Transradial approach for percutaneous transluminal angioplasty and stenting in the treatment of chronic mesenteric ischemia.

Chronic mesenteric ischemia (CMI) occurs in the presence of slowly progressive, long-standing stenoses of the visceral arteries secondary to atherosclerosis. Angioplasty and stenting are emerging as therapeutic alternatives to surgery in treating CMI. The transradial approach is an attractive alternative access for performing stenting in CMI at improved safety and ease. A case of CMI treated with stenting of the visceral arteries by both transradial and femoral approaches is presented here. The main difficulty in accessing the celiac and mesenteric arteries through the femoral approach is the angle between the aorta and these vessels, which often leads the operator to use multiple catheters. The main advantage of the radial approach (as well as the brachial one) is that it allows easy coaxial alignment of the catheter with the artery. The main problem is the inadequate length of the currently available catheters. The radial approach eliminates the risk for vascular complications and permits early ambulation.

Primary angioplasty in CADASIL.

We report an acute coronary event in a young patient suffering from cerebral autosomal dominant arteriopathy with sub-cortical infarcts and leucoencephalopathy (CADASIL) successfully treated by primary angioplasty and direct stenting. Coronary involvement and pathophysiology of this genetic disorder is discussed.