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Lésions trop complexes:Les 

limites de la voie radiale 

Dr Hakim Benamer 

Pr Jacques Monsegu

Mr BUS. Agé de 75 ans 

SCA ST – avec troponine à 1.5 ng/ml 

FdR: Tabagisme ancien 

ATCD cardio: 0 

ECG: T

Coronarographie le 3/12/2010 

Atteinte Bitronculaire IVA 2 et Cx

Coronarographie 3 dec 2010 

Atteinte Bitronculaire IVA 2 et Cx

Heart Team 

Traitement médical seul 

Angioplastie: IVA et Cx ? 

Chirurgie 

Revascularisation FFR guidée 

Angioplastie 

Stratégie 

Voie d’abord

Angioplasties de l‘IVA 2 et Cx 6 dec 2010 

Voie radiale droite (EBU 3.5 6F) 

Ballon apex 2.0x12 mm

Angioplasties de l‘IVA 2 et Cx 

Circonflexe: Prédilatation au ballon 2.5x12mm puis stent nu 3x14 mm

Résultat sur l‘IVA que faire? 

Malgré anchoring ballon dans la diagonale 

pas possible de passer le stent dans l’IVA

Cathlab Team 

Traitement médical seul ? 

Angioplastie redux de l’IVA? 

Chirurgie combinée? 

Stratégie 

Voie d’abord

Angioplastie de l‘IVA 7 dec 2010 

Abord radial droit 6F EBU 3.75

Rotablator fraise de 1.25mm 

Plusieurs passages à 190.000 t/m

Inflations très prolongées, neutralisation de 

l‘héparine, stent nu 2.5x14 mm 

Stent nu 2.5x14 mm puis Ballon 3.0x15 mm 

Que faire ?

Drainage

Assurer l‘hémodynamique 

Intubation/ Drainage/Cell saver

Assurer l‘hémodynamique 

Intubation/ Dreinage/Cell saver

Jostent Graft master 3x12 et 3x16 mm 

Anchoring ballon 2.5x12 mm 

7 F Radiale AL1

Résultat

Aval DES 2.25x15 mm 

Amont bifurcation DES 3x18 mm

En fin de procédure (extubé et retrait drain)

Pourquoi autant d‘obstination creased as successive punctures were pour performed andla this 

was due to vessel narrowing or occlusion. Although it is 

voie radiale? 

1 - Tridux de radiale est-ce vraiment raisonnable? 

2 - Appui moins Thrombose bon déjà un de échec la de radiale franchissement du stent 

3 – Rota et voie radiale 

4 - 7 French par voie radiale dans 

primo 

un contexte 

ponction 

de survie! 

redux p 

Ø 2.63±0.35 2.53±0.39 < 0.05 

Fig. 1. Time course of radial arterial diameter changes. No 

significant change in mean internal radial arterial diameter was 

observed between preprocedure and 1 day after procedure for 

either an initial procedure or a repeat procedure. The mean 

radial arterial diameter was 2.63 0.35 mm before the initial 

procedure and 2.51 0.29 mm 4.5 months after the first procedure 

1771 (P < patients 

0.05). No significant difference in radial arterial 

diameter changes was observed for patients receiving the di- 

dont 117 redux 

agnostic procedure or PTCA. 

TABLE III. Procedural Results and Complications 

Initial Repeated 

Success rate (%) 114 (97.4) 115 (98.3) 

Cross-over a 

3 (2.6) 2 (1.7) 

Puncture failure 

Vascular complications (%) 

0 (0) 0 (0) 

Perforations 0 (0) 0 (0) 

Occlusion b 

0 (0) 3 (2.6) 

Major bleeding 0 (0) 0 (0) 

a Cross-over to femoral artery. 

b P 0.05. 

cases at 4 weeks, one case at 2 weeks); two cases had 

high SAR (0.91 and 0.93) and one case had small radial 

artery diameter (1.82 mm). Late recanalization of the 

occluded radial artery during the 12 weeks after procedure 

was not observed in three cases (Table III). 

at the time of repeated use, due maybe to the physician 

being skillful with radial artery puncture technique and 

catheter manipulation. Sakai et al. [10] have reported that 

the dropout rates for transradial approach (TRA) in- 

difficult to explain the mechanism of the vessel narrowing 

in our study, we demonstrated significant vessel 

narrowing after the transradial procedure during longterm 

follow-up. 

Considering recent increased concern of the radial 

artery as a grafting artery in coronary artery bypass 

grafts, radial artery occlusion or functional loss might be 

important problem in patients with transradial coronary 

procedures [14,15]. In our study, the frequency of radial 

artery occlusion was 0% and 2.6% after the initial and 

repeated procedure, respectively. Although it is difficult 

to find the factor of radial arterial occlusion due to low 

Ratio 0.68 ± 0.12 0.70 ± 0.12 ns 

incidence of radial artery occlusion, we could hypothe- 

size that the bigger size of arterial sheath might incite 

more injury to the arterial puncture site. In the repeated 

procedure, more PTCA was performed compared to the 

initial procedure (P 0.04). This relation might be 

inferred from the other findings; the radial arterial occlusion 

was very low (0.8%) in transradial coronary angiography 

with a 4 Fr catheter (0.8%) [5] and 2.8% for 

transradial coronary artery angioplasty using at least 6 Fr 

catheter in our data. The incidence of radial artery occlusion 

among 1,771 transradial coronary procedures 

during the same study period was 11 patients (0.6%). 

Therefore, radial artery occlusion was higher in repeateduse 

patients than in total first-use patients (2.6% vs. 

0.7%; P 0.01). Radial artery occlusion is similar to 

Nagai et al. [13] (2%), but less than Saito et al. [16] 

(6.8%). Saito et al. [16] included cases with high proportion 

of SAR higher than 1.1, in contrast to SAR of less 

Yoo Cathet Cardiovasc Intervent 2003; 58: 301-4

Pourquoi autant d‘obstination pour la 

voie radiale? 

1 - Tridux de radiale est-ce vraiment raisonnable? 

2 - Appui moins bon déjà un échec de franchissement du stent 

3 - Rota et voie radiale 

4 - 7 French par voie radiale dans un contexte de survie!

Backup Force of Guiding Catheters for the Right Coronary 

Artery in Transfemoral and Transradial Interventions 

Ikari Y, J invasive Cardiol 2009;21:570–574







(guiding) Anchoring techniques 

Anchoring wire 

Anchoring balloon 

Anchoring stent 

Mother and child 

Tornus …


voie radiale? 

1 - Tridux de radiale est-ce vraiment raisonnable 


3 - Rota et voie radiale 


1000 

0 

NCN : EVOLUTION DE L’ACTIVITE 2002-2006 

16 

1003 

1.6% 

26 

1043 

2.5% 

36 

1176 

3% 

ROTA 2002 ROTA 2003 ROTA 2004 ROTA 2005 ROTA 2006 

56 

4% 

1384 

62 

1375 

4,5% 

Ph Brunel RadialAlpes 2009

% 

2005, Between July and december 

29 french centers, All consecutive rotablator procedures 

252 patients, 2.13% (0,3-6%) of all procedures 

100 

80 

60 

40 

20 

0 

REGISTRE TAROT : FRANCE 6 mois 

22 

78 

RADIALE FEMORALE 


% 

10 

9 

8 

7 

6 

5 

4 

3 

2 

1 

0 

0,79 

5,95 

TAROT : COMPLICATIONS 

1,98 

(n=252) 

1,19 0,39 0,39 

Perforation dissection spasm slow flow burr stall guide wire 

rupture 



voie radiale? 



3 - Taille de la fraise 



voie radiale? 




4 - 7 French par voie radiale dans un contexte de survie! 

Yoo CCVI 2003 ; 58:301-304

O.D. 

2.00mm 

O.D. 

O.D. 2.29mm 

2.29mm 

O.D. 

2.16mm 

O.D. 

O.D. 2.49mm 

2.49mm 

O.D. 

2.29mm 

O.D. 

2.62mm 

O.D. 

2.62mm


voie radiale? 






voie radiale? 






voie radiale? 





CONCLUSIONS 

Toujours la Radiale 

Connaitre les atouts et des faiblesses 

de la voie d’abord radiale pour arbitrer les choix 

techniques 

Faiblesses 

- Tailles variables 

- Variations anatomiques 

- Problèmes de support (Dte > Gche)

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