Abstract
Since September 2006, our institution has performed 64-slice multidetector computed tomographic coronary angiography (MDCTA), which allows coronary assessments. At this institution, approximately 200 dialysis patients are followed as outpatients or inpatients. Of these patients, those at high risk for ischemic heart disease are actively followed by to computed tomographic coronary angiography. A woman of highly advanced age (in her 90s) come to our institution on foot in order to undergo same-day coronary angiography via the right radial artery. Although she had experienced almost no chest symptoms indicating unstable angina, coronary MDCT suggested mild stenosis of the right coronary artery. The same-day coronary angiography demonstrated 99% stenosis in segment 1 of the proximal coronary artery. The lesion was much more severe than expected on prior angiograms. Following the same-day angiography, percutaneous coronary angioplasty was successfully performed via the right radial artery. Percutaneous coronary intervention (PCI) via the radial artery is called transradial intervention (TRI) by PCI specialists. Although TRI requires more advanced techniques than PCI via the femoral artery, it is less invasive (causing less bleeding) and safer than femoral PCI. The patient was at substantially higher risk for PCI because of her very advanced age and history of dialysis. Her chest pain was mild and stable and did not suggest the presence of such a severe stenosis, which could not be expected based on prior computed tomographic coronary angiography. Under these circumstances including risk factors, the highly stenotic lesion in the right proximal coronary artery was successfully treated by TRI, which is considered tolerable by patients of highly advanced age. We herein report this case of successful TRI with a discussion of the literature.
