comparison of coronary angiography results performed via radial or ulnar artery using a single catheter in patients presenting with acute ST elevation myocardial infraction

Comparison of coronary angiography results performed via radial or ulnar artery using a single catheter in patients presenting with acute st elevation myocardial infarction AIM: This study aims to compare the procedural success, complication rates, and clinical outcomes of transradial and transulnar arterial interventions in patients undergoing primary PCI due to acute ST-elevation myocardial infarction (STEMI). The effectiveness of access routes was specifically evaluated in procedures performed using a single catheter. MATERIALS AND METHODS: A total of 258 patients diagnosed with STEMI and undergoing primary PCI were included in the study. Eighteen patients were excluded for not meeting the study criteria, and the remaining 240 patients were randomized 1:1 into radial and ulnar groups. After randomization, four patients in the ulnar group could not undergo the procedure via the ulnar route; therefore, two patients continued via the femoral route, and two via the radial route. Similarly, in the radial group, nine patients could not proceed via the radial route; thus, two patients continued via the ulnar route, and seven via the femoral route. The remaining 231 patients underwent the procedure via the assigned route: 113 via the radial route (Group R) and 118 via the ulnar route (Group U), and their data were analyzed. Procedural success, the number of arterial punctures, procedure duration, complication rates (spasm, hematoma, arterial occlusion), and clinical outcomes were retrospectively compared. RESULTS: No significant difference in procedural success was observed between patients undergoing transulnar and transradial interventions. However, the number of arterial punctures was higher in the transulnar group (≥2 punctures: Group R: 24 (21.2%), Group U: 48 (40.7%); p=0.001), and the puncture duration was longer (Group R: 15 sec [10-20], Group U: 15 sec [10-30], p=0.001). The two groups had no significant difference regarding post-procedural hematoma formation or arterial occlusion rates. CONCLUSION: Our study demonstrated that single-catheter transulnar access, when performed by experienced operators, offers a similar procedural success rate and safety profile to transradial access. However, transulnar access was associated with a longer puncture duration and an increased number of puncture attempts. Transulnar access may be considered a reliable alternative when transradial access is not feasible. Keywords: Acute coronary syndrome, percutaneous coronary intervention, single catheter use, transradial access, transulnar Access