Pancholy, Samir B

Abstract Transradial angiography and intervention continues to become increasingly common as an access site for coronary procedures. Since the first “Best Practices” paper in 2013, ongoing trials have shed further light onto the safest and most efficient methods to perform these procedures. Specifically, this document comments on the use of ultrasound to facilitate radial access, the role of ulnar artery access, the utility of non‐invasive testing of collateral flow, strategies to prevent radial artery occlusion, radial access for primary PCI and topics that require further study.

AbstractObjectiveExamining the efficacy and outcomes of intracoronary (IC) instillation of adenosine using a novel perforated balloon technique (PBT) to combat no‐reflow phenomenon during percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS).BackgroundOccurrence of no‐reflow during PCI is a serious adverse prognostic event and inability to re‐establish better flow is associated with poor outcomes. Several pharmacological and non‐pharmacological interventions have been used to treat this situation. This series describes the use of PBT for IC adenosine administration and its effects on outcomes during real world interventional practice.MethodsSubjects comprised of 24 patients with ACS (out of a total of 1,634 patients undergoing PCI between January 2016 and June 2017) in whom we used PBT for IC administration of adenosine to treat coronary no‐reflow.ResultsPBT for IC adenosine instillation was used in 24 (1.5%) of 1,634 patients undergoing PCI. TIMI grade III flow was established in 21 patients (87.5%). In two patients (8.3%) TIMI grade II flow was established and in one patient (4.2%) we were unsuccessful.ConclusionWe demonstrate the safety and efficacy of a novel strategy for adenosine instillation in the distal coronary bed, the PBT. This technique enables rapid and cost‐effective treatment of no‐reflow phenomenon during PCI for ACS.