ABSTRACT
BACKGROUND: The distal radial represents an evolution of the standard radial approach. Distal radial arterial access (DRA) in the so-called "anatomical snuffbox" is technically more difficult but offers potential advantages for patients. Moreover, the use of the distal radial would preserve the proximal radial from the risk of arterial occlusion after interventional procedures performed through the radial artery. METHODS: We enrolled 100 consecutive elective patients undergoing cardiac catheterization (diagnostic or procedural). Arterial access to the distal radial was entirely managed by nursing staff supervised by the interventional cardiologist. In this single-centre single-operator experienced study, the same nurse operator performed puncture, wiring, and sheath advancement. RESULTS: The technical feasibility was 89% and the failure rate occurred in the first 50 cases as evidenced by the learning curve. There were no major complications and the rate of minor complications is in line with that of the radial literature. BMI (OR 1.19; 95% CI: 1.03-1.38), non-radial dominance (OR 3.5; 95% CI: 1.04-12.3) and operator's experience (OR 0.59; 95% CI: 0.35-0.99 for every 20 consecutive cases performed) were associated with DRA failures. CONCLUSIONS: The experience is encouraging and beneficial for all staff and patients with a high percentage of technical success and few mild complications.
Subject(s)
Learning Curve , Percutaneous Coronary Intervention , Humans , Nurse's Role , Radial Artery/surgery , Wrist , Percutaneous Coronary Intervention/adverse effectsABSTRACT
Vibsatin A is a new neurotrophic vibsane-type diterpenoid comprising a bridged bicyclo[4.2.1]nonane skeleton. Inspired by Sawamura's works, we generated the bicyclic backbone through a Conia-ene-derived 7-exo-dig cyclization from an enantiomerically enriched TIPS-based silyl enol ether. The reaction, catalyzed by a sensitive gold(I) complex, was efficiently performed on a large scale by glovebox free techniques. Furthermore, the shape of this system was exploited for subsequent installation of all of the stereogenic centers.
ABSTRACT
A formal [3+2] cyclization mediated by silver(I) oxide and 1,8-diazabicyclo[5.4.0]undec-7-ene (DBU) is described herein. Through a broad variety of carbonyl compounds, this system can promote cyclization reactions with high yield (up to 85 %) and diastereoselectivity (up to 95:5) for a straightforward access to complex and congested dihydrofuran derivatives in one step under mild conditions. Based on DFT studies, the proposed mechanism would involve an allenyl silver intermediate.
