ADVERTISEMENT
Ask the Expert
A Q&A for Cath Labs with Physicians Performing Radial Access
August 2010
Does your cath lab do acute myocardial infarction patients via the radial approach, and does it interfere with the door-to-balloon time?
Excellent question. At our facility, we prefer to do all ST-elevation myocardial infarctions (STEMIs) via the transradial approach. As you know, STEMIs represent a subset of patients in which revascularization is very time-sensitive issue and these patients often require potent adjunctive anticoagulation therapy. Therefore, they are at increased risk for bleeding complications, particularly of the access site. Data from clinical trials has demonstrated that the radial approach is associated with lower bleeding complications in all subsets of patients (Figure 1). In addition, bleeding increases mortality, which is why the transradial approach is the default method for the majority of our STEMIs. I will share an acute myocardial infarction case using the radial approach. An 83-year-old male presented to the ED with left shoulder discomfort and intermittent nausea. He had ST elevation in lead II, III, and aVF. A Q3.5 guide was used to engage the left system. We then passed a balance wire and used an Export Aspiration Catheter (Medtronic, Minneapolis, MN) to perform mechanical thrombectomy. We used a double bolus of eptifibatide (Integrilin) and heparin. The door-to-balloon time was 60 minutes. As shown here, it is indeed possible to do a STEMI case via a radial approach, as long as you have an experienced team and interventionalist (this case was done by Dr. Zaheed Tai at Winter Haven Hospital).
Excellent question. At our facility, we prefer to do all ST-elevation myocardial infarctions (STEMIs) via the transradial approach. As you know, STEMIs represent a subset of patients in which revascularization is very time-sensitive issue and these patients often require potent adjunctive anticoagulation therapy. Therefore, they are at increased risk for bleeding complications, particularly of the access site. Data from clinical trials has demonstrated that the radial approach is associated with lower bleeding complications in all subsets of patients (Figure 1). In addition, bleeding increases mortality, which is why the transradial approach is the default method for the majority of our STEMIs. I will share an acute myocardial infarction case using the radial approach. An 83-year-old male presented to the ED with left shoulder discomfort and intermittent nausea. He had ST elevation in lead II, III, and aVF. A Q3.5 guide was used to engage the left system. We then passed a balance wire and used an Export Aspiration Catheter (Medtronic, Minneapolis, MN) to perform mechanical thrombectomy. We used a double bolus of eptifibatide (Integrilin) and heparin. The door-to-balloon time was 60 minutes. As shown here, it is indeed possible to do a STEMI case via a radial approach, as long as you have an experienced team and interventionalist (this case was done by Dr. Zaheed Tai at Winter Haven Hospital).
NULL
