Acute Coronary Syndrome ; Brain Ischemia ; complications ; pathology ; Carotid Arteries ; pathology ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; pathology ; Dyspnea ; Female ; Fibrinolytic Agents ; administration & dosage ; therapeutic use ; Humans ; Middle Aged ; Myocardial Infarction ; etiology ; pathology ; Risk Factors ; Stroke ; complications ; pathology ; Time Factors ; Tissue Plasminogen Activator ; administration & dosage ; therapeutic use

INTRODUCTIONThis study aims to assess the safety and feasibility of brachial arterial puncture for coronary procedures when radial access is not possible. Radial arterial approach is the usual option for coronary procedures in our hospital. Whenever radial access is not possible, the brachial approach is preferred instead of the femoral approach. As many clinicians considered percutaneous brachial coronary angiography as an obsolete and hazardous procedure, we carried out this study to compare the outcomes of the brachial approach to the femoral approach in our centre.

MATERIALS AND METHODSWe retrospectively evaluated all cases of brachial artery puncture and femoral artery puncture in our centre from 1 January 2007 to 31 March 2009 through a prospectively collected database and looked for all complications which occurred in both groups.

RESULTSThe femoral group had a slightly higher incidence of major complications--3 out of 121 cases (2.5%) in the femoral group and 1 out of 180 cases (0.6%) in the brachial group, even though this was not statistically significant (P = 0.15). There was also no difference between these 2 groups for minor complications: 8 patients (4.4%) in the brachial group and 6 patients (5%) in the femoral group developed haematoma that did not require any blood transfusion or surgery. There was no incidence of brachial artery thrombosis and no puncture-related neurological deficit documented in the brachial group.

CONCLUSIONBrachial artery puncture and catheterisation may be a viable, safe and efficient alternative to the transfemoral approach in a centre that is experienced with the arm approach, when radial access is not possible.

Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; methods ; Brachial Artery ; Cardiac Catheterization ; adverse effects ; methods ; Coronary Angiography ; methods ; Feasibility Studies ; Female ; Femoral Artery ; Humans ; Male ; Middle Aged ; Retrospective Studies