Transulnar Compared With Transradial Artery Approach as a Default Strategy for Coronary Procedures
Open Access
- 1 June 2013
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation: Cardiovascular Interventions
- Vol. 6 (3), 252-261
- https://doi.org/10.1161/circinterventions.112.000150
Abstract
The ulnar artery is rarely selected for coronary angiography or percutaneous coronary intervention despite the expanding use of the transradial approach. We aimed to establish noninferiority of a default transulnar relative to transradial approach in terms of feasibility and safety. This was a prospective, randomized, multicenter, parallel-group study involving 902 patients at 5 sites eligible to undergo diagnostic coronary angiography and percutaneous coronary intervention. Patients were randomized in a 1:1 ratio to either transradial approach (reference intervention) or transulnar approach (experimental intervention) regardless of the Allen test results. The primary end point was a composite of cross-over to another arterial access, major adverse cardiovascular events, and major vascular events of the arm at 60 days. The study was prematurely terminated after the first interim analysis because of inferiority of the transulnar approach. Although the difference in the primary end point became inconclusive after adjustment for operator clustering (24.30%; 99.99% confidence interval [CI], −7.98% to 56.58%; P =0.03 at α=0.0001), need for cross-over in the transulnar group remained inferior to transradial access site with a difference of 26.34% (95% CI, 11.96%–40.69%; P =0.004). As a result of higher cross-over rates, a first-line transulnar strategy was proven inferior to the transradial approach for coronary procedures. At present, the transulnar route should not be regarded as an acceptable alternative to the transradial access site. URL: http://www.clinicaltrials.gov . Unique identifier: NCT01364532.Keywords
This publication has 27 references indexed in Scilit:
- Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trialThe Lancet, 2011
- The Transradial Approach to Percutaneous Coronary InterventionJournal of the American College of Cardiology, 2010
- Assessment of acute injuries and chronic intimal thickening of the radial artery after transradial coronary intervention by optical coherence tomographyEuropean Heart Journal, 2010
- Radial Artery Cannulation: A Comprehensive Review of Recent Anatomic and Physiologic InvestigationsAnesthesia & Analgesia, 2009
- Ulnar Artery as Access Site for Cardiac Catheterization: Anatomical ConsiderationsJournal of Interventional Cardiology, 2008
- Transulnar versus transradial artery approach for coronary angioplasty: The PCVI‐CUBA studyCatheterization and Cardiovascular Interventions, 2006
- Effectiveness of Ulnar Artery Catheterization After Failed Attempt to Cannulate a Radial ArteryThe American Journal of Cardiology, 2005
- Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures: Systematic overview and meta-analysis of randomized trialsJournal of the American College of Cardiology, 2004
- Percutaneous ulnar artery approach for primary coronary angioplasty: Safety and feasibilityCatheterization and Cardiovascular Interventions, 2003
- Percutaneous ulnar artery approach for coronary angiography: A preliminary report in nine patientsCatheterization and Cardiovascular Interventions, 2001