Transulnar versus transradial artery approach for coronary angioplasty: the PCVI-CUBA study.
OBJECTIVE
To compare in terms of efficacy and safety the transulnar to the transradial approach for coronary angiography and angioplasty.


BACKGROUND
Opposite to the transradial approach, which is now widely used in catheterization laboratories worldwide, the ulnar artery approach is rarely used for cardiac catheterization.


METHODS
Diagnostic coronarography, followed or not by angioplasty, was performed by transulnar or transradial approach, chosen at random. A positive (normal) direct or reverse Allen's test was required before tempting the radial or the ulnar approach, respectively. MACE were recorded till 1-month follow-up. Doppler ultrasound assessment of the forearm vessels was scheduled for all the angioplastied patients.


RESULTS
Successful access was obtained in 93.1% of patients in the ulnar group (n = 216), and in 95.5% of patients in the radial group (n = 215), P = NS. One hundred and three and 105 angioplasty procedures were performed in 94 and 95 patients in ulnar and radial group, with success in 95.2% and 96.2% of procedures in ulnar and radial group, respectively (P = NS). Freedom from MACE at 1-month follow-up was observed in 93 patients in both groups (97.8% for ulnar group and 95.8% for radial group), P = NS. Asymptomatic access site artery occlusion occurred in 5.7% of patients after transulnar and in 4.7% of patients after transradial angioplasty. A big forearm hematoma, and a little A-V fistula were observed, each in one patient, in the ulnar group.


CONCLUSIONS
The transulnar approach for diagnostic and therapeutic coronary interventions is a safe and effective alternative to the transradial approach, as both techniques share a high success rate and an extremely low incidence of entry site complications. The transulnar approach has the potential to spare injury to the radial artery in anticipation of its use as a coronary bypass conduit.
Aptecar
Eduardo
E
Pôle Cardio-Vasculaire Interventionnel, Clinique Les Fontaines, Melun, France. eaptecar@club-internet.fr
Pernes
Jean-Marc
JM
Chabane-Chaouch
Mourad
M
Bussy
Nicolas
N
Catarino
Gino
G
Shahmir
Ali
A
Bougrini
Karim
K
Dupouy
Patrick
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D000925:Anticoagulants / Q000008:administration & dosage; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D017535:Ulnar Artery / Q000000981:diagnostic imaging; D014463:Ultrasonography
D000925:Anticoagulants