Balloon-assisted tracking: a must-know technique to overcome difficult anatomy during transradial approach.
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).


CONCLUSION
BAT technique was useful to address the anatomical issues and tortuosities of radial, brachial, and subclavian vasculature during TRA.
['Patel|Tejas|T|', 'Shah|Sanjay|S|', 'Pancholy|Samir|S|', 'Rao|Sunil|S|', 'Bertrand|Olivier F|OF|', 'Kwan|Tak|T|']
D000368:Aged D000369:Aged, 80 and over D015906:Angioplasty, Balloon, Coronary D001916:Brachial Artery D006328:Cardiac Catheterization D002406:Catheterization, Peripheral D017023:Coronary Angiography D004867:Equipment Design D005260:Female D061847:Hospitals, High-Volume D006801:Humans D008297:Male D008875:Middle Aged D058729:Peripheral Arterial Disease D011677:Punctures D017534:Radial Artery D012189:Retrospective Studies D013348:Subclavian Artery D062666:Vascular Access Devices
balloon-assisted tracking coronary angiography coronary intervention radial artery