Evolving Techniques to Improve Radial/Ulnar Artery Access: Crossover Rate of 0.3% in 1,000 Consecutive Patients Undergoing Cardiac Catheterization and/or Percutaneous Coronary Intervention via the Wrist.

ABSTRACT

OBJECTIVES: To evaluate several techniques to reduce crossover rates in wrist artery access in patients undergoing cardiac catheterization (CC)/percutaneous coronary intervention (PCI). BACKGROUND: Palpation-guided radial artery (RA) access for CC/PCI is associated with a crossover rate to femoral artery (FA) access in up to 7.6%. METHODS: A retrospective analysis of a single-center consecutive series of patients undergoing CC/PCI was performed. After one 0.4 mg sublingual NTG tablet, the RA and UA were assessed by intraprocedural ultrasound imaging to select the more suitable artery for ultrasound-guided access. A tight "knuckle wire" technique using a 0.014 inch Prowater® coronary wire was used to negotiate RA, UA, and brachial loops when a standard wire would not easily cross. Crossover was defined as any reason requiring secondary arterial access from the contralateral arm or FA. RESULTS: A total of 1,162 consecutive patients treated from January 2012 to April 2014 were evaluated. Primary arterial access from the wrist (RA/UA) was performed in 1,000 (86.1%, RA 977, UA 23) and planned FA access in 162 patients (13.9%). The overall crossover rate from the wrist was 0.3% as a result of 3/1,000 patients requiring crossover to the contralateral arm (radial loop n = 1, brachial loop n = 1, vessel injury n = 1). No crossover to the FA was necessary. All primary FA access sites were successful. CONCLUSIONS: Crossover rates of primary wrist artery access to alternative arterial access for CC/PCI can be reduced to less than 1% applying the aforementioned techniques.