1. Growing segment of the population Higher prevalence of CAD
Background
Growing segment of the population
Higher prevalence of CAD
More severe CAD (multivessel, calcification)
Co-morbidity factors (renal insuffisency, PAD)
High Risk Sub-groups
The radial approach in octogenarians
Stefano Rigattieri, Yves Louvard, Martial Hamon
Trans-radial cardiovascular interventions, M Hamon & EP Mc Fadden
Chapter 15, Text book, ESM Editions 2003; in press
Massy
2003
The Octoplus study group
Y. Louvard, H. Benamer, P. Garot, D. Hildick-Smith,
C. Loubeyre, T. Lefevre, R. Sabatier, G. Grollier, M. Hamon
Martial Hamon
Caen, France

2. High Risk Sub-groups Rationale Technical issues Interventions Results
Invasive strategies
in octogenarians
Difficult
anatomy
Interventions
Results
Massy
2003
Martial Hamon
Caen, France
Complex
PCI/TRI
Highlighting
Important issues

3. enhanced benefit in the elderly
Stent
Invasive
Rationale
Aged
(n=301)
Nonaged
(n=5885)
Coronary stenting: MACE * *
Invasive
Strategies
& related issues *
Chauhan MS et al. JACC 2001; 37:856-62
( p<0.001) *
GPIIb/IIIa blockers:
enhanced benefit in the elderly
GPIIb/IIIa
INV (%)
CON (%) OR
Death
5.3
5.9
0.88
Death or MI
8.8
13.6
0.61
Death,MI,or Re-
Hosp for ACS
17.1
21.7
0.75
Bach et al. Circulation. 2001; Abstract: AHA.
P=0.017
Age > 65 ( n = 962, avg = 73 yrs )
95% CI
Time study
(300 patients, 80 yrs)
Invasive
Stent
GPIIb/IIIa
Three VD: 60%
Left main stem: 14%
Revasc.:74% (PCI:72%)
Time Investigators. Lancet 2001;358:

4. Radial Technical issues Spasm Haematoma
Quick and adequate single puncture
Short sheath, 5F
Radial
Cannulation

5. Loops Subclavian artery Aorta Catheter Brachial artery Brachial artery
Spasm
Haematoma
Delayed
Loops
Technical
issues
Subclavian artery
Aorta
access
Never forced
Fluoroscopic guidance
Hydrophilic wire
Alternative approach
Catheter
Manipulation
Brachial artery
(Proximal)
Brachial artery
(Distal)
Radial artery

6. Aorta Catheter access 1. Right subclavian artery
Spasm
Haematoma
Stroke
1. Right subclavian artery
2. Brachiocephalic trunk
3. Right common carotid artery
4. Right vertebral artery
5. Right internal thoracic artery 3 4 1 2
Technical
issues
Exchange wire (260 cm)
J tip, 0.032"
Fluoroscopic guidance   5
Ascending aorta elongation
Aorta
access
Catheter
Manipulation
Advanced age
Hyperstension

7. Catheter Three vessel disease male patient of 83 yrs
Complex
PCI/TRI
30°
60°
90°
Three vessel disease
male patient of 83 yrs
ACS, 5 Fr TRI, 48 hrs hospit.
Catheter
Manipulation

8. Success of TRA Success of TRA 100 80 60 40 20 Femoral 396 Radial 2072
Year 2001
All procedures
Success of TRA
100 80 60 40 20
Success
of TRA
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Department of Interventional Cardiology
University Hospital of Caen, Normandy, France

9. Impact An attempt to obtain zero access site complication 2.7% 1.1%
Others
Leeches
Transfusions
Surgery
3,0
2.7%
Highlighting
Important issues
2,5
2,0
P<
P<0.03 %
1,5
1.1%
1,0
0.3%
0.2%
0,5
0,0
n=1269
n=1108
n=396
n=2072
Impact
Femoral
Radial
Femoral
Radial
2000
2000
2001
2001
Department of Interventional Cardiology
University Hospital of Caen, Normandy, France
Randomized studies:
Access Study, Kiemeneij F. J Am Coll Cardiol 1997
Carafe study, Louvard Y. Catheter Cardiovasc Interv 2001

10. Preliminary results (n=288, 83 yrs, 54% male, ACS 48%)
Radial
(n=137)
Femoral
(n=141) p
Cross-over (%)
11.7
9.5 ns
Angio. Duration (min)
18 ± 11
16 ± 11
X-ray Duration (min)
6 ± 5
4 ± 3
0.000
PCI success (%)
96.8
94.7
PCI X-ray duration
10 ± 8
11 ± 10
PCI duration (min)
28 ± 18
33 ± 23
Primary end-point (%)
1.4
5.9
Haematoma > 3 cm (%)
2.2
11.4
0.004
Highlighting
Important issues
Octoplus
Randomised
study
The Octoplus study group
Y. Louvard, H. Benamer, P. Garot, D. Hildick-Smith,
C. Loubeyre, T. Lefevre, R. Sabatier, G. Grollier, M. Hamon