title: Ad hoc transradial coronary angioplasty strategy: experience and results in a single centre.
abstract: BACKGROUND
  The combination of diagnostic and angioplasty as a single procedure is becoming common practice in many institutions, but the feasibility of this strategy performed with the transradial approach in a large group of patients has not been evaluated. This study was performed to explore the feasibility, safety and cost-effectiveness of the transradial approach as a single procedure for diagnostic angiography and angioplasty, including stent implantation.
  
  
  METHODS
  From February 1999 and November 2000 the percutaneous transradial approach was attempted in 800 patients with functional radial arch attested using Allen's test. Interventional procedures, PTCA and stent implantation, when indicated and appropriated, have been performed as a single procedure.
  
  
  RESULTS
  Out of 800 patients submitted to coronarography, 390 were treated with PTCA and or stent implantation as single procedure. In this group of patients, 425 lesions (1.2 lesions/patient) were treated. A PTCA was performed in 98 (23.5%) lesions and PTCA plus stent implantation were performed in 327 (76.5%) lesions. Procedural success was achieved in 419/425 lesions (98.5%) in the radial group and in 98% in the staged group. The mean time to place the sheath was longer in the transradial group (P<0.01), but the time required to obtain hemostasis was markedly shorter in the transradial patients (P<0.01); no differences in fluoroscopy time, contrast volume and catheters per case was found. Access site bleeding complications were significantly reduced in the radial group (P<0.01) and total hospital length of stay was lesser in the radial group (mean days 1.9) as compared to femoral group (mean days 2.9) with a reduction of total hospital charge. The reduction of costs for 100 patients was Euro 78,000.
  
  
  CONCLUSIONS
  Our results show that a combined strategy of angiography and angioplasty via the radial artery is feasible, safe, more comfortable for the patient, and more cost-effective than a staged procedure. This approach might be ideal for outpatient or ad hoc invasive coronary procedures.
authors.affiliation: Catheterisation Laboratory, Cardiology Department, S Anna Hospital, Como, Italy. galli.mario@tin.it
authors.forename: Mario
authors.initials: M
authors.lastname: Galli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Tano
authors.forename: Stefano
authors.initials: S
authors.lastname: Mameli
authors.forename: Elena
authors.initials: E
authors.lastname: Butti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Politi
authors.forename: Santino
authors.initials: S
authors.lastname: Zerboni
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ferrari
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000191:economics / Q000379:methods*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017534:Radial Artery; D012449:Safety; D015607:Stents