Feasibility and applicability of coronary stent implantation with the direct brachial approach: Results of a single-center study

Implantation of stents in selected patients improves outcome after coronary angioplasty. Newer antiplatelet regimes limit access site complications associated with stenting by the percutaneous femoral approach, but a substantial proportion of patients will require anticoagulant therapy for concomitant disease or will have peripheral vascular disease that prevents access from the leg. We investigated procedural success and outcome in consecutive patients undergoing elective stent implantation in our institution. In 73 patients who were receiving anticoagulation therapy and were stented by a direct approach to the left brachial artery, 98.6% of stents were successfully deployed, with a major vascular access site complication rate of 1.4%. Equipment consumption, procedural success rate, and fluoroscopy time were similar in patients stented by the direct brachial or percutaneous femoral approach. Where the percutaneous femoral approach is precluded or patients are anticoagulated, stent procedures can be successfully performed by the direct brachial approach with a low rate of access site complications, even when large-caliber guiding catheters are required.