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Radial approach to day case intervention in coronary artery lesions (RADICAL): a single centre safety and feasibility study
  1. S Kumar,
  2. R Anantharaman,
  3. P Das,
  4. J Hobbs,
  5. C Densem,
  6. J Ansell,
  7. D H Roberts
  1. Blackpool Victoria Hospital, Blackpool, Lancashire, UK
  1. Correspondence to:
    Dr Somnath Kumar
    Department of Cardiology, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire FY3 8NZ, UK; somnathkumarhotmail.com

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Transradial arterial access for percutaneous coronary intervention (PCI) is increasing in popularity. Its advantages are a significant reduction of vascular complications at the access site and immediate mobilisation.1 Same day discharge following transradial PCI is therefore possible and we report our initial experience with a consecutive group of 150 patients treated in a regional cardiac centre over a period of 21 months.

METHODS

Patients listed for elective PCI were initially selected for potential day case PCI on clinical (Canadian Cardiovascular Society class I–III) and angiographic criteria (complex lesions in degenerated saphenous vein grafts at risk of producing distal embolisation, bifurcation lesions involving a significant side branch of more than 2 mm diameter, and unprotected left main stem stenosis were excluded) by the consultant cardiologist (DHR). During further assessment in the pre-admission stage patients were excluded on clinical (excessive co-morbidity) and social (no carer available at home on the night of the procedure) criteria. A non-ischaemic Allen’s test was required, ensuring adequate ulnar collateral supply. All patients were prescribed aspirin 300 mg and clopidogrel 300 mg in the pre-admission clinic and were instructed to take them on the evening before the procedure.

PCI (2–3 cases) was performed in a morning session by one consultant and a supervised specialist registrar as first or second operator. Following successful radial puncture, intra-arterial drugs were administered to prevent radial spasm (200 μg of glyceryl trinitrate and 2.5 mg verapamil) followed by the insertion of a Cook 6 French, 23 cm hydrophilic sheath. Intravenous heparin (70 units/kg) was routinely administered. Guide catheter selection was similar to the femoral approach with a half French size reduction in …

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