Key result
The transulnar approach was associated with a lower rate of composite major adverse cardiac and vascular events compared to transradial access (7.4% vs 11.6%; P<0.001).
Why the study?
Little evidence supports using the transulnar approach as the primary access site for diagnostic coronary angiography or interventions.
Does the transulnar approach reduce major adverse cardiac and vascular events compared to the transradial approach in patients undergoing coronary angiography and/or angioplasty?
Observational (n=587)
Does the transulnar approach reduce major adverse cardiac and vascular events compared to the transradial approach in patients undergoing coronary angiography and/or angioplasty?
Absolute Event Rate: 7.4% vs 11.6%
p-value: p=<0.001
The transulnar approach is a safe and effective alternative to the transradial approach for coronary angiography and interventions, with potentially fewer vascular complications.
Should not yet change radial-first practice; leaves open whether transulnar access improves outcomes in randomized trials.
The transulnar approach (TUA) has been considered both as primary access and as a secondary access site after transradial access (TRA) failure for coronary invasive procedures. However, there is little evidence supporting the use of the TUA as the first approach to diagnostic coronary angiography (CAG) or interventions. Patients (n = 587) who underwent CAG and/or angioplasty (292 patients via TRA, 295 patients via TUA) were included. The primary end points of the study were major adverse cardiac events and major vascular events (hematoma, vascular occlusion, vasospasm), and secondary end points included angiographic success, crossover rate, and angiographic procedural times. The mean age was 60 ± 21 years. The composite primary end points occurred in 34 (11.6%) patients in the TRA and 22 (7.4%) patients in the TUA arm ( P < .001). More arterial occlusion and more arterial spasm than in the TUA and similar urgent target vessel revascularization were observed in the TRA group in 48 hours. Based on previous studies and our clinical experience, we speculated that the TUA performed by an experienced operator has equal status with the TRA for coronary catheterization, especially in patients with a palpable ulnar pulse.
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Gündüz et al. (2020) conducted an observational in Coronary artery disease requiring angiography or angioplasty (n=587). Transulnar approach (TUA) vs. Transradial access (TRA) was evaluated on Composite of major adverse cardiac events and major vascular events (hematoma, vascular occlusion, vasospasm) (p=<0.001). The transulnar approach was associated with a lower rate of composite major adverse cardiac and vascular events compared to transradial access (7.4% vs 11.6%; P<0.001).
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