Coronary angiography and angioplasty are commonly performed through the radial artery. In some patients, anatomical variations of the radial and brachial arteries, such as loops, increased tortuosity or sharp angulations may pose challenges to equipment advancement.
Both the hydrophilic guidewire 0,035'' approach and the "Serpentine" technique have been described in the literature as techniques for overcoming radial anatomical challenges, with the hydrophilic guidewire approach being the more commonly used method.
In practical terms, both techniques involve the use of the same standard materials, with differences relating mainly to operator handling and technical manipulation. This study does not introduce any experimental device, material, or treatment; instead, it aims to compare the established approach using a 0.035'' hydrophilic guidewire with the emerging " Serpentine" technique with respect to effectiveness, procedural time, and safety.
Age ≥18 years
Feasibility of TRA
Indication for coronary angiography
Angiographic documentation of radial or brachial artery loop/tortuosity
STEMI - high risk NSTEMI presentation
Hemodynamic instability
Anatomical contraindications (e.g., arteriovenous fistula)
Significant calcification of the radial or brachial artery on angiographic evaluation.
Parallel
Serpentine Technique
Procedure/SurgeryCatheter-based navigation technique using controlled rotational catheter manipulation to cross radial or brachial artery loops, tortuosity, or sharp angulation during transradial coronary angiography or PCI.
Hydrophilic Technique
Procedure/SurgeryNavigation of radial or brachial artery loops, tortuosity, or sharp angulation using a 0.035-inch hydrophilic guidewire during transradial coronary angiography or PCI.
Successful crossing of anatomical obstacles and procedure completion
Successful crossing of radial/brachial artery loops or tortuosity with completion of coronary angiography or PCI.
Total procedure time
Total procedure time until completion of coronary angiography or PCI.
Fluoroscopy time
Total fluoroscopy time measured during coronary angiography or PCI.
Radiation exposure
Cumulative radiation dose assessed by Air Kerma and Dose Area Product (DAP) during the procedure.
Contrast volume used
Total contrast medium volume used during coronary angiography or PCI.
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