title: Balloon-assisted tracking: a must-know technique to overcome difficult anatomy during transradial approach.
abstract: OBJECTIVE
  To examine the use and outcomes of balloon-assisted tracking (BAT) technique for dealing with complexities of arm and chest vasculature during transradial approach (TRA) at a single high volume radial center.
  
  
  BACKGROUND
  TRA has been used for coronary angiography and percutaneous coronary interventions (PCI) around the world. Different techniques have been described to address the anatomical issues and tortuosities for successful completion of coronary angiography and PCI. This study describes the use of BAT technique and associated outcomes during real world clinical practice.
  
  
  METHODS
  Subjects comprised 63 patients, (out of total 8,245 patients between January 2011 and December 2012) in whom we encountered significantly complex anatomical course in radial, brachial, or subclavian region, leading to difficult advancement of a diagnostic or a guide catheter despite trying all standard maneuvers. In all of them BAT technique was used and they were retrospectively analyzed for the purpose of this study.
  
  
  RESULTS
  About 63 (0.76%) of 8,245 patients met the study criteria. Twenty-five (39.7%) patients had very small RA. Twenty-two (34.9%) had severe RA tortuosity. Four (6.3%) had complex RA loops. Six (9.5%) had severe RA spasm and six (9.5%) had severe subclavian tortuosity and/or stenosis. We encountered technical failure in three (4.8%) patients (two had very small RA and one had 360 degree RA loop).
  
  
  CONCLUSIONS
  BAT technique was useful to address the anatomical issues and tortuosities of radial, brachial, and subclavian vasculature during TRA.
authors.affiliation: Apex Heart Institute, Ahmedabad, India; Department of Cardiology, Sheth V.S. General Hospital and Smt. N.H.L. Municipal Medical College, Ahmedabad, 380 006, India.
authors.forename: Tejas
authors.initials: T
authors.lastname: Patel
authors.forename: Sanjay
authors.initials: S
authors.lastname: Shah
authors.forename: Samir
authors.initials: S
authors.lastname: Pancholy
authors.forename: Sunil
authors.initials: S
authors.lastname: Rao
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
authors.forename: Tak
authors.initials: T
authors.lastname: Kwan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001916:Brachial Artery / Q000000981:diagnostic imaging; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D017023:Coronary Angiography / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications* / Q000000981:diagnostic imaging; D011677:Punctures; D017534:Radial Artery / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000000981:diagnostic imaging; D062666:Vascular Access Devices
keywords: balloon-assisted tracking; coronary angiography; coronary intervention; radial artery