American Journal of Medicine and Medical Sciences

p-ISSN: 2165-901X    e-ISSN: 2165-9036

2025;  15(4): 1042-1044

doi:10.5923/j.ajmms.20251504.38

Received: Mar. 15, 2025; Accepted: Apr. 8, 2025; Published: Apr. 10, 2025

 

Transradial Coronary Interventions in Complex Coronary Artery Disease: A Focus on Bifurcation Lesions and Acute Coronary Syndrome

Giyozoda Laylo Bakhtiyorovna1, Salaxitdinov Shuxrat Najmitdinovich2, Alimov Daniyar Anvarovich3, Mirzakarimov Khayrulla Faizullayevich4, Tursunov Sardor Bakhtinurovich5

1Interventional Cardiologist in the Angiography Department at the National Research Center for Emergency Medical Care (RNCEMP)

2Candidate of Medical Sciences, Associate Professor, Deputy Director of the National Children's Medical Center, Co-Chair of the Association of Interventional Cardiologists of the Republic of Uzbekistan, Permanent Member of the International Committee of the European Association of Percutaneous Cardiovascular Interventions (EAPCI 2022-2026)

3Professor, Director of the RNCEMP Center

4Interventional Cardiologist in the Angiography Department at the RNCEMP

5Candidate of Medical Sciences, Head of the Angiography Department at the RNCEMP

Copyright © 2025 The Author(s). Published by Scientific & Academic Publishing.

This work is licensed under the Creative Commons Attribution International License (CC BY).
http://creativecommons.org/licenses/by/4.0/

Abstract

Complex coronary artery disease (CAD), particularly bifurcation lesions and acute coronary syndrome (ACS), present significant challenges in interventional cardiology. The transradial approach (TRA) has emerged as an important strategy in coronary interventions, offering benefits such as reduced bleeding complications and faster recovery. This article focuses on the role of transradial coronary interventions (TRI) in treating bifurcation lesions in patients with ACS, exploring the efficacy, safety, and outcomes of TRI compared to other approaches. A comprehensive review of recent studies was conducted, focusing on TRI for complex CAD and ACS. Various techniques for bifurcation lesion management and their outcomes were assessed, with a focus on acute settings. Transradial interventions have shown promising results in ACS patients, with reduced complication rates, shorter hospital stays, and improved patient satisfaction. Specifically, TRI in bifurcation lesions presents unique challenges but is associated with positive outcomes when using modern techniques such as stent implantation, dual antiplatelet therapy (DAPT), and intravascular imaging.

Keywords: Transradial, Coronary Artery Disease, Acute Coronary Syndrome, Bifurcation Lesions, Percutaneous Coronary Intervention, Angiography, Interventional Cardiology, Stenting, Radial Artery Access

Cite this paper: Giyozoda Laylo Bakhtiyorovna, Salaxitdinov Shuxrat Najmitdinovich, Alimov Daniyar Anvarovich, Mirzakarimov Khayrulla Faizullayevich, Tursunov Sardor Bakhtinurovich, Transradial Coronary Interventions in Complex Coronary Artery Disease: A Focus on Bifurcation Lesions and Acute Coronary Syndrome, American Journal of Medicine and Medical Sciences, Vol. 15 No. 4, 2025, pp. 1042-1044. doi: 10.5923/j.ajmms.20251504.38.

Article Outline

1. Introduction
2. Materials and Methods
3. Results and Discussions
4. Conclusions

1. Introduction

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. Complex forms of CAD, such as bifurcation lesions and those complicating acute coronary syndrome (ACS), require specialized intervention techniques. Among the various strategies for coronary intervention, the transradial approach (TRA) has emerged as a promising alternative to the traditional femoral access, offering various advantages such as reduced bleeding complications, faster recovery, and lower mortality rates. [1]
Bifurcation lesions represent a particularly challenging aspect of CAD due to the need to address both the main vessel and the side branch effectively. These lesions are found in about 20% to 30% of patients undergoing coronary angiography. The management of bifurcation lesions in ACS patients is even more complex, as rapid decision-making and precise execution are essential to prevent further myocardial damage.
In this review, we will explore the role of transradial coronary interventions in the management of complex coronary artery disease, focusing on bifurcation lesions and acute coronary syndrome. The objective is to provide an overview of the clinical evidence supporting the use of TRI in these patients and to discuss the outcomes and challenges associated with this approach.

2. Materials and Methods

This article synthesizes findings from multiple sources, including randomized controlled trials (RCTs), observational studies, and meta-analyses, focusing on transradial coronary interventions in the context of bifurcation lesions and acute coronary syndrome. We performed a systematic search in PubMed, Scopus, and Web of Science databases, considering publications from 2010 to 2023.
Inclusion criteria for studies were:
Patients with acute coronary syndrome (ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), unstable angina).
Complex coronary artery disease with bifurcation lesions.
Studies comparing transradial versus transfemoral approaches.
Data on procedural success, complications, and outcomes (e.g., mortality, bleeding complications, hospital length of stay).
Studies were selected based on their relevance, quality of evidence, and sample size.
We excluded studies that focused only on non-ACS patients or did not involve bifurcation lesions. [2]
We also included insights from expert opinion papers, clinical practice guidelines, and real-world experience in handling TRA for bifurcation lesions in complex CAD.

3. Results and Discussions

Transradial Access in Acute Coronary Syndrome (ACS)
The transradial approach has significantly improved the safety and outcomes in patients with acute coronary syndrome (ACS), especially in those with complex coronary anatomy. TRA offers several advantages over the traditional femoral approach, such as reduced access-site complications (e.g., hematomas, pseudoaneurysms), reduced risk of vascular complications, and a quicker recovery time.
A pivotal study published in The Lancet in 2017 demonstrated that TRA was associated with a lower risk of major bleeding and death compared to the transfemoral approach. This finding was particularly notable in ACS patients, where rapid access and minimizing procedural complications are crucial for survival.
Bifurcation Lesions and Their Management
Bifurcation lesions, characterized by the involvement of the main vessel and a side branch, are inherently challenging due to the risk of stent failure, side-branch occlusion, and restenosis. The management of bifurcation lesions has evolved over the years, with improvements in stent technology, guide catheter design, and interventional techniques. [3]
Several strategies are used to treat bifurcation lesions, including one-stent and two-stent techniques. The two-stent approach, involving stenting both the main vessel and side branch, is generally preferred for more complex bifurcations but comes with a higher risk of complications such as stent thrombosis and restenosis. Advances in drug-eluting stents (DES) have led to better long-term outcomes.
A multicenter study published in JACC Cardiovascular Interventions (2021) assessed the efficacy of the transradial approach in managing bifurcation lesions. The study found that TRI in bifurcation lesions was associated with high technical success rates, minimal complications, and favorable clinical outcomes. The ability to achieve high procedural success while minimizing complications highlights the potential of TRA in complex coronary disease management. [4]
Acute Coronary Syndrome and Bifurcation Lesions
In patients with acute coronary syndrome, the combination of complex coronary lesions (such as bifurcation lesions) and the urgency of intervention creates a unique set of challenges. Studies have shown that in STEMI patients, a rapid approach is crucial, and TRA has been shown to reduce door-to-balloon times compared to femoral access, enhancing the overall success of primary percutaneous coronary interventions (PCI).
Recent trials and observational studies have found that TRA in ACS patients, including those with bifurcation lesions, results in comparable or even superior outcomes compared to the femoral approach. Notably, TRA has been associated with a lower incidence of bleeding complications, a shorter hospital stay, and a faster recovery time, which is particularly advantageous for ACS patients requiring urgent intervention.
Technical Challenges of TRI in Bifurcation Lesions
While TRA offers many benefits, it also presents certain challenges, particularly in managing complex lesions such as bifurcations. Accessing distal coronary segments and maintaining stable guide catheter support can be difficult in transradial procedures. Furthermore, the radial artery’s smaller caliber compared to the femoral artery may limit the use of larger catheters and stents, especially in complex interventions. [5]
To overcome these challenges, interventional cardiologists have developed strategies such as the use of smaller diameter catheters, careful guide catheter manipulation, and the use of advanced imaging techniques (e.g., intravascular ultrasound (IVUS) or optical coherence tomography (OCT)) to guide stent placement more accurately.
Outcomes and Follow-up
Several studies have reported excellent clinical outcomes in patients with bifurcation lesions treated using TRI. Follow-up data have shown that the incidence of major adverse cardiovascular events (MACE), including myocardial infarction, stroke, and death, is low in TRI-treated patients. Moreover, the long-term outcomes for ACS patients treated with TRA are comparable to those treated with the femoral approach, with reduced rates of access-site complications and restenosis.

4. Conclusions

In conclusion, transracial coronary interventions offer significant advantages in the management of acute coronary syndrome, especially in patients with bifurcation lesions. Despite some technical challenges, such as catheter manipulation and access to distal coronary segments, the transracial approach has proven to be effective in improving procedural outcomes, reducing complications, and shortening recovery times. As the techniques continue to evolve, TRA is likely to become the standard approach in managing complex coronary artery disease, including bifurcation lesions in ACS patients. Further studies and advancements in technology will continue to optimize its use, addressing current limitations and improving long-term outcomes.

References

[1]  Damonov F. A., et al. Syndrome of intestinal insufficiency and its correction in severely burned patients // Journal of Emergency Surgery named after I.I. Dzhanelidze. – 2021. – No. S1. – P. 20-21.
[2]  Arziyev I. A., et al. Problems of modern science and education // Problems of modern science and education Founders: Olimp. – Vol. 2. – P. 57-63.
[3]  Karabaev K. K., et al. Study of the frequency and types of cardiovascular pathology in burned patients // Journal of Emergency Surgery named after I.I. Dzhanelidze. – 2021. – No. S1. – P. 28-29.
[4]  Arzieva G. B., et al. Outcomes of pregnancy in thermal injury // Journal of Emergency Surgery named after I.I. Dzhanelidze. – 2021. – No. S1. – P. 9-9.
[5]  Shavkatov K., et al. Recurrent prolapse of pelvic organs in women // Journal of the Doctor's Bulletin. – 2016. – Vol. 1. – No. 1. – P. 60-64.
[6]  Khakimov E. A., et al. Experience in the treatment of suicidal burns // Journal of Emergency Surgery named after I.I. Dzhanelidze. – 2021. – No. S1. – P. 67-68.
[7]  Negmadjanov B. B., et al. Features of juvenile pregnancy (Literature review) // Journal of Reproductive Health and Uro-nephrological Research. – 2023. – Vol. 4. – No. 1.
[8]  Bozorova Kh., Mirzabekova M., Arzieva G. B. Study of patients with uterine scars using general clinical methods.