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Safety and Efficacy of Transulnar Route in Percutaneous Coronary Intervention: 30 days follow-up

Background Percutaneous coronary intervention (PCI) is the mainstay treatment in patients with coronary artery disease (CAD). The utility of transulnar approach (TUA) has been a topic of debate. Therefore, we aimed to evaluate the safety and efficacy of TUA in this study.
Methods This was a prospective, single-center, interventional study conducted between September 2005 and November 2021 at a tertiary-care center in India. Consecutive patients (≥18 years) with CAD requiring PCI using TUA were enrolled in this study. Patients with a negative Allen’s or reverse Allen’s test (>10 seconds), nonpalpable ulnar artery, cardiogenic shock, and the need for a large guiding catheter were excluded. Patients were clinically followed-up at one week to monitor occlusion and 30 days to observe and manage major adverse cardiovascular events (MACE; composite of myocardial re-infarction, target vessel revascularization, disabling stroke, and death).
Results A total of 200 patients were enrolled in this study with a mean age of 58.2±10.7 years. Majority of patients (38%) belonged to the age group of 56-65 years and this study observed a male predominance (80.5%). Follow-up of one week revealed no anatomical variations of the ulnar artery and there was no trauma to the ulnar nerve. Ulnar occlusion, however, was seen in three (1.5%) patients. Forearm hematoma was observed in one patient which was then managed conservatively. At 30-days follow-up, (MACE) did not occur in any of the patients.
Conclusion In the case that TRA cannot be performed, TUA can be used as a safe and effective alternative access route for PCI, avoiding the transfemoral approach.

Keywords: Coronary artery disease, catheterization, transulnar approach, transradial approach