Study Of The Safety Of Performing Transradial Artery Percutaneous Coronary Intervention For Allen Test Negative Patients

Transradial artery percutaneous coronary intervention (TRA-PCI) has small invasion, convenient for hemostasis and little vascular complications, not limited patients, action, easily recovering from diseases. Especially when the introducer is taken off, the heparin can maintain infusion immediately after procedure, which can prevent occluding events and acute coronary syndrome (ACS). But the hand ischemia is the most severe complications after TRA-PCI. So patients should be performed Allen test before TRA-PCI in order to free the hand ischemia complications. Doctors think that it is excellent for ulnar arteries of those Allen test positive patients to supply the blood to hands, so they are suitable for TRA-PCI. On the contrary, it is poor for ulnar arteries of Allen test negative patients to supply the blood to hands, so TRA-PCI is absolutely contraindicated for them.But there are often some Allen test negative patients with abdominal aorta as well as iliac artery sever occlusion, which make transfemoral artery percutaneous coronary intervention fail. In addition, to poor heart function with heart failure which the patients can not get down in a long time or others particular situations, which transfemoral artery percutaneous coronary intervention is not suitable of them. In these cases, it is of the best plans for doctors to choose TRA-PCI after they weight about advantages and disadvantages.ObjectiveThe aim of the study was to probe the safety of performing TRA-PCI for Allen test negative patients.Methods106 patients performed TRA-PCI were enrolled into the study. Allen test was performed strictly before operation. According to Allen test, the patients were divided into positive group (Allen test time <10 seconds) and negative group (Allen test time≥10 seconds). During the TRA-PCI, patients were performed ulnar artery angiography, deep palmar arch angiography, superficial palmar arch angiography. There was no significant difference between the two groups in age, sex, height, BMI, smoking, past history ( primary hypertension, diabetes, hyperlipidemia), systolic blood pressure, diastolic blood pressure, blood fasting sugar, LDL-c, total cholesterol level and Triglyceridemia (p>0.05). We mainly observed ulnar artery diameter, deep palmar arch conditions, superficial palmar arch conditions, the frames countings through angiography on the side of ulnar vessel system, and hand ischemia after PCI (follow up 3months).Results1. The parameters of ulnar artery diameter in negative group was 2.02±0.18mm, and 2.07±0.17mm in positive group. The parameters of ulnar artery diameter had no significant difference between the two groups (p>0.05).2. There were 49 cases in negative group who had deep palmar arch, accounting for 85.96%. There were 43 cases in positive groupwho had deep palmar arch, accounting for 87.75%. The deep palmar arch had no significant difference between the two group (p>0.05).3. There were 43 cases in negative group who had superficial palmar arch, accounting for 75.44%. There were 40cases in positive group who had superficial palmar arch, accounting for 81.63%. The superficial palmar arch had no significant difference between the two group (p>0.05).4. Neither deep palmar arch nor superficial palmar arch in negative group was 3 cases, accounting for 5.26%, while all patients in the positive group possessed deep palmar arch or superficial palmar arch. Neither deep palmar arch nor superficial palmar arch had marked difference between the two groups (p<0.05).5. The frames countings of ulnar artery to microcirculation vessels in negative group was 218.6±63.6 frames, and 180.8±44.1 frames in positive group (p>0.05). The frames countings had no significant difference between the two groups (p>0.05).6. There were 8 cases in negative group of the frames countings more than 380 frames, accounting for 8.77%. While the positive group had only 1 case which the frames countings were exact 380 frames. The frames countings which was more than 380 frames had marked difference between the two groups (p<0.05) .7. None of patients had been found to suffer from hand ischemia after PCI. (follow up for 3 months)Conclusion1. It was good for most of Allen test negative patients in ulnar artery diameter, deep palmar arch, superficial palmar arch, the frames countings, so TRA-PCI was suitable for Allen test negative patients.2. None of patients had been found to suffere from hand ischemia in a long period following up. It means that it is safe for Allen test negative patients to be performed TRA-PCI.3. To those patients who Allen test time is marked extended, it should be careful for doctors to performe TRA-PCI.In general, it is not absolutely contraindicated for most Allen test negative patients, but safe to be performed TRA-PCI.