attempt

A canulação percutânea da artéria radial é uma abordagem útil na realização de cateterismos coronários pela menor incidência de complicações e pelas vantagens, como deambulação precoce, maior conforto e menores custos. Nos pacientes em que essa técnica não é possível, a abordagem ulnar mostra-se uma alternativa exequível e segura. Neste artigo, os autores descrevem um caso de angioplastia coronária pela abordagem transulnar após insucesso na canulação da artéria radial ipsilateral, sem complicações isquêmicas, seguido de uma revisão da literatura sobre o tema.

Percutaneous cannulation of the radial artery is a useful approach in coronary catheterization due to the lower incidence of complications and advantages such as early ambulation, greater comfort and lower costs. In patients where this technique is not possible, the ulnar approach proved to be a feasible and safe alternative. In this article, the authors describe a case of coronary angioplasty by transulnar approach after failure of the ipsilateral radial artery cannulation without ischemic complications, followed by a literature review on the subject.

Estudo comparativo do uso do diltiazem como droga antiespástica em cinecoronariografia por via transradial / Comparative study of the use of diltiazem as an antispasmodic drug in coronary angiography via the transradial approach

OBJECTIVE: To evaluate the impact of the use, prior to the procedure, of injectable diltiazem to prevent complications. METHODS: Between September 2000 and July 2001, 50 patients underwent transradial coronary angiography and were randomized to receive placebo (GI) or diltiazem (GII) through a catheter inserted into the radial artery. All patients received isosorbide mononitrate. Ultrasound analyses of the radial artery were performed before examination, 30 minutes afterwards, and 7 days afterwards to evaluate the flow, the diameter, and the artery output. RESULTS: The radial artery diameter of GI was 2.4± 0.5 mm before the procedure and 2.3±0.5 mm after 30 minutes (NS), whereas in GII the diameter was 2.2±0.3 mm before the examination and 2.5±0.4 mm 30 minutes after it (P<0.001). Radial artery output in group 1 was 7.3±5.l2 mL/min before the examination and 6.1±3.5 mL/min 30 minutes after the examination (NS), and GII had an increase of 5.9±2.5 mL/min before examination to 9.05± 7.78 mL/min after the examination (P=0.04). Complications (spasm, occlusion, and partial obstruction) occurred in 4 patients (17.4 percent) in GI and did not occur in GII (P=0.04). CONCLUSION: The study suggests a decrease in vascular complications through the transradial access for coronary angiography with the use of diltiazem as an antispasmodic drug, resulting in the significant increase in the diameter of the radial artery and radial artery output