Introduction: The systemic immune inflammation index (SII), based on lymphocyte, neutrophil, and platelet counts, has been shown to be an independent indicator of no-reflow phenomenon during percutaneous intervention. However, the relationship between SII and no-reflow phenomenon (NRP) that...

Amaç: Üst ekstremite arterlerinden perkütan girişimler sonrası psödoanevrizma nadiren görülür. Bu çalışmada üst ekstremitede iatrojenik psödoanevrizması olan hastaların demografik özelliklerini ve psödoanevrizma tedavi yöntemlerini değerlendirmeyi amaçladık. Yöntem ve Gereçler: 2012-2022 yılları arasında kliniğimizde psödoanevrizma nedeniyle takip edilen 17 hasta retrospektif olarak incelendi. Son nokta sinir hasarı, kompartman sendromu, tromboembolik olay, fistül ve cerrahi ihtiyacı olarak belirlendi. Sinir hasarı, elektromiyografi ve semptomlarla görüldüğü gibi aksonal dejenerasyon olarak belirlendi. Bulgular: Çalışmaya alınan 17 hastanın 8'inde radial arter psödoanevrizması, 5'inde ulnar arter psödoanevrizması ve 4'ünde brakiyal arter psödoanevrizması gelişti. 15'i konservatif yöntemlerle tedavi edilirken, 2'si cerrahi olarak tedavi edildi. İkisinden biri geç dönemde teşhis edilen 9X9 mm çapındaki psödoanevrizma nedeniyle, diğeri ise ağrı ve 36x26 mm çapındaki psödoanevrizma nedeniyle ameliyat edildi. Bir hastada ulnar sinir hasarı tespit edildi. Bir hastaya fistül teşhisi konuldu. Ulnar sinir yaralanması ve brakial arterovenöz fistül konservatif yöntemlerle ameliyatsız tedavi edildi. Sonuç: Üst ekstremite arterlerinde perkütan girişim sonrası gelişen psödoanevrizmaların çoğu konservatif yöntemler ile tedavi edilebilmektedir. Girişimsel kardiyologlar psödoanevrizmalar için farklı tedavi yöntemlerinin olduğunu bilmeli ve güncel veriler ışığında başarılı bir şekilde tedavi edebilmelidir. Erken tanı ve tedavi, geç tanı daha kötü komplikasyonlara ve cerrahi müdahale gereksinimine yol açtığı için hayati önem taşımaktadır.

Objectives: This study presents our experience with prilocaine-induced methemoglobinemia in patients undergoing permanent pacemaker (PPM) or implantable cardioverter defibrillator (ICD) implantation. Methodology: We conducted a retrospective analysis of patients who developed clinically significant methemoglobinemia following PPM or ICD implantation between 2019 and 2023. Results: Out of 651 patients who underwent PPM or ICD implantation, 19 patients developed methemoglobinemia after prilocaine administration and were included in the analysis. Of these, 68.4% (13 patients) were female, with a mean age of 75.1 ± 10.1 years, indicating a predominantly elderly population. Regarding comorbidities, 16 patients had hypertension, 10 had diabetes mellitus, 7 had coronary artery disease, and 5 had congestive heart failure. A dual-chamber pacemaker was implanted in 12 patients, a single-chamber pacemaker in 3, a dual-chamber ICD in 2, and a single-chamber ICD in 2. The mean haemoglobin level was 11.5 ± 1.3 g/dL, with 13 patients (68.4%) presenting with anaemia. Mean serum albumin was 32.8 ± 3.7 g/dL, with hypoalbuminemia observed in 9 patients (47.4%). The mean glomerular filtration rate was 67.0 ± 23.3 mL/min/1.73 m², and 15 patients (78.9%) had reduced renal function. The average oxygen saturation among those who developed methemoglobinemia was 87.1 ± 2.0%. The mean MetHb level prior to treatment was 10.2 ± 3.9%, which significantly decreased to 1.9 ± 0.5% following treatment (p < 0.001). Conclusion: Clinicians should consider the possibility of methemoglobinemia in patients with unexplained low oxygen saturation that is inconsistent with their clinical presentation. Prompt administration of methylene blue in patients with comorbidities can lead to rapid clinical improvement.

Objectives: Radial artery spasm (RAS) is a common complication of transradial coronary angiography that may adversely affect procedural success and patient comfort. This study aimed to evaluate clinical, procedural, and anthropometric factors associated with RAS in patients undergoing elective transradial coronary angiography, with a particular focus on the wrist circumference-to-body mass index (WC/BMI) ratio as a novel predictor. Methods: A total of 466 patients who underwent elective coronary angiography via the right radial artery between January 2024 and December 2024 were included. All procedures were performed using a 6 Fr introducer sheath according to a standardized protocol. Radial artery spasm was clinically defined as operator resistance during catheter manipulation accompanied by patient-reported pain or marked discomfort in the accessed arm. Wrist circumference and body mass index were measured before the procedure, and the WC/BMI ratio was calculated. Radial artery diameter was assessed using ultrasonography. Variables associated with RAS were evaluated using univariable and multivariable logistic regression analyses. Due to collinearity between WC/BMI and radial artery diameter, two separate multivariable models were constructed. Discriminative performance was assessed using receiver operating characteristic (ROC) curve analysis. Results: Radial artery spasm occurred in 51 patients (10.9%). Patients who developed RAS had significantly lower WC/BMI ratios and smaller radial artery diameters compared with those without spasm (both p ≤ 0.001). In multivariable analysis, a lower WC/BMI ratio was independently associated with an increased risk of RAS (odds ratio [OR] 0.51 per 0.1-unit increase; 95% confidence interval [CI] 0.34–0.78; p = 0.002). Similarly, smaller radial artery diameter remained an independent predictor of RAS (OR 0.83 per 0.1 mm increase; 95% CI 0.75–0.92; p < 0.001). The area under the curve (AUC) was 0.651 for WC/BMI and 0.636 for radial artery diameter. The combined model demonstrated improved discriminative ability (AUC 0.713). Conclusions: The WC/BMI ratio is a simple, practical, and readily obtainable anthropometric parameter that can predict the risk of radial artery spasm before transradial coronary angiography. When combined with radial artery diameter, it provides improved discrimination for identifying patients at higher risk of RAS.

Background/Objectives: Transradial access (TRA) is a standard approach in the management of ST-segment elevation myocardial infarction (STEMI); however, evidence on using a single catheter for both diagnostic angiography and percutaneous coronary intervention (PCI) is limited. This study evaluates the feasibility and clinical outcomes of using a single Judkins Left (JL) 3.5 guiding catheter via TRA in STEMI patients. Methods: A total of 1139 patients undergoing radial access PCI with a single JL 3.5 catheter were included. Procedural success was defined as completing both diagnostic coronary angiography and PCI without catheter exchange. Procedural characteristics and access-site complications were evaluated. Results: The success rate of completing diagnostic angiography and PCI using a single JL 3.5 guiding catheter without catheter exchange was 91.1%. Compared to procedures requiring multiple catheters, the single-catheter group had significantly lower total contrast volume (200 vs. 250 mL), procedure time (20 vs. 30 min), fluoroscopy time (10.3 vs. 17.6 min), radiation dose (358 vs. 545 mGy), and needle-to-balloon time (6 vs. 9 min), all with p < 0.001. Access-site complications were also lower (8.2% vs. 15.8%; p = 0.010), primarily due to reduced radial artery spasm (4.0% vs. 12.9%; p = 0.001). Conclusions: A single JL 3.5 catheter strategy via transradial access is a safe, efficient, and effective method for STEMI intervention, offering significant procedural and clinical advantages.

Background: Transulnar access has emerged as a feasible alternative to transradial access for coronary angiography. However, the electrophysiological effects of proximal and distal transulnar approaches on ulnar nerve function remain insufficiently characterized. This study aimed to compare electrophysiological changes following proximal and distal transulnar coronary angiography and to evaluate their association with ulnar nerve involvement. Methods: This single-center retrospective observational study included 97 patients who underwent proximal (n = 56) or distal (n = 41) transulnar coronary angiography and developed post-procedural pain and/or paresthesia. Electroneuromyography and nerve conduction studies were performed before the procedure and at the fourth post-procedural week. Sensory and motor amplitudes, conduction velocities, and delta (Δ) changes were compared between groups. Generalized estimating equation analysis was additionally performed to evaluate longitudinal electrophysiological changes after adjustment for demographic and procedural variables. Results: No significant between-group differences were observed in pre- or post-procedural electrophysiological parameters. Although significant reductions in right ulnar sensory amplitude were observed over time, only 4 patients (4.1%) demonstrated post-procedural ulnar sensory amplitudes below the laboratory reference range, and no patient developed clinically significant ulnar neuropathy. Comparison of electrophysiological changes (Δ values) revealed no significant differences between proximal and distal transulnar access techniques. Generalized estimating equation analysis, adjusted for age and procedural characteristics, confirmed that the magnitude of electrophysiological changes over time was comparable between the two groups. Conclusions: Both proximal and distal transulnar access may be associated with mild, predominantly sensory, subclinical ulnar nerve involvement. However, distal transulnar access did not result in greater electrophysiological deterioration or additional neurological risk compared with proximal access.