Abstract Background This research comes from the increasing need for an alternative wrist access approach in PCI when the standard right radial is not accessible, most commonly due to the presence of RAO. Its use is still controversial in the interventional community, due to lack of data. Objective To evaluate the role of existing collateral circulation in the safety of transulnar access with ipsilateral RAO. Materials and methods In the period of over a decade, in a high-volume radialist center, 1756 consecutive patients underwent percutaneous coronary procedures through primarily chosen TUA with ipsilateral radial occlusion. All patients were followed for procedural safety. Using pre-procedural wrist artery angiography, we performed measurements in 80 patients by using QCA (quantitative angiography), of the largest diameter of the collaterals from the interosseus and ulnar artery that were supplying the occluded radial artery and the ulnar artery diameter itself. The values of UA diameter were compared with previous available angiographies before the existence of RAO. For a satisfactory diameter of the collaterals, the investigators defined the values above 0.8 mm. The patients were followed up clinically and by duplex ultrasonography of the ulnar artery. Results All 1756 TUA procedures were successfully performed without ischemic complications of the punctured arm. Previous TRA was present in all patients, 32% of patients had multiple previous TRA (3), with 10 being the largest number. QCA assessment showed an increasing of UA diameter after RAO of 0.28±0.35мм and also over time (p0,0001). The collateral circulation for the occluded radial artery evaluated by QA was with a medium diameter of 1.14±0.2 мм. On duplex ultrasound follow up up to one year, there wasn’t a single case of UAO detected. There were no clinical or ischemic hand complications seen during long-term follow up. Conclusion Transulnar approach with ipsilateral RAO is safe and successful for PCI in experienced radial centers. Anatomical assessment of the UA and collaterals proved increasing of the UA diameter over time and satisfactory diameter of the collateral circulation in all patients.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.
Taleska et al. (Sun,) studied this question.