AJULAR Study Supports Transulnar Access for Coronary Interventions

March 15, 2015— Rajendra Gokhroo, MD, presented finding from the AJULAR (Ajmer Ulnar Artery) working group study at the American College of Cardiology’s (ACC) 64th annual scientific session in San Diego, California. The goal of the trial was to compare outcomes after transradial versus transulnar access in patients undergoing coronary angiography. The study’s findings suggest that transulnar access may have similar vascular, crossover, and spasm rates as transradial access in patients undergoing coronary angiography and intervention.

As summarized by the ACC, the trial randomized 2,532 patients in a 1:1 fashion to either transradial (n = 1,262) or transulnar (n = 1,270) access. All interventionists had a minimum experience of 50 transulnar cannulations. Inclusion criteria were that the ulnar artery was easily palpable and the anatomy was favorable. Exclusion criteria were the inability to palpate either the radial or ulnar artery, primary angioplasty, cardiogenic shock, patients on chronic hemodialysis, vasospastic disease (Raynaud’s disease), severe forearm skeletal deformities, and post–coronary artery bypass grafting.

The AJULAR investigators reported that the primary composite outcome of the rate of major adverse cardiac events or major vascular events for transulnar versus transradial access was 14.6% vs 14.4%; P = .92. The major adverse cardiac events rates were 2.9% for transulnar access versus 3.2% for transradial access (P = .79), and the rates of large hematoma were 1% versus 0.9%. Secondary outcomes included crossover (4.4% vs 3.8%; P = .44) and vessel spasm (6.9% vs 8.7%; P = .1).

According to the AJULAR investigators, the results of this trial indicate that transulnar catheterization is feasible and seems to have similar vascular, crossover, and spasm rates as transradial catheterization. Previous studies have shown that operator experience is key to successful completion, and in this trial, all operators had performed a minimum of 50 transulnar cases before. Transulnar catheterization may be a viable nonfemoral access route for coronary angiography and interventions, concluded the AJULAR investigators in the ACC summary.