5993 Radial vs. Ulnar artery anomalies in STEMI patients: 6 year results from routine Wrist artery angiography

Abstract

Objective: To assess and compare the rates of wrist artery anomalies and their impact on the success of STEMI procedures in a large series of patients. Methods: All consecutive 4303 STEMI patients, in the period from March 2011 until December 2016 were examined. Preprocedural wrist artery angiography was performed in all patients. Clinical and procedure characteristics, type of radial anatomy variants, transfer and procedure time were analyzed. Results: From 4303 STEMI patients, RRA was done in 4169 (96%) patients, transulnar in 80 (1,7%) patients, LRA with 37 (0,8%), TFA in 8 (0,17%) and TBA in 9 (0,2%)patients. Anatomical variants of the RA and UA were present in 432 (10%) STEMI patients. 330 (7,6%) STEMI patients had Radial artery anomalies and 102 (2,4%) had Ulnar artery anomalies on wrist angiography. The most frequent variant in both groups was high-bifurcating radial and ulnar artery origin from the axillary and brachial arteries in 304 (7,1%) patients, with 230 (5,3%) and 74 (1,8%) respectively. From RA anomalies 43 (1,0%) patients had a full radial loop and 57 (1,3%) had extreme radial artery tortuosity. None of the patients had UA loop and UA tortuosities were present in 0,6% (28) patients. Highest incidence of of cross-over was present in patients with complex radial artery loop 16/43 (37%). No UA anomaly in the 80 patients with TUA required access site crossover to another approach. TUA had more punctures with 7% of patients with multiple punctures compared with TRA with only 1%. Conclusion: The ulnar artery has a significantly smaller percentage of anomalies than the radial artery with a low percentage of access crossover in STEMI patients. Pre-procedural wrist artery angiography in STEMI patients gives the operator an opportunity to successfully plan the strategy for crossing the anomaly or transfer to a new approach in the interest of saving time and reducing door to baloon time.