Due to the ageing population and raised life expectancy, elderly patients are increasingly referred for percutaneous coronary intervention (PCI) during acute coronary syndromes (ACS). Bleeding complications are not infrequent during ACS, occurring in 2–5% of patients with prognostic and economic consequences. In particular, periprocedural bleeding and vascular complications are associated with worse clinical outcome, prolonged hospital stay and increased short- and long-term mortality, especially in elderly patients with acute coronary syndromes. We report the case of an 83-year old female referred to our hospital because of non-ST segment elevation myocardial infarction with high bleeding risk and unsuitable radial artery undergoing transulnar sheathless PCI during bivalirudin infusion. The clinical, technical, pharmacological and prognostic implications are discussed.
NewbyL.K.Acute coronary syndromes in the elderly.J Cardiovasc Med (Hagerstown).2011; 12: 220–2.
2.
HammC.W., BassandJ.P., AgewallS.ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).Eur Heart J Aug 26 2011. [Epub ahead of print]
3.
MoscucciM., FoxK.A., CannonC.P.Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE).Eur Heart J2003; 24: 1815–23.
4.
MehranR., PocockS.J., StoneG.W.Associations of major bleeding and myocardial infarction with the incidence and timing of mortality in patients presenting with non-ST-elevation acute coronary syndromes: a risk model from the ACUITY trial.Eur Heart J2009; 30: 1457–66.
5.
JollyS.S., AmlaniS., HamonM.Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials.Am Heart J2009; 15: 132–40.
6.
AgostoniP., Biondi-ZoccaiG.G., de BenedictisM.L.Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; Systematic overview and meta-analysis of randomized trials.J Am Coll Cardiol2004; 44: 349–56.
7.
AmorosoG., LaarmanG.J., KiemeneijF.Overview of the transradial approach in percutaneous coronary intervention.J Cardiovasc Med2007; 8: 230–7.
8.
AptecarE., PernesJ.M., Chabane-ChaouchM.Transulnar versus transradial artery approach for coronary angioplasty: the PCVI-CUBA study.Catheter Cardiovasc Interv2006; 67: 711–20.
9.
LimbrunoU., RossiniR., De CarloM.Percutaneous ulnar artery approach for primary coronary angioplasty: safety and feasibility.Catheter Cardiovasc Interv2004; 61: 56–9.
10.
ManginL., BertrandO.F., De La RochellièreR.The transulnar approach for coronary intervention: a safe alternative to transradial approach in selected patients.J Invasive Cardiol2005; 17: 77–9.
11.
RobertsE.B., PalmerN., PerryR.A.Transulnar access for coronary angiography and intervention: an early review to guide research and clinical practice.J Invasive Cardiol2007; 19: 83–7.
12.
DeftereosS., GiannopoulosG., TousoulisD.Sheathless transulnar versus standard femoral arterial access for percutaneous coronary intervention on bifurcation lesions.Int J Cardiol2011; 149: 398–400.
13.
VerheugtF.W., SteinhublS.R., HamonM.Incidence, prognostic impact, and influence of antithrombotic therapy on access and nonaccess site bleeding in percutaneous coronary intervention.JACC Cardiovasc Interv2011; 4: 191–7.
14.
MehranR., LanskyA.J., WitzenbichlerB.HORIZONS-AMI Trial Investigators. Bivalirudin in patients undergoing primary angioplasty for acute myocardial infarction (HORIZONS-AMI): 1-year results of a randomised controlled trial.Lancet2009; 374: 1149–59.
15.
AgostoniP., ZuffiA., Biondi-ZoccaiG.Pushing wrist access to the limit: homolateral right ulnar artery approach for primary percutaneous coronary intervention after right radial failure due to radial loop.Catheter Cardiovasc Interv2011; 78: 894–7.
16.
De AndradeP.B., TebetM., AndradeM.Performance of coronary procedures through the transulnar access without assessment of the integrity of the deep palmar arch.J Interv Cardiol2008; 21: 562–5.
