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      Feasibility of Coronary Angiography and Percutaneous Coronary Intervention via Left Snuffbox Approach

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          Abstract

          Background and Objectives

          Feasibility of coronary angiography (CAG) and percutaneous coronary intervention (PCI) via left snuffbox approach is still concerned. We aimed to investigate efficacy and safety of the left snuffbox approach for CAG and PCI.

          Methods

          Left snuffbox approach was tried in 150 patients who planned to perform CAG or PCI for suspected myocardial ischemia between 1 November 2017 and 31 March 2018.

          Results

          Success rate of radial artery (RA) cannulation via snuffbox approach was 88.0% (n=132). Among 132 individuals, 58 (43.9%) acute coronary syndrome (ACS) patients were included. The diameter of snuffbox RA was significantly smaller than conventional RA (2.57 mm vs. 2.72 mm, p<0.001) from quantitative computed angiography of 101 patients. However, CAG via snuffbox approach by 6 French sheath was successfully performed in all 132 patients. In addition, there was significant correlation between the snuffbox and conventional RA diameter (r=0.856, p<0.001). In 42 PCI cases, including 25 patients with acute myocardial infarction (AMI), the success rate of PCI via snuffbox approach was 97.6% (n=41). Intravascular imaging-guided PCI was performed in 8 (19.5%) patients and multi-vessel PCI in 4 (9.8%) cases. Regarding vascular complication, forearm swelling with bruising, not requiring surgery or transfusion, occurred in 2 (4.9%) PCI cases.

          Conclusions

          Left snuffbox approach is suitable for CAG and PCI compared with the conventional radial approach.

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          Most cited references19

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          2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation

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            Left distal transradial access in the anatomical snuffbox for coronary angiography (ldTRA) and interventions (ldTRI).

            To demonstrate the feasibility of distal left transradial approach for patients in whom left radial access is preferred over right radial access for coronary angiography and interventions. This procedure is more convenient for the operator. For the right- handed patient, left radial access is more convenient because of the free use of the right hand after the procedure. In addition, this technique reduces the chance for radial artery occlusion at the site of the distal forearm.
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              Bleeding, blood transfusion, and increased mortality after percutaneous coronary intervention: implications for contemporary practice.

              Advances in percutaneous coronary intervention (PCI) during the past decade have led to more widespread use of these procedures in older and sicker patients. Refinement of periprocedural antithrombotic therapy has played a particularly important role in reducing ischemic complications to very low levels in routine practice. Although the use of more powerful antiplatelet agents has been associated with increased risk of bleeding (especially among the elderly and patients with serious comorbidities), such complications have traditionally been viewed as benign in nature. Recent studies, however, have identified major bleeding after PCI as an important predictor of increased mortality. Whether this relationship between bleeding and risk of death is cause-and-effect, or merely an association based on shared risk factors, remains unclear. In this review, we examine the basis for a possible causal link between post-PCI bleeding and subsequent mortality. Possible mechanisms underpinning such a link are discussed, including a potential adverse role for blood transfusion in this setting. A framework for further clinical evaluation of this issue is presented.
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                Author and article information

                Journal
                Korean Circ J
                Korean Circ J
                KCJ
                Korean Circulation Journal
                The Korean Society of Cardiology
                1738-5520
                1738-5555
                December 2018
                06 August 2018
                : 48
                : 12
                : 1120-1130
                Affiliations
                Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea.
                Author notes
                Correspondence to Youngkeun Ahn, MD, PhD, FACC, FSCAI. Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61469, Korea. cecilyk@ 123456hanmail.net
                Author information
                https://orcid.org/0000-0001-5568-4161
                https://orcid.org/0000-0003-2022-9366
                https://orcid.org/0000-0003-0565-0742
                https://orcid.org/0000-0001-7069-2047
                https://orcid.org/0000-0001-6026-1702
                https://orcid.org/0000-0003-4162-7902
                https://orcid.org/0000-0003-0192-8161
                https://orcid.org/0000-0002-3186-0770
                https://orcid.org/0000-0003-2424-810X
                Article
                10.4070/kcj.2018.0181
                6221867
                30088362
                102fbfde-24be-412b-96e4-b5213f883cf8
                Copyright © 2018. The Korean Society of Cardiology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 May 2018
                : 05 July 2018
                : 17 July 2018
                Categories
                Original Article

                Cardiovascular Medicine
                radial artery,coronary angiography,percutaneous coronary intervention

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