Factors Affecting Radial Artery Occlusion After Right Transradial Artery Catheterization for Coronary Intervention and Procedures.

Objective: To determine the factors influencing proximal radial artery occlusion (PRAO) right radial artery after coronary intervention. Methods: This is a single-center prospective observational study. A total of 460 patients were selected to undergo coronary angiography (CAG) or percutaneous coronary intervention (PCI) via the proximal transradial approach (PTRA) or distal transradial approach (DTRA). The 6F sheath tube were received by all patients. Radial artery ultrasound was performed 1 day before procedure and 1-4 days after procedure. Patients were divided into the PRAO group (42 cases) and the non-PRAO group (418 cases). General clinical data and preoperative radial artery ultrasound indexes of the two groups were compared to analyze related factors leading to PRAO. Results: The total incidence of PRAO was 9.1%, including 3.8% for DTAR and 12.7% for PTRA. The PRAO rate of DTRA was significantly lower than that of PTRA (p < 0.05). Female, low body weight, low body mass index (BMI) and CAG patients were more likely to develop PRAO after procedure (p < 0.05). The internal diameter and cross-sectional area of the distal radial artery and proximal radial artery were smaller in the PRAO group than in the non-PRAO group, and the differences were statistically significant (p < 0.05). Multifactorial model analysis showed that the puncture approach, radial artery diameter and procedure type were predictive factors of PRAO, and the receiver operating characteristic curve showed a good predictive value. Conclusion: A larger radial artery diameter and DTRA may reduce the incidence of PRAO. Preoperative radial artery ultrasound can guide the clinical selection of appropriate arterial sheath and puncture approach.

Comparison of distal transradial approach versus conventional transradial approach for coronary angiography and percutaneous coronary intervention: A prospective observational study.

Background: Compared with the conventional transradial approach (TRA), there are limited data on the efficacy and safety of the novel distal transradial approach (DTRA). This study aimed to verify the effectiveness and safety of the DTRA for percutaneous coronary angiography and intervention. Besides, we also try to highlight the potential of the DTRA in reducing radial artery occlusion (RAO), shorter time to hemostasis, and improved patient comfort. Methods: This single-center prospective observational study enrolled patients treated with DTRA (n = 527) in the first 9 months and with TRA (n = 586) in the next 8 months from May 2020 to December 2021. The primary endpoint was the proximal RAO rate at 30 days. Results: Baseline data were similar between the two groups. The proximal radial artery occlusion rate at 30 days [2.3% vs. 7.0%], the success rate of puncture [86.4% vs. 96.7%], the Numeric Rating Scale score [1.97 ± 1.89 vs. 4.61 ± 2.68], and the incidence of postoperative subcutaneous hematoma and finger numbness [3.4% vs. 8.2%, 2.7% vs. 4.4%] were lower. The puncture time [6.93 ± 7.25 min vs. 3.18 ± 3.52 min] was longer, and the time until radial compression device removal was shorter [CAG: 138.61 ± 38.73 min vs. 191.6 ± 61.22 min, PCI:221.46 ± 62.45 min vs. 276.28 ± 76.39 min] in the DTRA group than TRA group (all P < 0.05). Multivariate logistic regression analysis revealed that the DTRA (OR 0.231, 95% confidence interval [CI] 0.088-0.769, P = 0.001),BMI<18.5 kg/m2 (OR 2.627, 95% CI 1.142-4.216, P = 0.004), Diabetes mellitus (OR 2.15, 95%CI1.212-3.475, P = 0.014), RCD removal time (CAG,min) (OR 1.091, 95% CI 1.013-1.441, P = 0.035) and RCD removal time (PCI,min) (OR 1.067, 95% CI 1.024-1.675, P = 0.022) were the independent risk factors of RAO 1 month after intervention procedure. Conclusion: DTRA was found to a lower incidence of postoperative RAO and bleeding-related complications, shorter time to achieve hemostasis, and greater patient comfort.

Safety and feasibility of a 7F thin-walled sheath via distal transradial artery access for complex coronary intervention.

Background: Compared with traditional trans-radial artery access (TRA), there are limited data that can confirm the efficacy and safety of a 7F thin-walled sheath placed via distal TRA (dTRA) for percutaneous coronary intervention (PCI). Objective: This study aims to analyze the safety and efficacy of the placement of a 7F thin-walled sheath via dTRA for PCI. Methods: This was a single-center retrospective observational study in which 102 patients who received complex PCIs with a 7F thin-walled sheath placed via dTRA in the catheter room of our hospital from May 2020 to October 2021 were included. The basic information, puncture success rate, radial artery occlusion (RAO) rate, radial artery lumen diameter and area, surgical data, pain score, and complication rate were observed and recorded. Results: The puncture success rate was 90.2% in the 102 patients, and the success rate of the operation was 97.8% among 92 patients with a successful puncture. The PCIs for patients included emergency PCIs and all types of complex PCIs. Color Doppler ultrasound performed at 1 and 30 d after the procedure showed that the RAO rate was 2.2%, the distal RAO rate was 3.3%, the postoperative average pain score was 2.2 points, and there were five patients (5.4%) with local hematoma, all of which were grade 1-2. Radial artery spasm and nervous injury occurred in two patients (2.2%), and arteriovenous fistula occurred in one patient (1.1%). Radial artery perforation, radial artery dissection, pseudoaneurysm, and sheath kinking did not occur. Conclusion: The placement of a 7F thin-walled sheath via dTRA for PCI showed a high puncture and procedural success rate, a low postoperative RAO rate, and a low incidence of local hematoma and other complications. The placement of a 7F Glidesheath Slender® via dTRA for PCI is safe and feasible.

Analysis of the Risk Factors Related to the Success Rate of Distal Transradial Artery Access in Patients with Coronary Heart Disease.

Objective: The aim of this study was to explore the factors influencing the success rate of distal transradial access (dTRA) for coronary intervention. Methods: A total of 246 patients who underwent either coronary angiography or percutaneous coronary intervention in the Xuzhou Central Hospital were enrolled in this study. Access via the distal radial artery was the first choice for the procedure, and the success rate of this approach was recorded. All patients underwent color Doppler ultrasonography of the distal radial artery at the right anatomical snuff box in order to measure the artery diameter. The patients were divided into two groups depending on the success of the dTRA; 44 patients with unsuccessful punctures were assigned to the observation group and 202 patients with successful punctures acted as the control group. The basic clinical data of the two groups were recorded, and the differences between the two groups with respect to various indices were evaluated. Logistic regression analysis was carried out to explore the factors influencing the success rate of dTRA. Results: Of the 246 patients, dTRA was achieved in 202, giving a puncture success rate of 82.11%. Logistic regression analysis showed that the success rate of dTRA was positively correlated with the diameter of the distal radial artery (odds ratio [OR] = 3.381, P = 0.005) and hypertension (OR = 2.427, P = 0.016), and negatively correlated with female gender (OR = 0.429, P = 0.036) and diabetes mellitus (OR = 0.325, P = 0.002). Conclusion: The results of this study suggest that hypertension and distal radial artery diameter have a positive effect on the success rate of dTRA, while diabetes and female gender have a negative effect.

Effects of Early Intracoronary Administration of Nicorandil During Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction.

BACKGROUND: To determine whether nicorandil administration distal to the thrombus in the coronary artery during percutaneous coronary intervention (PCI) in acute ST-segment elevation myocardial infarction (STEMI) patients reduced the incidence of no-reflow phenomenon, reperfusion injury, and adverse events. METHODS: This randomised controlled trial involved 170 STEMI patients who underwent PCI. All patients underwent thrombectomy and tirofiban injection (10µg/kg) distal to the vascular lesion via a suction catheter, followed by nicorandil (84 patients; 2mg) or saline injection (86 patients; 2mL) at the same site. The primary endpoint (major adverse cardiac events, MACEs) was 6-month cardiovascular mortality or unplanned readmission rate due to worsening congestive heart failure. The secondary endpoints were thrombolysis in myocardial infarction (TIMI) grade, TIMI myocardial perfusion grade (TMPG), resolution of ST-segment elevation (defined as >50% decrease in ST elevation); and ventricular arrhythmias. RESULTS: Upon Kaplan-Meier analysis, freedom from MACEs was 92.9% in the nicorandil group and 81.4% in the placebo (p=0.026). The numbers of patients achieving TIMI grade 3 (95.24% vs. 86.05%; p=0.040) and TMPG 3 (94.05% vs. 83.72%; p=0.033) were greater in the nicorandil group than in the control group. Resolution of ST-segment elevation occurred in 84.52% and 68.60% patients in the nicorandil and control groups, respectively (p=0.014). Ventricular arrhythmias occurred in 5.95% and 16.28% patients in the nicorandil and control groups, respectively (p=0.032). CONCLUSIONS: Early administration of nicorandil distal to the vascular lesion during PCI in STEMI patients may reduce the incidence of reperfusion injury, and improve short-term clinical outcomes. TRIAL REGISTRATION NUMBER: NCT02435797.

Optical coherence tomographic analysis of drug-eluting in-stent restenosis at different times: A STROBE compliant study.

The imaging characteristics of drug-eluting in-stent restenosis (ISR) at different times varied; however, the mechanism had not yet been elucidated.To analyze the imaging characteristics of drug-eluting ISR at different time points by optical coherence tomography (OCT) and investigate the cause of the stent treatment failure.A total of 70 patients with drug-eluting ISR undergoing OCT were enrolled (intimal hyperplasia ≥50% of stent area) and implanted with drug-eluting stents. According to stent implantation time, the patients were divided into 2 groups: early in-stent restenosis group (E-ISR group) (group A, n = 35, stent age ≤12 months) and late in-stent restenosis group (L-ISR group) (group B, n = 35, stent age ≥24 months). A qualitative analysis of the restenosis tissue included the nature of restenosis tissue (homogeneous and heterogeneous), neoatherosclerosis, thin-cap fibroatheroma (TCFA), and microvessels.The ratio of ≥75% cross-sectional area stenosis between the L-ISR and E-ISR groups was (60.00% vs 34.28%, P < .05). The heterogeneous intima, neoatherosclerosis, TCFA, and microvessels were more prevalent in the L-ISR group as compared to the E-ISR group (71.43% vs 45.71%, P < .05; 48.57% vs 22.86%, P < .05; 25.71% vs 5.71%, P < .05; 22.86% vs 2.86%, P < .05, respectively).The morphological characteristics of L-ISR were significantly different from those in the E-ISR; the former was closer to the atherosclerotic plaque, which provided a new approach for the treatment of drug-eluting ISR.

Effect of nicorandil administration on myocardial microcirculation during primary percutaneous coronary intervention in patients with acute myocardial infarction.

INTRODUCTION: Prevention of the no-reflow phenomenon has a crucial role in primary percutaneous coronary intervention (P-PCI) procedures. AIM: To assess the effects of early intracoronary administration of nicorandil (NIC) during P-PCI on myocardial microcirculation in patients with acute myocardial infarction (AMI). MATERIAL AND METHODS: A total of 120 patients with first acute anterior wall ST segment elevation myocardial infarction who underwent P-PCI were randomly divided into two groups: the NIC group (A, n = 60) and the placebo group (B, n = 60). Before stent placement, NIC or normal saline was injected using a guiding catheter. The thrombolysis in myocardial infarction (TIMI) grade, TIMI myocardial perfusion grade (TMPG), resolution of ST segment elevation (defined as > 50% decrease in ST elevation) 1 h after surgery, and 99Tcm-methoxyisobutyl isocyanide (MIBI) rest myocardial perfusion imaging (MPI) via single-photon emission computed tomography (99Tcm-MIBI SPECT) findings 10 days after surgery were compared between the two groups. RESULTS: The number of patients who achieved TIMI grade 3 (96.67% vs. 86.67%; p = 0.047) and TMPG 3 (95% vs. 83.33%; p = 0.040) was higher in the NIC group than in the placebo group. Resolution of ST segment elevation occurred in 95% and 81.67% of the patients in the NIC and placebo groups, respectively (p = 0.023); the MPI score of the two groups was 4.1 ±1.89 and 7.3 ±2.65, respectively (p = 0.014). CONCLUSIONS: Early coronary administration of NIC can significantly reduce the damage in the myocardial microcirculation caused by P-PCI and the myocardial infarct size in patients with AMI.

Spontaneous hematoma in the setting of dual anti-platelet therapy with ticagrelor: A case report.

A 69-year-old male patient was admitted to hospital because a lump was discovered, accompanied with pain lasting 5 h under his right scapula. Two months earlier, he had undergone a double-stent insertion operation due to lesions on the end of the left main coronary artery, the opening of left circumflex artery, and the opening of the anterior descending branch. After the operation, he was administered with dual anti-platelet therapy (DAPT) with aspirin and ticagrelor and was diagnosed with hematoma under his right scapula through ultrasonic inspection. It was established that no other factor, except DAPT, was responsible for his spontaneous hematoma.

Birth intervention and non-maternal infant-handling during parturition in a nonhuman primate.

Direct intervention in infant delivery by non-parturient individuals is a rare phenomenon in nonhuman primates. In contrast, birth assistance by other individuals, or the practice of midwifery, is universal among human societies and generally believed to be a behavior unique to our species. It has been proposed that the enlarged head of the human fetus and the relatively narrow birth canal constrained by bipedalism has made human parturition more difficult than in nonhuman primates, and these anatomic challenges have led to the rotation of the fetus in the birth canal and an occiput anterior (i.e., backward-facing) orientation of emergence. These characteristics have hindered the mother's ability to self-assist the delivery of the infant, therefore necessitating assistance by other individuals or midwives for successful birth. Here we report the first high-definition video recordings of birth intervention behavior in a wild nonhuman primate, the white-headed langur (Trachypithecus leucocephalus). We observed that while a primiparous female gave birth to an infant in an occiput posterior (i.e., forward-facing) orientation, a multiparous female intervened in the delivery by manually pulling the infant out of the birth canal and cared for it in the following hours. Our finding shows extensive social interactions throughout parturition, and presents an unequivocal case of non-maternal intervention with infant birth in a nonhuman primate.

Mechanism on microwave-assisted acidic solvolysis of black-liquor lignin.

Microwave-assisted degradation of black-liquor lignin with formic acid was studied, concerning the product yield and distribution of phenolic compounds against reaction temperature (110-180°C) and reaction time (5-90 min). The liquid product consisting of bio-oil 1 and bio-oil 2, achieved the maxima yield of 64.08% at 160°C and 30 min (bio-oil 1: 9.69% and bio-oil 2: 54.39%). The chemical information of bio-oil 1 and bio-oil 2 were respectively identified by means of Gas Chromatography-Mass Spectrometer (GC-MS) and Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), while the solid residue was analyzed by Gel Permeation Chromatography (GPC) and Fourier Transform Infrared Spectroscopy (FTIR). A possible mechanism was proposed for the microwave-assisted acidic solvolysis of lignin, specifying the kinetic relationship among the primary cracking of lignin, repolymerization of the oligomers and formation of solid residue.