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Hahalis G, Deftereos S, Bertrand OF. Ulnar artery: The Ulysses ultimate resort for coronary procedures. Hellenic J Cardiol 2016; 57:S1109-9666(16)30146-4. [PMID: 27712911 DOI: 10.1016/j.hjc.2016.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/06/2016] [Indexed: 11/22/2022] Open
Abstract
Despite the increasing worldwide adoption of the transradial access site, the ulnar artery (UA) only very infrequently serves as a primary option for coronary procedures. In contrast to the uncertainty surrounding previous reports regarding the feasibility and safety, recent data from larger registries and randomized trials provide more conclusive evidence that the transulnar route may be safely selected as an alternative arterial access approach. However, a default transulnar strategy appears time-consuming and is associated with higher crossover rates compared with the radial artery (RA). Once arterial access is obtained, the likelihood of a successful coronary procedure is high and similar between the two forearm arteries. The UA has similar flow-mediating vasodilating properties with and seems at least as vulnerable as the RA with regard to incident occlusion, with UA occlusion (UAO) rates being probably higher than previously anticipated. A learning curve effect may not be apparent for crossover rates among experienced radialists, but increasing experience is associated with reduction in the fluoroscopy time, contrast volume and frequency of large hematoma formation. The UA may represents an important alternative access site for coronary procedures, and experienced radial operators should obtain additional skills to perform the transulnar approach. Nevertheless, in view of this method's lower feasibility compared to the RA, an initial ulnar access strategy should be reserved for carefully selected patients to ensure satisfactory cannulation rates.
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Stolker JM, Hadid M, Hussain ZM, Rough SJ, Ibrahim M, Kennedy KF, Safley DM, Baklanov DV, Neumayr RH. Training the next generation of invasive cardiologists: Feasibility of implementing a trans-radial access program at an academic hospital. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:431-437. [PMID: 27460342 DOI: 10.1016/j.carrev.2016.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/02/2016] [Accepted: 05/06/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Slow adoption of trans-radial access (TRA) for left heart catheterization (LHC) in the U.S. may be related to concerns about procedural complexity and a steep learning curve. However, TRA acceptance among novice operators remains poorly characterized. METHODS We initiated a 1-year TRA learning period among lower-risk outpatients, followed by a "radial-first" policy for all LHC patients beginning year 2. By year 3, all fellows prospectively collected diagnostic LHC data as part of a quality improvement study. TRA procedural characteristics were compared with patients undergoing trans-femoral access for the 3months prior to the TRA program, and trends over time were evaluated. RESULTS Between 7/2009 and 6/2012, we identified 960 patients undergoing LHC via TRA by 23 rotating cardiology fellows supervised by 5 interventional cardiologists. When evaluated against the 160 trans-femoral comparator patients, TRA patients had lower procedural success through the initial access site (88% vs. 99%, p<0.001) and longer fluoroscopy times (9.5 [5.8-15.9] vs. 6.5 [3.1-12.7] min, p<0.001), with similar contrast volumes and fewer catheters used. Despite tackling more complex patients during years 2-3, there were improvements in fluoroscopy times, catheter utilization, contrast volumes, and procedural success rates over time (all p<0.001). CONCLUSIONS The dedicated adoption of TRA by an academic catheterization laboratory demonstrated improvements in efficiency and resource utilization over a relatively short period of time. Additional exposure to TRA during training may help facilitate acceptance of this approach among the next generation of invasive cardiologists. SHORT SUMMARY (FOR ANNOTATED TABLE OF CONTENTS) When initiating a trans-radial access program for cardiac catheterization at an academic training hospital, procedural success rates were lower and fluoroscopy times were higher than traditional trans-femoral access. Nonetheless, other procedural variables were similar between the 2 approaches, and improvements over time were consistent with the learning curves reported among experienced cardiologists in prior studies. Exposure to trans-radial access during training may help facilitate acceptance of this approach among the next generation of invasive cardiologists.
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Affiliation(s)
- Joshua M Stolker
- Mercy Heart and Vascular, Washington and Saint Louis, MO, United States; Saint Louis University, Saint Louis, MO, United States.
| | - Mazen Hadid
- Saint Louis University, Saint Louis, MO, United States.
| | | | | | - Majd Ibrahim
- Saint Louis University, Saint Louis, MO, United States.
| | - Kevin F Kennedy
- Saint Luke's Mid America Heart Institute, Kansas City, MO, United States.
| | - David M Safley
- Saint Luke's Mid America Heart Institute, Kansas City, MO, United States.
| | - Dmitri V Baklanov
- Saint Luke's Mid America Heart Institute, Kansas City, MO, United States.
| | - Robert H Neumayr
- Mercy Heart and Vascular, Washington and Saint Louis, MO, United States; Saint Louis University, Saint Louis, MO, United States.
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103
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Affiliation(s)
- John A Bittl
- Interventional Cardiology Section, Munroe Regional Medical Center, Ocala, Florida.
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104
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Elmahdy MF, ElMaghawry M, Hassan M, Kassem HH, Said K, Elfaramawy AA. Comparison of Safety and Effectiveness Between Right Versus Left Radial Arterial Access in Primary Percutaneous Coronary Intervention for Acute ST Segment Elevation Myocardial Infarction. Heart Lung Circ 2016; 26:35-40. [PMID: 27374862 DOI: 10.1016/j.hlc.2016.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/12/2016] [Accepted: 04/23/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Transradial approach (TRA) is now considered the standard of care in many centres for elective and primary percutaneous intervention (PCI). The use of the radial approach in ST segment elevation myocardial infarction (STEMI) patients has been associated with a significant reduction in major adverse cardiac events. However, it is still unclear if the side of radial access (right vs. left) has impact on safety and effectiveness of TRA in primary PCI. So this study was conducted to compare the safety, feasibility, and outcomes of right radial access (RRA) vs. left radial access (LRA) in the setting of primary PCI. METHODS We retrospectively analysed the data of 400 consecutive patients presenting to our institution with STEMI for whom primary PCIs were performed via RRA and LRA. RESULTS Mean age of the whole studied population was 57±12.8 years, with male predominance (77.2%). There were 202 cases in the RRA group and 198 in the LRA group, with no significant difference in demographics and clinical characteristics for patients included in both groups. There was no significant difference in procedure success rate (97.5% for RRA vs. 98.4% for LRA; P=0.77). In addition, no significant difference between both approaches was observed in the contrast volume, number of catheters, fluoroscopy time (FT), needle-to-balloon time, post-procedure vascular complications, in hospital reinfarction, stroke/transient ischaemic attack (TIA) or death. CONCLUSION Right radial access and LRA are equally safe and effective in the setting of primary PCI. Both approaches have a high success rate and comparable needle-to-balloon time.
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Affiliation(s)
- Mahmoud Farouk Elmahdy
- Cardiology Department, Cairo University, Cairo, Egypt; Cardiology Department, Aswan Heart Centre, Aswan, Egypt.
| | | | | | | | - Karim Said
- Cardiology Department, Cairo University, Cairo, Egypt
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105
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Ferrante G, Rao SV, Jüni P, Da Costa BR, Reimers B, Condorelli G, Anzuini A, Jolly SS, Bertrand OF, Krucoff MW, Windecker S, Valgimigli M. Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials. JACC Cardiovasc Interv 2016; 9:1419-34. [PMID: 27372195 DOI: 10.1016/j.jcin.2016.04.014] [Citation(s) in RCA: 335] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 04/11/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of this study was to provide a quantitative appraisal of the effects on clinical outcomes of radial access for coronary interventions in patients with coronary artery disease (CAD). BACKGROUND Randomized trials investigating radial versus femoral access for percutaneous coronary interventions have provided conflicting evidence. No comprehensive quantitative appraisal of the risks and benefits of each approach is available across the whole spectrum of patients with stable or unstable CAD. METHODS The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for randomized trials comparing radial versus femoral access for coronary interventions. Data were pooled by meta-analysis using a fixed-effects or a random-effects model, as appropriate. Pre-specified subgroup analyses according to clinical presentation, in terms of stable CAD, non-ST-segment elevation acute coronary syndromes, or ST-segment elevation myocardial infarction were performed. RESULTS Twenty-four studies enrolling 22,843 participants were included. Compared with femoral access, radial access was associated with a significantly lower risk for all-cause mortality (odds ratio [OR]: 0.71; 95% confidence interval [CI]: 0.59 to 0.87; p = 0.001, number needed to treat to benefit [NNTB] = 160), major adverse cardiovascular events (OR: 0.84; 95% CI: 0.75 to 0.94; p = 0.002; NNTB = 99), major bleeding (OR: 0.53; 95% CI: 0.42 to 0.65; p < 0.001; NNTB = 103), and major vascular complications (OR: 0.23; 95% CI: 0.16 to 0.35; p < 0.001; NNTB = 117). The rates of myocardial infarction or stroke were similar in the 2 groups. Effects of radial access were consistent across the whole spectrum of patients with CAD for all appraised endpoints. CONCLUSIONS Compared with femoral access, radial access reduces mortality and MACE and improves safety, with reductions in major bleeding and vascular complications across the whole spectrum of patients with CAD.
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Affiliation(s)
- Giuseppe Ferrante
- Department of Cardiovascular Medicine, Humanitas Research Hospital, Humanitas Clinical and Research Center, Rozzano, Italy.
| | - Sunil V Rao
- Duke Clinical Research Institute, Durham, North Carolina
| | - Peter Jüni
- Applied Health Research Centre The HUB, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bruno R Da Costa
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Bernhard Reimers
- Department of Cardiovascular Medicine, Humanitas Research Hospital, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Gianluigi Condorelli
- Department of Cardiovascular Medicine, Humanitas Research Hospital, Humanitas Clinical and Research Center, Rozzano, Italy; Humanitas University, Rozzano, Italy
| | - Angelo Anzuini
- Department of Interventional Cardiology, Humanitas Mater Domini, Castellanza, Italy
| | - Sanjit S Jolly
- McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Olivier F Bertrand
- Interventional Cardiology, Quebec Heart-Lung Institute, Quebec City, Quebec, Canada
| | | | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland.
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106
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Singh S, Singh M, Grewal N, Khosla S. Transradial vs Transfemoral Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction: A Systemic Review and Meta-analysis. Can J Cardiol 2016; 32:777-90. [PMID: 27233893 DOI: 10.1016/j.cjca.2015.08.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/01/2015] [Accepted: 08/19/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The objective of this meta-analysis to evaluate safety and efficacy of transradial vs the transfemoral approach for primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients. METHODS Randomized controlled trials that compared the transfemoral vs the transradial approach in STEMI patients who underwent PCI were searched in PubMed, Embase, CENTRAL, Cumulative Index to Nursing and Allied Health Literature, and clinicaltrials.gov. Random effect models were used to pool effect sizes. RESULTS Sixteen trials, comprising data from 9726 patients, were included in the meta-analysis. All-cause mortality (risk ratio [RR], 0.68; 95% confidence interval [CI], 0.54-0.85; relative risk reduction [RRR], 32.8%; I(2) = 0), major bleeding (RR 0.56; 95% CI, 0.42-0.74; RRR, 48.1%; I(2) = 0), access site bleeding (RR, 0.38; 95% CI, 0.29-0.50; RRR, 63.9%; I(2) = 0), major adverse cardiovascular events (RR, 0.80; 95% CI, 0.68-0.94; RRR, 19.3%; I(2) = 0), and length of hospital stay (standardized mean difference, -0.38 days; 95% CI, -0.46 to -0.31 days) were significantly lower with the transradial compared with the transfemoral approach. The greatest reduction in major bleeding was found in the subgroup with trials recruiting only primary PCI participants compared with varying proportions of rescue PCIs. Glycoprotein IIb/IIIa inhibitor use and cross-over rates did not have a significant association with outcome measures in the subgroup analysis. Incidence of stroke was numerically greater with the transradial approach but did not achieve statistical significance (RR, 1.22; 95% CI, 0.56-2.66; I(2) = 0). Overall statistical heterogeneity (I(2)) was very low except for length of hospital stay. CONCLUSIONS The transradial approach for PCI in STEMI patients significantly reduced all-cause mortality, major and access site bleeding, major adverse cardiovascular events, and length of hospital stay. Difference in stroke incidence was not statistically significant with the transradial vs the transfemoral approach.
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Affiliation(s)
- Sukhchain Singh
- Department of Hospital Medicine at Ingalls Memorial Hospital, Harvey, Illinois, USA; Department of Cardiovascular Medicine at Mount Sinai Medical Center, Chicago, Illinois, USA.
| | - Mukesh Singh
- Chicago Medical School, North Chicago, Illinois, USA
| | - Navsheen Grewal
- Department of Cardiovascular Medicine at Mount Sinai Medical Center, Chicago, Illinois, USA; School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sandeep Khosla
- Department of Cardiovascular Medicine at Mount Sinai Medical Center, Chicago, Illinois, USA; Department of Cardiovascular Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
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107
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Angiolillo DJ, Bhatt DL, Steg PG, Stone GW, White HD, Gibson CM, Hamm CW, Price MJ, Prats J, Liu T, Mahaffey KW, Harrington RA. Impact of cangrelor overdosing on bleeding complications in patients undergoing percutaneous coronary intervention: insights from the CHAMPION trials. J Thromb Thrombolysis 2016; 40:317-22. [PMID: 26024789 DOI: 10.1007/s11239-015-1233-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Overdosing of parenteral antithrombotic therapies can increase the risk of bleeding. Cangrelor is a potent intravenous platelet P2Y12 receptor antagonist with rapid onset and offset of action. In patients undergoing percutaneous coronary interventions (PCI), compared with control, cangrelor (30 µg/kg bolus, followed immediately by a 4 µg/kg per minute infusion for 2-4 h or until the conclusion of the index PCI, whichever was longer) reduces periprocedural thrombotic complications without an increase in major bleeding complications, although minor bleeding is increased. The impact of cangrelor overdosing on bleeding is unknown and represented the aim of this analysis. Patients with cangrelor overdosing were identified among safety population patients enrolled in the CHAMPION program (n = 25,107). Overdose was defined as administration of an excess >20 % of the bolus dose (30 μg/kg) and/or infusion rate (4 μg/kg per min). Bleeding complications were assessed. Among the safety analysis population in the CHAMPION program, 12,565 patients received cangrelor. A total of 36 overdosed cangrelor patients (0.29 %) were identified in this pooled analysis (20 with both bolus and infusion, 5 with bolus only, and 11 with infusion only). In the majority of patients, the dose did not exceed 2.5 times the recommended dose. Bleeding events were balanced between treatment arms and were consistent with those in the overall CHAMPION program. Only one overdosed patient experienced a serious bleed. There was no correlation between bleeding and magnitude of cangrelor overdose. In a large clinical trial program of patients undergoing PCI, cangrelor overdosing was rare and not associated with an increase in bleeding complications, an observation that may be attributed to its very short-half life and rapid offset of action.
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Affiliation(s)
- Dominick J Angiolillo
- University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA,
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108
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Lee SH, Jeong MH, Han KR, Sim DS, Yoon J, Youn YJ, Cho BR, Cha KS, Hyon MS, Rha SW, Kim BO, Shin WY, Park KS, Cheong SS. Comparison of Transradial and Transfemoral Approaches for Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome and Anemia. Am J Cardiol 2016; 117:1582-1587. [PMID: 27018932 DOI: 10.1016/j.amjcard.2016.02.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Abstract
Anemia is an independent predictor of bleeding complications and poor clinical outcomes after percutaneous coronary intervention. Percutaneous coronary transradial intervention (TRI) is better than percutaneous coronary transfemoral intervention (TFI) in terms of reducing bleeding complications that can affect the prognosis. This study aims to investigate the clinical outcomes between TRI and TFI for patients with anemia. We analyzed periprocedure complications, in-hospital mortality, and major adverse cardiac events for one year in the Korean TRI registry from January 2013 to April 2014. Patients with chronic kidney disease for whom TFI is preferred were excluded. Anemia was defined as hemoglobin <13 g/dl for men and <12 g/dl for women. A total of 1,279 patients were finally enrolled. Of these, 348 patients had anemia. Among them, 253 patients (72.7%) underwent TRI and 95 patients (27.3%) underwent TFI. There were no significant differences of baseline demographic characteristics between the TRI and TFI groups, except for the incidence of dyslipidemia (TRI 23.7% vs TFI 12.6%, p = 0.023). Multivariate logistic regression analysis revealed lower incidence of composite severe bleeding complications (hazard ratio 0.34, 95% CI 0.12 to 0.99, p = 0.049) and lower incidence of in-hospital mortality than TFI group (hazard ratio 0.74, 95% CI 0.62 to 0.88, p = 0.042). In conclusion, this study suggests that the TRI for patients with anemia may be translated into better prognosis in terms of lower rates of bleeding complications and in-hospital mortality.
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109
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Pau D, Patel NJ, Patel N, Cohen MG. The Transradial Approach for Cardiac Catheterization and Percutaneous Coronary Intervention: A Review. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2016. [DOI: 10.15212/cvia.2016.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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110
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Radial versus femoral access for percutaneous coronary intervention in ST-elevation myocardial infarction patients treated with fibrinolysis: Results from the randomized routine early invasive clinical trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:295-301. [PMID: 27116940 DOI: 10.1016/j.carrev.2016.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/11/2016] [Accepted: 03/21/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND To investigate the relationship between arterial access site choice (radial versus femoral) and clinical outcomes among STEMI patients undergoing routine PCI after fibrinolysis. METHODS Patient-level data from trials of STEMI patients evaluating routine PCI after fibrinolysis were included. The primary endpoint was 30-day major bleeding; secondary endpoints included 30-day death and re-infarction. RESULTS 1891 patients underwent PCI (trans-radial n=338, trans-femoral n=1553). Trans-radial PCI patients were less likely to be >75years (2% vs. 8%, p=0.0001), heavier (median weight 82 [72-90] vs. 80 [70-90] kg, p=0.0013) and more likely in Killip class I at presentation (87% vs. 82%, p=0.03). At 30days, trans-radial PCI was associated with a similar unadjusted risk for major bleeding (3.7% vs. 1.2%, Odds Ratio [OR] 0.43 [95% CI 0.13-1.48], p=0.18), mortality (3.4% vs. 1.2%, OR 0.34 [0.09-1.28], p=0.11) and re-infarction (3.9% vs. 4.7%, OR 1.25 [0.60-2.58], p=0.56). In multivariable analysis, radial access was associated with similar estimates for bleeding and death/reinfarction risk. CONCLUSIONS In STEMI patients treated with fibrinolysis and undergoing an early routine invasive strategy, radial compared to femoral PCI is chosen in younger, less ill patients and is independently associated with similar risk of bleeding, re-infarction, and mortality. SUMMARY This study evaluated the relationship between arterial access choice (radial versus femoral) and in-hospital and 30-day outcomes in patients undergoing routine PCI after fibrinolysis for STEMI. We included patient-level data from trials evaluating a strategy of routine PCI after fibrinolysis for STEMI. Of 1891 patients undergoing PCI, trans-radial access (n=338) was chosen in younger, lower risk patients. At 30days, trans-radial access was associated with a similar unadjusted and adjusted risk of major bleeding, re-infarction and mortality.
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111
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Jin C, Li W, Qiao SB, Yang JG, Wang Y, He PY, Tang XR, Dong QT, Li XD, Yan HB, Wu YJ, Chen JL, Gao RL, Yuan JQ, Dou KF, Xu B, Zhao W, Zhang X, Xian Y, Yang YJ. Costs and Benefits Associated With Transradial Versus Transfemoral Percutaneous Coronary Intervention in China. J Am Heart Assoc 2016; 5:e002684. [PMID: 27107136 PMCID: PMC4843527 DOI: 10.1161/jaha.115.002684] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 03/12/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transradial percutaneous coronary intervention (PCI) has been increasingly adopted in clinical practice, given its potential advantages over transfemoral intervention; however, the impact of different access strategies on costs and clinical outcomes remains poorly defined, especially in the developing world. METHODS AND RESULTS Using data from a consecutive cohort of 5306 patients undergoing PCI in China in 2010, we compared total hospital costs and in-hospital outcomes for transradial intervention (TRI) and transfemoral intervention. Patients receiving TRI (n=4696, 88.5%) were slightly younger (mean age 57.4 versus 59.5 years), less often women (21.6% versus 33.1%), more likely to undergo PCI for single-vessel disease, and less likely to undergo PCI for triple-vessel or left main diseases. The unadjusted total hospital costs were 57 900 Chinese yuan (¥57 900; equivalent to 9190 US dollars [$9190]) for TRI and ¥67 418 ($10,701) for transfemoral intervention. After adjusting for all observed patient and procedural characteristics using the propensity score inverse probability weighting method, TRI was associated with a lower total cost (adjusted difference ¥8081 [$1283]). More than 80% of the cost difference was related to lower PCI-related costs (adjusted difference -¥5162 [-$819]), which were likely driven by exclusive use of vascular closure devices in transfemoral intervention, and lower hospitalization costs (-¥1399 [-$222]). Patients receiving TRI had shorter length of stay and were less likely to experience major adverse cardiac events or post-PCI bleeding. These differences were consistent among clinically relevant subgroups with acute myocardial infarction, acute coronary syndrome, and stable angina. CONCLUSIONS Among patients undergoing PCI, TRI was associated with lower cost and favorable clinical outcomes compared with transfemoral intervention.
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Affiliation(s)
- Chen Jin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Bin Qiao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin-Gang Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pei-Yuan He
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin-Ran Tang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiu-Ting Dong
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiang-Dong Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-Bing Yan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong-Jian Wu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ji-Lin Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Run-Lin Gao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin-Qing Yuan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ke-Fei Dou
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Zhao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Xian
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Yue-Jin Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Lim YH, Lee Y, Shin J, Yoon J, Lee SH, Rha SW, Lee JH, Jeong MH, Cho BR, Kim KS. Comparisons of Clinical and Procedural Outcomes Between Transradial and Transfemoral Approaches in Percutaneous Coronary Intervention (from the Korean Transradial Intervention Prospective Registry). Am J Cardiol 2016; 117:1272-81. [PMID: 26899492 DOI: 10.1016/j.amjcard.2016.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/22/2016] [Accepted: 01/22/2016] [Indexed: 10/22/2022]
Abstract
As few studies have reported the impact of transradial interventions (TRIs) versus transfemoral interventions (TFIs) on percutaneous coronary interventions using real-world registry data, we compared the clinical and procedural outcomes between TRIs and TFIs in the Korean Transradial Intervention Prospective Registry. Patients undergoing percutaneous coronary interventions were consecutively registered from February 2014 to July 2014 in this multicenter registry. Composite events were evaluated for all-cause deaths, nonfatal myocardial infarctions, and repeat revascularizations within 30 days. Nonlesion complications included access site complications and bleeding events. A total of 1,225 patients (232 for TFIs and 993 for TRIs) were analyzed. All-cause deaths and composite events were more frequent in the TFI group than in the TRI group. Procedure failures and nonlesion complications were also more frequent in the TFI group, whereas lesion complication rates were similar in the 2 groups. Procedure times were not different between the 2 groups, whereas fluoroscopy times were longer and contrast volumes were larger in the TFI group. However, in a propensity score-matched cohort, all-cause deaths, composite events, procedure failures, and lesion and nonlesion complications were not different between the 2 groups. In contrast, in the matched cohort, the procedure and fluoroscopy times were longer and the contrast volumes were larger in the TFI group. In conclusion, TRI was as effective and safe as TFI in terms of short-term clinical outcomes, procedure success rates, and complication rates, whereas TRI was more effective for reducing procedure times and hazardous exposure to radiation and contrast media.
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Davies RE, Gilchrist IC. It's still important, just doesn't hurt. Catheter Cardiovasc Interv 2016; 87:875-6. [DOI: 10.1002/ccd.26537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/10/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Rhian E. Davies
- MS Hershey Medical Center; Penn State University, College of Medicine, Heart & Vascular Institute; Hershey Pennsylvania
| | - Ian C. Gilchrist
- MS Hershey Medical Center; Penn State University, College of Medicine, Heart & Vascular Institute; Hershey Pennsylvania
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114
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Jang HJ, Kim JY, Han JD, Lee HJ, Kim JS, Park JS, Choi RK, Choi YJ, Shim WH, Kwon SW, Kim TH. Numbness after Transradial Cardiac Catheterization: the Results from a Nerve Conduction Study of the Superficial Radial Nerve. Korean Circ J 2016; 46:161-8. [PMID: 27014346 PMCID: PMC4805560 DOI: 10.4070/kcj.2016.46.2.161] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/13/2015] [Accepted: 07/28/2015] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives Numbness on the hand occurs infrequently after a transradial cardiac catheterization (TRC). The symptom resembles that of neuropathy. We, therefore, investigated the prevalence, the predicting factors and the presence of neurological abnormalities of numbness, using a nerve conduction study (NCS). Subjects and Methods From April to December 2013, all patients who underwent a TRC were prospectively enrolled. From among these, the patients who experienced numbness on the ipsilateral hand were instructed to describe their symptoms using a visual analogue scale; subsequently, NCSs were performed on these patients. Results Of the total 479 patients in the study sample, numbness occurred in nine (1.8%) following the procedure. The NCS was performed for eight out of the nine patients, four (50%) of which had an abnormal NCS result at the superficial radial nerve. A larger sheath and history of myocardial infarction (p=0.14 and 0.08 respectively) tended towards the occurrence of numbness; however, only the use of size 7 French sheaths was an independent predictor for the occurrence of numbness (odds ratio: 5.50, 95% confidence interval: 1.06-28.58, p=0.042). The symptoms disappeared for all patients but one, within four months. Conclusion A transient injury of the superficial radial nerve could be one reason for numbness after a TRC. A large sheath size was an independent predictor of numbness; therefore, large sized sheaths should be used with caution when performing a TRC.
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Affiliation(s)
- Ho-Jun Jang
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Ji-Young Kim
- Department of Neurology, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Jae Deok Han
- Department of Rehabilitation, Sejong General Hospital, Bucheon, Korea
| | - Hyun Jong Lee
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Je Sang Kim
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Jin Sik Park
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Rak Kyeong Choi
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Young Jin Choi
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Won-Heum Shim
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Sung Woo Kwon
- Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
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115
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Rashid M, Kwok CS, Pancholy S, Chugh S, Kedev SA, Bernat I, Ratib K, Large A, Fraser D, Nolan J, Mamas MA. Radial Artery Occlusion After Transradial Interventions: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2016; 5:e002686. [PMID: 26811162 PMCID: PMC4859386 DOI: 10.1161/jaha.115.002686] [Citation(s) in RCA: 234] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/22/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Radial artery occlusion (RAO) may occur posttransradial intervention and limits the radial artery as a future access site, thus precluding its use as an arterial conduit. In this study, we investigate the incidence and factors influencing the RAO in the current literature. METHODS AND RESULTS We searched MEDLINE and EMBASE for studies of RAO in transradial access. Relevant studies were identified and data were extracted. Data were synthesized by meta-analysis, quantitative pooling, graphical representation, or by narrative synthesis. A total of 66 studies with 31 345 participants were included in the analysis. Incident RAO ranged between <1% and 33% and varied with timing of assessment of radial artery patency (incidence of RAO within 24 hours was 7.7%, which decreased to 5.5% at >1 week follow-up). The most efficacious measure in reducing RAO was higher dose of heparin, because lower doses of heparin were associated with increased RAO (risk ratio 0.36, 95% CI 0.17-0.76), whereas shorter compression times also reduced RAO (risk ratio 0.28, 95% CI 0.05-1.50). Several factors were found to be associated with RAO including age, sex, sheath size, and diameter of radial artery, but these factors were not consistent across all studies. CONCLUSIONS RAO is a common complication of transradial access. Maintenance of radial patency should be an integral part of all procedures undertaken through the radial approach. High-dose heparin along with shorter compression times and patent hemostasis is recommended in reducing RAO.
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Affiliation(s)
- Muhammad Rashid
- St. Helens & Knowsley Teaching Hospital (NHS) TrustWhiston HospitalPrescotUK
- Keele Cardiovascular Research GroupUniversity of KeeleStoke‐on‐TrentUK
| | - Chun Shing Kwok
- Keele Cardiovascular Research GroupUniversity of KeeleStoke‐on‐TrentUK
| | - Samir Pancholy
- The Wright Center for Graduate Medical EducationThe Commonwealth Medical CollegeScrantonPA
| | | | | | - Ivo Bernat
- University Hospital and Faculty of Medicine PilsenPilsenCzech Republic
| | - Karim Ratib
- Royal Stoke HospitalUniversity Hospital North Midlands TrustStoke‐on‐TrentUK
| | - Adrian Large
- Royal Stoke HospitalUniversity Hospital North Midlands TrustStoke‐on‐TrentUK
| | - Doug Fraser
- Manchester Heart CentreManchester Royal InfirmaryManchesterUK
| | - James Nolan
- Royal Stoke HospitalUniversity Hospital North Midlands TrustStoke‐on‐TrentUK
| | - Mamas A. Mamas
- Keele Cardiovascular Research GroupUniversity of KeeleStoke‐on‐TrentUK
- Royal Stoke HospitalUniversity Hospital North Midlands TrustStoke‐on‐TrentUK
- Farr InstituteInstitute of Population HealthUniversity of ManchesterUK
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Bavishi C, Panwar SR, Dangas GD, Barman N, Hasan CM, Baber U, Kini AS, Sharma SK. Meta-Analysis of Radial Versus Femoral Access for Percutaneous Coronary Interventions in Non-ST-Segment Elevation Acute Coronary Syndrome. Am J Cardiol 2016; 117:172-8. [PMID: 26704032 DOI: 10.1016/j.amjcard.2015.10.039] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/22/2015] [Accepted: 10/22/2015] [Indexed: 11/29/2022]
Abstract
Radial access for percutaneous coronary intervention (PCI) has been shown to reduce mortality and vascular complications compared to femoral access in patients with ST-segment elevation myocardial infarction. However, efficacy and safety of radial access PCI in non-ST-segment elevation acute coronary syndrome (NSTE ACS) is not well understood. A systematic search of electronic databases was performed through July 2015 to search and identify relevant studies. We evaluated the following short-term outcomes: all-cause mortality, major bleeding, access site bleeding, and need for blood transfusions. In addition, we evaluated 1-year mortality. Studies were pooled using random effects model. Nine studies including a total of 220,126 patients (radial approach: 94,663 patients [43%], femoral approach: 125,463 patients [57%]) were included in the analysis. On pooled analysis, no significant difference in incidence of short-term all-cause mortality was found between radial and femoral access (odds ratio [OR] 0.78, 95% CI 0.57 to 1.07, p = 0.12). Radial access was associated with significant reduction in major bleeding (OR 0.52, 95% CI 0.36 to 0.73, p = 0.0002), access-site bleeding (OR 0.41, 95% CI 0.22 to 0.78, p = 0.007), and need for blood transfusions (OR 0.61, 95% CI 0.41 to 0.91, p = 0.02). Furthermore, the 1-year mortality was significantly lower in radial approach (OR 0.72, 95% CI 0.55 to 0.95, p = 0.02). In conclusion, in patients with non-ST-segment elevation acute coronary syndrome undergoing PCI, radial access is associated with decreased bleeding and access-site complications.
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Affiliation(s)
- Chirag Bavishi
- Department of Cardiology, Mount Sinai St. Luke's & West Hospitals, New York, New York
| | - Sadik R Panwar
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York
| | - George D Dangas
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York
| | - Nitin Barman
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York
| | - Choudhury M Hasan
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York
| | - Usman Baber
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York
| | - Annapoorna S Kini
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York
| | - Samin K Sharma
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York.
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Abstract
OPINION STATEMENT Since its first introduction, radial access for diagnostic and interventional cardiovascular procedures has progressively evolved with advances in understanding, capabilities, and ease of operation. Numerous studies have demonstrated its safety, efficacy, and cost-effectiveness. Overall, radial catheterization is a valid alternative to the femoral approach with additional benefits of shorter length of hospital stay and reduced patient costs when performed by experienced interventionists. Moreover, with reduced rates of access site complications and enhanced patient satisfaction, the transradial approach has emerged as the preferred vascular access route for most coronary interventions, even in cases of acute myocardial infarction.
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118
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Andò G, Capodanno D. Radial Versus Femoral Access in Invasively Managed Patients With Acute Coronary Syndrome: A Systematic Review and Meta-analysis. Ann Intern Med 2015; 163:932-40. [PMID: 26551857 DOI: 10.7326/m15-1277] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Studies in patients with acute coronary syndrome (ACS) undergoing invasive management showed conflicting conclusions regarding the effect of access site on outcomes. PURPOSE To summarize evidence from recent, high-quality trials that compared clinical outcomes occurring with radial versus femoral access in invasively managed adults with ACS. DATA SOURCES English-language publications in MEDLINE, EMBASE, and Cochrane databases between January 1990 and August 2015. STUDY SELECTION Randomized trials of radial versus femoral access in invasively managed patients with ACS. DATA EXTRACTION Two investigators independently extracted the study data and rated the risk of bias. DATA SYNTHESIS Of 17 identified randomized trials, 4 were high-quality multicenter trials that involved a total of 17 133 patients. Pooled data from the 4 trials showed that radial access reduced death (relative risk [RR], 0.73 [95% CI, 0.59 to 0.90]; P = 0.003), major adverse cardiovascular events (RR, 0.86 [CI, 0.75 to 0.98]; P = 0.025), and major bleeding (RR, 0.57 [CI, 0.37 to 0.88]; P = 0.011). Radial procedures lasted slightly longer (standardized mean difference, 0.11 minutes) and had higher risk for access-site crossover (6.3% vs. 1.7%) than did femoral procedures. LIMITATION Heterogeneity in outcomes definitions and potential treatment modifiers across studies, including operator experience in radial procedures and concurrent anticoagulant regimens. CONCLUSION Compared with femoral access, radial access reduces mortality, major adverse cardiovascular events, and major bleeding in patients with ACS undergoing invasive management. PRIMARY FUNDING SOURCE None. (PROSPERO registration number: CRD42015022031).
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Affiliation(s)
- Giuseppe Andò
- From the University of Messina, Messina, and Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Davide Capodanno
- From the University of Messina, Messina, and Ferrarotto Hospital, University of Catania, Catania, Italy
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119
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Azzalini L, Tosin K, Chabot-Blanchet M, Avram R, Ly HQ, Gaudet B, Gallo R, Doucet S, Tanguay JF, Ibrahim R, Grégoire JC, Crépeau J, Bonan R, de Guise P, Nosair M, Dorval JF, Gosselin G, L'Allier PL, Guertin MC, Asgar AW, Jolicœur EM. The Benefits Conferred by Radial Access for Cardiac Catheterization Are Offset by a Paradoxical Increase in the Rate of Vascular Access Site Complications With Femoral Access: The Campeau Radial Paradox. JACC Cardiovasc Interv 2015; 8:1854-64. [PMID: 26604063 DOI: 10.1016/j.jcin.2015.07.029] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 07/30/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to assess whether the benefits conferred by radial access (RA) at an individual level are offset by a proportionally greater incidence of vascular access site complications (VASC) at a population level when femoral access (FA) is performed. BACKGROUND The recent widespread adoption of RA for cardiac catheterization has been associated with increased rates of VASCs when FA is attempted. METHODS Logistic regression was used to calculate the adjusted VASC rate in a contemporary cohort of consecutive patients (2006 to 2008) where both RA and FA were used, and compared it with the adjusted VASC rate observed in a historical control cohort (1996 to 1998) where only FA was used. We calculated the adjusted attributable risk to estimate the proportion of VASC attributable to the introduction of RA in FA patients of the contemporary cohort. RESULTS A total of 17,059 patients were included. At a population level, the VASC rate was higher in the overall contemporary cohort compared with the historical cohort (adjusted rates: 2.91% vs. 1.98%; odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.17 to 1.89; p = 0.001). In the contemporary cohort, RA patients experienced fewer VASC than FA patients (adjusted rates: 1.44% vs. 4.19%; OR: 0.33, 95% CI: 0.23 to 0.48; p < 0.001). We observed a higher VASC rate in FA patients in the contemporary cohort compared with the historical cohort (adjusted rates: 4.19% vs. 1.98%; OR: 2.16, 95% CI: 1.67 to 2.81; p < 0.001). This finding was consistent for both diagnostic and therapeutic catheterizations separately. The proportion of VASCs attributable to RA in the contemporary FA patients was estimated at 52.7%. CONCLUSIONS In a contemporary population where both RA and FA were used, the safety benefit associated with RA is offset by a paradoxical increase in VASCs among FA patients. The existence of this radial paradox should be taken into consideration, especially among trainees and default radial operators.
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Affiliation(s)
- Lorenzo Azzalini
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Kunle Tosin
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Robert Avram
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Hung Q Ly
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Benoit Gaudet
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Richard Gallo
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Serge Doucet
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Réda Ibrahim
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Jean C Grégoire
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Jacques Crépeau
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Raoul Bonan
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Pierre de Guise
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Mohamed Nosair
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Gilbert Gosselin
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | | | - Anita W Asgar
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - E Marc Jolicœur
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
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120
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Patel T, Shah S, Pancholy S. "Combo" technique for the use of 7F guide catheter system during transradial approach. Catheter Cardiovasc Interv 2015; 86:1033-40. [PMID: 26255995 DOI: 10.1002/ccd.26119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 07/05/2015] [Indexed: 11/09/2022]
Abstract
Even a regular lumen of radial artery may create difficulty in smooth negotiation and propagation of a 7F guide catheter while performing intervention through transradial approach. We describe successive five cases of a simple and innovative "Combo" technique, which helps relatively atraumatic tracking of a 7F guide catheter through the course of arm and chest vasculature for successful completion of procedure without significant damage and local pain.
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Affiliation(s)
- Tejas Patel
- Apex Heart Institute, Ahmedabad, India.,Department of Cardiology, Sheth V.S. General Hospital and Smt. N.H.L. Municipal Medical College, Ahmedabad, India
| | - Sanjay Shah
- Apex Heart Institute, Ahmedabad, India.,Department of Cardiology, Sheth V.S. General Hospital and Smt. N.H.L. Municipal Medical College, Ahmedabad, India
| | - Samir Pancholy
- Department of Cardiology, the Wright Center for Graduate Medical Education, the Commonwealth Medical College, Scranton, Pennsylvania
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121
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Gutierrez JA, Harrington RA, Blankenship JC, Stone GW, Steg PG, Gibson CM, Hamm CW, Price MJ, Généreux P, Prats J, Deliargyris EN, Mahaffey KW, White HD, Bhatt DL. The effect of cangrelor and access site on ischaemic and bleeding events: insights from CHAMPION PHOENIX. Eur Heart J 2015; 37:1122-30. [PMID: 26400827 PMCID: PMC4823635 DOI: 10.1093/eurheartj/ehv498] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/28/2015] [Indexed: 12/17/2022] Open
Abstract
Aims To assess whether the use of the femoral or radial approach for percutaneous coronary intervention (PCI) interacted with the efficacy and safety of cangrelor, an intravenous P2Y12 inhibitor, in CHAMPION PHOENIX. Methods and results A total of 11 145 patients were randomly assigned in a double-dummy, double-blind manner either to a cangrelor bolus and 2-h infusion or to clopidogrel at the time of PCI. The primary endpoint, a composite of death, myocardial infarction, ischaemia-driven revascularization, or stent thrombosis, and the primary safety endpoint, Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) defined severe bleeding, were evaluated at 48 h. Of the patients undergoing PCI and receiving study drug treatment, a total of 8064 (74%) and 2855 (26%) patients underwent femoral or radial PCI, respectively. Among the femoral cohort, the primary endpoint rate was 4.8% with cangrelor vs. 6.0% with clopidogrel (odds ratio, OR [95% confidence interval, CI] = 0.79 [0.65–0.96]); among the radial cohort, the primary endpoint was 4.4% with cangrelor vs. 5.7% with clopidogrel (OR [95% CI] = 0.76 [0.54–1.06]), P-interaction 0.83. The rate of GUSTO severe bleeding in the femoral cohort was 0.2% with cangrelor vs. 0.1% with clopidogrel (OR [95% CI] = 1.73 [0.51–5.93]). Among the radial cohort, the rate of GUSTO severe bleeding was 0.1% with cangrelor vs. 0.1% with clopidogrel (OR [95% CI] = 1.02 [0.14–7.28]), P-interaction 0.65. The evaluation of safety endpoints with the more sensitive ACUITY-defined bleeding found major bleeding in the femoral cohort to be 5.2% with cangrelor vs. 3.1% with clopidogrel (OR [95% CI] = 1.69 [1.35–2.12]); among the radial cohort the rate of ACUITY major bleeding was 1.5% with cangrelor vs. 0.7% with clopidogrel (OR [95% CI] = 2.17 [1.02–4.62], P-interaction 0.54). Conclusion In CHAMPION PHOENIX, cangrelor reduced ischaemic events with no significant increase in GUSTO-defined severe bleeding. The absolute rates of bleeding, regardless of the definition, tended to be lower when PCI was performed via the radial artery. Clinical trial registration http://www.clinicaltrials.gov identifier: NCT01156571.
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Affiliation(s)
- J Antonio Gutierrez
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | | | | | - Gregg W Stone
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY, USA
| | - Ph Gabriel Steg
- DHU FIRE, INSERM Unité 1148, Université Paris-Diderot, and Hôpital Bichat, Assistance-Publique-Hôpitaux de Paris, Paris, France NHLI, Imperial College, Royal Brompton Hospital, London, UK
| | - C Michael Gibson
- Beth Israel Deaconess Medical Center, Division of Cardiology, Boston, MA, USA
| | | | - Matthew J Price
- Scripps Clinic and Scripps Translational Science Institute, La Jolla, CA, USA
| | - Philippe Généreux
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY, USA
| | | | | | | | - Harvey D White
- Green Lane Cardiovascular Service, Auckland, New Zealand
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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122
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Kedev S, Petkoska D, Zafirovska B, Vasilev I, Bertrand OF. Safety of Slender 5Fr Transradial Approach for Carotid Artery Stenting With a Novel Nitinol Double-Layer Micromesh Stent. Am J Cardiol 2015; 116:977-81. [PMID: 26189035 DOI: 10.1016/j.amjcard.2015.05.063] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 05/31/2015] [Accepted: 05/31/2015] [Indexed: 11/17/2022]
Abstract
We aimed to evaluate the feasibility and safety of performing percutaneous carotid stent implantation with a newly designed double-layer stent using transradial slender 5Fr techniques. We recruited 10 consecutive patients who underwent percutaneous carotid stenting using nitinol double-layer micromesh (Roadsaver) stents. Mean age of patients was 66 years. Seven patients had ≥2 high-risk criteria according to SAPPHIRE classification. Indication was neurologic symptoms in 7 and severe lesion without symptoms in 3 cases. Type 2 aortic arch was present in 8 patients and type 1 in 2 patients. Access was right radial artery in 9 cases and right ulnar artery in 1 case. Right carotid artery was stented in 4 cases and left carotid artery in 6 cases. Embolic protection device (EPD) was used in 6 cases. Nine stents were successfully delivered using 5Fr destination sheath (n = 7) or shuttle sheath (n = 2), and 1 was implanted using Mo-Ma 8Fr proximal EPD. Procedural success was obtained in all cases with only 1 case of temporary vasospasm due to distal EPD. Total procedural time was 21 minutes (13 to 30 minutes) with filter time of 5 ± 1 minutes. Fluoroscopy time was 8 minutes (5 to 12 minutes) and contrast volume was 150 ml (100 to 200 ml). Hospital stay was 1 ± 1 day with 4 patients discharged on the same day of the procedure. Using right transradial approach and slender 5Fr techniques, this new double-layer micromesh stent can be implanted in left and right carotid arteries with promising results.
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Affiliation(s)
- Sasko Kedev
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia.
| | - Danica Petkoska
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Biljana Zafirovska
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Ivan Vasilev
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Olivier F Bertrand
- Interventional Cardiology, Quebec Heart-Lung Institute, Quebec, Quebec, Canada
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Roule V, Lemaitre A, Sabatier R, Lognoné T, Dahdouh Z, Berger L, Milliez P, Grollier G, Montalescot G, Beygui F. Transradial versus transfemoral approach for percutaneous coronary intervention in cardiogenic shock: A radial-first centre experience and meta-analysis of published studies. Arch Cardiovasc Dis 2015; 108:563-75. [PMID: 26365478 DOI: 10.1016/j.acvd.2015.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 04/22/2015] [Accepted: 06/01/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND The transradial approach for percutaneous coronary intervention (PCI) is associated with a better outcome in myocardial infarction (MI), but patients with cardiogenic shock (CS) were excluded from most trials. AIMS To compare outcomes of PCI for MI-related CS via the transradial versus transfemoral approach. METHODS A prospective cohort of 101 consecutive patients admitted for PCI for MI-related CS were treated via the transradial (n=74) or transfemoral (n=27) approach. Cox proportional hazards models adjusted for prespecified variables and a propensity score for approach were used to compare mortality, death/MI/stroke and bleeding between the two groups. A complementary meta-analysis of six studies was also performed. RESULTS Patients in the transradial group were younger (P=0.039), more often male (P=0.002) and had lower GRACE and CRUSADE scores (P=0.003 and 0.001, respectively) and rates of cardiac arrest before PCI (P=0.009) and mechanical ventilation (P=0.006). Rates of PCI success were similar. At a mean follow-up of 756 days, death occurred in 40 (54.1%) patients in the transradial group versus 22 (81.5%) in the transfemoral group (adjusted hazard ratio [HR]: 0.49, 95% confidence interval [CI] 0.28-0.84; P=0.012). The transradial approach was associated with reduced rates of death/MI/stroke (adjusted HR: 0.53, 95%CI: 0.31-0.91; P=0.02) and major bleeding (adjusted HR: 0.34, 95%CI: 0.13-0.87; P=0.02). The meta-analysis confirmed the benefit of transradial access in terms of mortality (relative risk [RR]: 0.63, 95%CI: 0.58-0.68) and major bleeding (RR: 0.43, 95%CI: 0.32-0.59). CONCLUSION The transradial approach in the setting of PCI for ischaemic CS is associated with a dramatic reduction in mortality, ischaemic and bleeding events, and should be preferred to the transfemoral approach in radial expert centres.
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Affiliation(s)
- Vincent Roule
- Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - Adrien Lemaitre
- Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - Rémi Sabatier
- Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - Thérèse Lognoné
- Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - Ziad Dahdouh
- Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - Ludovic Berger
- Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - Paul Milliez
- Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - Gilles Grollier
- Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - Gilles Montalescot
- ACTION academic group, Institut de Cardiologie, Pitié-Salpêtrière University Hospital, 75013 Paris, France
| | - Farzin Beygui
- Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France; ACTION academic group, Institut de Cardiologie, Pitié-Salpêtrière University Hospital, 75013 Paris, France.
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Miyasaka M, Tada N, Kato S, Kami M, Horie K, Honda T, Takizawa K, Otomo T, Inoue N. Sheathless guide catheter in transradial percutaneous coronary intervention for ST-segment elevation myocardial infarction. Catheter Cardiovasc Interv 2015; 87:1111-7. [PMID: 26354160 DOI: 10.1002/ccd.26144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 07/17/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of this study was to assess the safety and efficacy of sheathless guide catheters in transradial percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). BACKGROUND Transradial PCI for STEMI offers significant clinical benefits, including a reduced incidence of vascular complications. As the size of the radial artery is small, the radial artery is frequently damaged in this procedure using large-bore catheters. A sheathless guide catheter offers a solution to this problem as it does not require an introducer sheath. However, the efficacy and safety of sheathless guide catheters remain to be fully determined in emergent transradial PCI for STEMI. METHODS Data on consecutive STEMI patients undergoing primary PCI at the Sendai Kousei Hospital between September 2010 and May 2013 were analyzed. The primary endpoint was the rate of acute procedural success without access site crossover. Secondary endpoints included door-to-balloon time, fluoroscopy time, volume of contrast, and radial artery stenosis or occlusion rate. RESULTS We conducted transradial PCI for 478 patients with STEMI using a sheathless guide catheter. Acute procedural success was achieved in 466 patients (97.5%). The median door-to-balloon time was 45 min (range, 15-317 min). The median fluoroscopy time was 16.4 min (range, 10-90 min). The median volume of contrast was 134 mL (range, 31-431 mL). Radial stenosis or occlusion developed in 14 (3.8%) of the 370 evaluable patients. CONCLUSIONS This study showed that use of a sheathless guide catheter taking a transradial approach was effective and safe in primary PCI for STEMI. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Masaki Miyasaka
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Shigeaki Kato
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Masahiro Kami
- Division of Social Communication System for Advanced Clinical Research, Institute of Medical Science, University of Tokyo, Minato-Ku, Tokyo, Japan
| | - Kazunori Horie
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Taku Honda
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Kaname Takizawa
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Tatsushi Otomo
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Naoto Inoue
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Miyagi, Japan
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125
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Sciahbasi A, Rigattieri S, Sarandrea A, Cera M, Di Russo C, Fedele S, Romano S, Penco M, Rocco Pugliese F. Radial artery occlusion and hand strength after percutaneous coronary procedures: Results of the HANGAR study. Catheter Cardiovasc Interv 2015; 87:868-74. [PMID: 26269451 DOI: 10.1002/ccd.26142] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/27/2015] [Accepted: 07/17/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The aim of this prospective study was to evaluate muscle force of the hand, thumb, and forefinger in patients with prolonged radial occlusion after transradial percutaneous coronary procedures. BACKGROUND There are no data on hand strength and function in patients with prolonged radial occlusion after percutaneous coronary procedures. METHODS Elective patients with chronic stable angina undergoing percutaneous coronary procedures were evaluated the day before the procedure for radial artery patency, Allen test, hand grip, and thumb and forefinger pinch tests. The same measures were performed the day after the procedure and at follow-up. At follow-up, patients were divided in two groups according to the radial patency (group 1) or occlusion (group 2). RESULTS Of the 99 patients included in the study, 90 patients had a patent radial artery (group 1), and nine (9.1%) patients had an occluded artery (group 2). At baseline, there were no significant differences in hand grip test between the two groups (42 ± 11 kg in group 1 and 41 ± 17 kg in group 2, P = 0.74). In both groups, after the procedure, the hand grip test values was significantly reduced compared with baseline values (40 ± 11 kg in group 1, P < 0.0001 and 37 ± 17 kg in group 2, P = 0.007). Finally, at follow-up, in both groups, the hand grip test values returned to baseline values. Thumb and forefinger pinch tests did not show significant differences after the procedure and at follow-up, compared with baseline. CONCLUSIONS Radial artery occlusion after percutaneous coronary procedures was not associated with a reduction in hand and finger strength.
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Affiliation(s)
| | | | | | - Maria Cera
- Interventional Cardiology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Cristian Di Russo
- Interventional Cardiology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Silvio Fedele
- Interventional Cardiology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Silvio Romano
- Department of Cardiology, University of L'aquila, L'aquila, Italy
| | - Maria Penco
- Department of Cardiology, University of L'aquila, L'aquila, Italy
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126
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Mamas MA, Fraser DG, Ratib K, Fath-Ordoubadi F, El-Omar M, Nolan J, Neyses L. Minimising radial injury: prevention is better than cure. EUROINTERVENTION 2015; 10:824-32. [PMID: 24472679 DOI: 10.4244/eijv10i7a142] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Transradial (TR) coronary intervention is associated with fewer access-site-related bleeding complications and is independently associated with a lower risk of mortality following PCI compared to procedures undertaken through the femoral route. However, recent studies that have undertaken imaging of the radial artery through the use of IVUS and OCT, as well as histological studies, suggest that TR cardiac catheterisation is associated with significant injury to the radial artery wall resulting in significant endothelial cell dysfunction. The vascular endothelium plays a central role in the regulation of vascular tone, angiogenesis and vascular remodelling through the release of vasoactive mediators in response to a variety of stimuli. Hence, trauma to the vascular endothelium and subsequent changes in endothelial cell function may contribute to patterns of injury such as intimal hyperplasia and radial artery occlusion observed following TR cardiac catheterisation. Such injury patterns to the radial artery following TR procedures may limit the success and future utility of the TR approach. Minimisation of radial artery injury should be a key procedural component of procedures undertaken through the transradial approach.
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Affiliation(s)
- Mamas A Mamas
- Manchester Heart Centre, Manchester Royal Infirmary, Biomedical Research Centre, Manchester, United Kingdom
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127
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Le J, Bangalore S, Guo Y, Iqbal SN, Xu J, Miller LH, Coppola J, Shah B. Predictors of Access Site Crossover in Patients Who Underwent Transradial Coronary Angiography. Am J Cardiol 2015; 116:379-83. [PMID: 26026865 PMCID: PMC4499487 DOI: 10.1016/j.amjcard.2015.04.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/16/2015] [Accepted: 04/16/2015] [Indexed: 01/01/2023]
Abstract
Despite increasing use of the transradial approach (TRA) for coronary angiography, TRA failure and subsequent access site crossover remain a barrier to TRA adoption. The aim of this study was to elucidate patient and procedural characteristics associated with TRA to transfemoral approach (TFA) crossover and examine TRA to TFA crossover by operator experience over time. This retrospective analysis identified 1,600 patients who underwent coronary angiography with possible percutaneous coronary intervention through TRA by operators with varied TRA experience in an urban tertiary care center from October 2010 to August 2013. Univariate and multivariable logistic regression were used to identify independent predictors of access site crossover, from TRA to TFA, and strength of association is presented as odds ratio (OR, 95% confidence interval [CI]). Access site crossover was noted in 166 patients (10.4%). Multivariable predictors of access site crossover included age >75 years (OR 1.90, 95% CI 1.23 to 2.91, p = 0.004) and operator experience (OR 2.98, 95% CI 1.96 to 4.52, p <0.0001). Less experienced operators (≤5 years TRA experience) had a decrease in access site crossover over time (quartile 1: 8.9%, quartile 2: 18.8%, quartile 3: 16.4%, and quartile 4: 8.6%, p <0.001), which paralleled an increase in the proportion of procedures using initial TRA over time (quartile 1: 38.0%, quartile 2: 53.7%, quartile 3: 54.8%, and quartile 4: 70.3%, p <0.001). Experienced operators (>5 years TRA experience) had no significant change in proportion of access site crossover over time (quartile 1: 2.8%, quartile 2: 6.4%, quartile 3: 5.6%, quartile 4: 5.8%, p = 0.54). In conclusion, rate of access site crossover in the contemporary era is relatively low and can be mitigated with operator experience.
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Affiliation(s)
- Jeffrey Le
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Sripal Bangalore
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Yu Guo
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York
| | - Sohah N Iqbal
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Jinfeng Xu
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York
| | - Louis H Miller
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
| | - John Coppola
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Binita Shah
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
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128
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Pancholy SB, Palamaner Subash Shantha G, Romagnoli E, Kedev S, Bernat I, Rao SV, Jolly S, Bertrand OF, Patel TM. Impact of access site choice on outcomes of patients with cardiogenic shock undergoing percutaneous coronary intervention: A systematic review and meta-analysis. Am Heart J 2015; 170:353-61. [PMID: 26299234 DOI: 10.1016/j.ahj.2015.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 05/05/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND The benefit of transradial access (TRA) in patients with cardiogenic shock (CS) is uncertain. We sought to determine the benefits of TRA in patients with CS undergoing coronary angiography/intervention. METHODS MEDLINE, Embase, Cochrane Central, and electronic databases were searched for studies that assessed the following: (1) patients with CS who underwent percutaneous coronary intervention (PCI) and (2) the association between choice of arterial access, 30-day all-cause mortality, and 30-day major adverse cardiac and cerebral events (MACCEs) using random-effects model. RESULTS From 3,652 retrieved citations, 8 studies involving 8,131 patients with CS undergoing PCI (via TRA: 2,321 patients, via TFA: 5,810 patients) were included. Transradial access was associated with significantly reduced risk for all-cause mortality (unadjusted: risk ratio [RR] 0.60, 95% CI 0.52-0.71, P < .001, I(2) = 29%, 8 included studies; adjusted: RR 0.55, 95% CI 0.46-0.65, P < .001, I(2) = 0%, 6 included studies) and MACCE (unadjusted: RR 0.68, 95% CI 0.63-0.73, P < .001, I(2) = 0%, 6 included studies; adjusted: RR 0.63, 95% CI 0.52-0.75, P < .001, I(2) = 0%, 4 included studies) at 30 days when compared with TFA. CONCLUSIONS Transradial access is associated with reduced mortality and MACCE at 30 days in patients with CS undergoing PCI. Considering the possible influence of selection bias on the effect estimate in our analysis, randomized controlled trials are needed to better assess this association.
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129
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Khoo CW, Holroyd EW, Butler R, Nolan J, Mamas MA. Transradial percutaneous coronary intervention in high-risk patients. Interv Cardiol 2015. [DOI: 10.2217/ica.15.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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130
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The choice of arterial access for percutaneous coronary intervention and its impact on outcome: An expert opinion perspective. Am Heart J 2015; 170:13-22. [PMID: 26093860 DOI: 10.1016/j.ahj.2015.04.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/23/2015] [Indexed: 11/20/2022]
Abstract
The prevention of major bleeding during percutaneous coronary intervention is one of the most widely discussed and often controversial topics within interventional cardiology. The choice of arterial access should be considered a mechanism for bleeding avoidance, and various strategies have been proposed to prevent or lower major bleeding and vascular complications with varying levels of strength. Herein, we review the current literature on arterial access as a bleeding avoidance strategy during percutaneous coronary intervention and its impact on outcome and provide a consensus opinion based on the strength of the evidence supporting various techniques.
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131
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Awad H, Quevedo E, Abas M, Brown M, Satiani B, Capers Q, Starr JE. Can the Anesthesiologist Use the Radial Artery for Monitoring After Transradial Artery Catheterization? ACTA ACUST UNITED AC 2015; 4:159-62. [PMID: 26050247 DOI: 10.1213/xaa.0000000000000151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The use of transradial coronary angiography and intervention is growing because of its advantages over the femoral approach. However, the small size of the radial artery can contribute to complications. We present a case of an in situ access complication of transradial coronary artery catheterization. It is important for the anesthesiologist to know about the short-term and long-term consequences of this intervention, which could lead to narrowing of the artery even beyond the site of puncture. Understanding these changes could help anesthesiologists make better decisions about using the radial artery for monitoring after transradial coronary artery catheterization procedures.
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Affiliation(s)
- Hamdy Awad
- From the *Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio; †Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio; and ‡Division of Cardiovascular Medicine, Department of Medicine, The Ohio State University, Wexner Medical Center, Columbus, Ohio
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132
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Huff CM, Kapadia S, Rao SV. Mechanisms by which transradial approach may reduce mortality in ST-segment-elevation myocardial infarction. Circ Cardiovasc Interv 2015; 7:621-7. [PMID: 25139088 DOI: 10.1161/circinterventions.114.001627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Christopher M Huff
- From the Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (C.M.H., S.K.); and The Duke Clinical Research Institute, Durham, NC (S.V.R.)
| | - Samir Kapadia
- From the Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (C.M.H., S.K.); and The Duke Clinical Research Institute, Durham, NC (S.V.R.).
| | - Sunil V Rao
- From the Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (C.M.H., S.K.); and The Duke Clinical Research Institute, Durham, NC (S.V.R.)
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133
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Hahalis G, Xathopoulou I, Tsigkas G, Almpanis G, Christodoulou I, Grapsas N, Davlouros P, Koniari I, Deftereos S, Raisakis K, Christopoulou G, Giannopoulos G, Kounis N, Pyrgakis V, Alexopoulos D. A comparison of low versus standard heparin dose for prevention of forearm artery occlusion after 5 French coronary angiography. Int J Cardiol 2015; 187:404-10. [DOI: 10.1016/j.ijcard.2015.03.366] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 03/23/2015] [Accepted: 03/25/2015] [Indexed: 01/28/2023]
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134
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A predictive score of radial artery spasm in patients undergoing transradial percutaneous coronary intervention. Int J Cardiol 2015; 188:76-80. [PMID: 25889332 DOI: 10.1016/j.ijcard.2015.04.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 03/10/2015] [Accepted: 04/03/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Radial artery spasm may hinder completion of transradial angiography or PCI, leading to access site crossover, prolonged procedure times and complications. The aim of this study was to derive a radial artery spasm risk score in patients undergoing elective percutaneous coronary intervention (PCI), prospectively validate it, and apply it in a real-life clinical setting. METHODS The study population consisted of 3 cohorts of patients undergoing elective PCI with transradial access: the derivation cohort (N=1006), the validation cohort (N=576) and the intervention cohort (N=140), consisting of patients with high risk score, in whom intensified spasm-preventive measures were applied. RESULTS Multivariable analysis in the derivation cohort showed that 5 weighted factors could be used to construct a risk score for spasm: body-mass index, height, current smoking, hypertension and peripheral artery disease (c-statistic 0.945, with an optimal cut-off of 4). In the validation cohort, the cut-off of 4 predicted spasm with a sensitivity of 84.5% and a specificity of 74.7%. In the intervention cohort, which included only patients with a spasm-risk score of ≥4, the rate of spasm was drastically reduced (odds ratio 0.32, 95% confidence interval 0.17-0.61), compared to the corresponding high spasm risk subgroup of patients of the validation cohort. CONCLUSION A spasm risk score can be used to predict radial artery spasm during elective transradial PCI. Using this score, a high spasm risk patient subgroup can be identified, where intensive spasm-preventive measures can lead to a significant reduction in the frequency of spasm.
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135
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Transradial left ventricular endomyocardial biopsy: assessment of safety and efficacy. Clin Res Cardiol 2015; 104:773-81. [DOI: 10.1007/s00392-015-0844-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/12/2015] [Indexed: 10/23/2022]
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136
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Wagener JF, Rao SV. A comparison of radial and femoral access for cardiac catheterization. Trends Cardiovasc Med 2015; 25:707-13. [PMID: 25912254 DOI: 10.1016/j.tcm.2015.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 03/24/2015] [Accepted: 03/24/2015] [Indexed: 01/26/2023]
Abstract
Over the past several years, the transradial approach (TRA) for cardiac catheterization has become increasingly adopted in the United States. The increased utilization of the TRA is grounded on 2 decades of research, showing reduced bleeding and vascular complications to complement improved patient quality of life. However, the concern over cost, radiation exposure, and acknowledged "learning curve" has kept the transfemoral approach (TFA) the mainstay of most US catheterization laboratories. More recent larger multi-centered randomized studies have aimed to address outcomes and these concerns between the TR and TF approaches. This article will review the changing trends in TRA in the US, discuss clinical (bleeding and mortality) and non-clinical (quality of life and cost) outcomes from recent randomized studies, and finally discuss certain aspects when it comes to adopting TRA.
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Affiliation(s)
| | - Sunil V Rao
- Duke Clinical Research Institute, Durham, NC
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137
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Alfonso CE, Cohen MG. Diagnostic and Guide Catheter Selection and Manipulation for Radial Approach. Interv Cardiol Clin 2015; 4:145-159. [PMID: 28582046 DOI: 10.1016/j.iccl.2014.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Transradial catheterization and percutaneous coronary interventions have multiple advantages, including reduced bleeding risk, reduced length of stay and costs, and increased patient comfort. Transradial catheterization and interventions requires the acquisition of various additional skill sets including radial arterial puncture, the ability to navigate the upper extremity vasculature, and understanding catheter selection and coronary engagement technique. Although standard femoral catheter shapes perform adequately from the left or right radial approach for coronary angiography, for percutaneous coronary intervention guide catheter support is critical. This article summarizes some practical learning points pertaining to navigating the upper extremity vasculature, and understanding catheter selection and coronary engagement technique.
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Affiliation(s)
- Carlos E Alfonso
- Cardiac Catheterization Laboratory, Cardiovascular Division, Department of Medicine, University of Miami Hospital, University of Miami Miller School of Medicine, 1400 Northwest 12th Avenue, Miami, FL 33136, USA
| | - Mauricio G Cohen
- Cardiac Catheterization Laboratory, Cardiovascular Division, Department of Medicine, University of Miami Hospital, University of Miami Miller School of Medicine, 1400 Northwest 12th Avenue, Miami, FL 33136, USA.
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138
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Abstract
Despite advances in antithrombotic and antiplatelet therapy, bleeding complications remain an important cause of morbidity and mortality in patients with acute ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Many bleeding events are related to the access site. Transradial access (TRA) PPCI is associated with significant reduction in bleeding and vascular complications and reduced cardiac mortality compared with the transfemoral approach (TFA). High-risk patients might particularly benefit from TRA. Radial skills providing procedural times and success rates comparable with those of the TFA are strongly recommended before using this technique in the STEMI PPCI setting.
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Affiliation(s)
- Sasko Kedev
- Medical Faculty, University Clinic of Cardiology, University of St. Cyril & Methodius, Vodnjanska 17, Skopje 1000, Macedonia.
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139
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Le L, Brooks A, Donovan M, Smith TA, Sternbergh WC, Bazan HA. Transradial approach for percutaneous intervention of malfunctioning arteriovenous accesses. J Vasc Surg 2015; 61:747-53. [DOI: 10.1016/j.jvs.2014.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
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140
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Anderson SG, Ratib K, Myint PK, Keavney B, Kwok CS, Zaman A, Ludman PF, de Belder MA, Nolan J, Mamas MA. Impact of age on access site-related outcomes in 469,983 percutaneous coronary intervention procedures: Insights from the British Cardiovascular Intervention Society. Catheter Cardiovasc Interv 2015; 86:965-72. [DOI: 10.1002/ccd.25896] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 02/08/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Simon G. Anderson
- Manchester Heart Centre, Manchester Royal Infirmary; Manchester United Kingdom
- Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester; Manchester United Kingdom
| | - Karim Ratib
- Department of Cardiology; University Hospital of North Staffordshire; Stoke-on-Trent, North Staffordshire United Kingdom
| | - Phyo K. Myint
- Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen; Aberdeen Scotland United Kingdom
| | - Bernard Keavney
- Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester; Manchester United Kingdom
| | - Chun Shing Kwok
- Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester; Manchester United Kingdom
| | - Azfar Zaman
- Department of Cardiology; Freeman Hospital; Newcastle Upon Tyne and Institute of Cellular Medicine, Newcastle University; Newcastle United Kingdom
| | - Peter F. Ludman
- Department of Cardiology; Queen Elizabeth Hospital, Edgbaston; Birmingham United Kingdom
| | - Mark A. de Belder
- Department of Cardiology; The James Cook University Hospital; Middlesbrough United Kingdom
| | - James Nolan
- Department of Cardiology; University Hospital of North Staffordshire; Stoke-on-Trent, North Staffordshire United Kingdom
| | - Mamas A. Mamas
- Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester; Manchester United Kingdom
- Farr Institute; Institute of Population Health; University of Manchester; Manchester United Kingdom
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141
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Truesdell AG, Delgado GA, Blakeley SW, Bachinsky WB. Transradial peripheral vascular intervention: challenges and opportunities. Interv Cardiol 2015. [DOI: 10.2217/ica.14.67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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142
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Liu Q, Wu Q. Radiation protection in cardiovascular interventions: what can we do? Med Princ Pract 2015; 24:299. [PMID: 25823647 PMCID: PMC5588223 DOI: 10.1159/000380911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 02/15/2015] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Qinghua Wu
- *Qinghua Wu, Department of Cardiovascular Disease, Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, Jiangxi 330006 (PR China), E-Mail
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143
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Nakata T, Ikeda S, Koga S, Yoshida T, Koide Y, Kawano H, Maemura K, Kohno S. Impact of Catheter Sheath Insertion into the Radial Artery on Vascular Endothelial Function Assessed by Reactive Hyperemia Peripheral Arterial Tonometry. Int Heart J 2015; 56:489-94. [DOI: 10.1536/ihj.15-094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Tomoo Nakata
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Satoshi Ikeda
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Seiji Koga
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Takeo Yoshida
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Yuji Koide
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Hiroaki Kawano
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Shigeru Kohno
- Second Department of Internal Medicine, Nagasaki University School of Medicine
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144
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Zaky A, Bendjelid K. Appraising cardiac dysfunction in liver transplantation: an ongoing challenge. Liver Int 2015; 35:12-29. [PMID: 24797833 DOI: 10.1111/liv.12582] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 04/26/2014] [Indexed: 12/26/2022]
Abstract
End-stage liver disease (ESLD) is a multisystemic disease that adversely and mutually aggravates other organs such as the heart. Cardiac dysfunction in ESLD encompasses a spectrum of disease that could be aggravated, precipitated or be occurring hand-in-hand with coexisting aetiological factors precipitating cirrhosis. Additionally and more complexly, liver transplantation, the curative modality of ESLD, is responsible for additional intra- and postoperative short- and long-term cardiac morbidity. The phenotypic distinction of the different forms of cardiac dysfunction in ESLD albeit important prognostically and therapeutically is not allowed by the current societal recommendations, due to conceptual, and methodological limitations in the appraisal of cardiac function and structure in ESLD and in designing studies that are based on this appraisal. This review comprehensively discusses the spectrum of cardiac dysfunction in ESLD, discusses the limitations of the current appraisal of cardiac dysfunction in ESLD, and proposes a hypothetical approach for studying cardiac dysfunction in liver transplant candidates.
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Affiliation(s)
- Ahmed Zaky
- Department of Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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145
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Mamas MA, Anderson SG, Carr M, Ratib K, Buchan I, Sirker A, Fraser DG, Hildick-Smith D, de Belder M, Ludman PF, Nolan J. Baseline bleeding risk and arterial access site practice in relation to procedural outcomes after percutaneous coronary intervention. J Am Coll Cardiol 2014; 64:1554-64. [PMID: 25301457 DOI: 10.1016/j.jacc.2014.05.075] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/06/2014] [Accepted: 05/13/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Transradial access (TRA) has been associated with reduced access site-related bleeding complications and mortality after percutaneous coronary intervention (PCI). It is unclear, however, whether these observed benefits are influenced by baseline bleeding risk. OBJECTIVES This study investigated the relationship between baseline bleeding risk, TRA utilization, and procedure-related outcomes in patients undergoing PCI enrolled in the British Cardiovascular Intervention Society database. METHODS Baseline bleeding risk was calculated by using modified Mehran bleeding risk scores in 348,689 PCI procedures performed between 2006 and 2011. Four categories for bleeding risk were defined for the modified Mehran risk score (MMRS): low (<10), moderate (10 to 14), high (15 to 19), and very high (≥20). The impact of baseline bleeding risk on 30-day mortality and its relationship with access site were studied. RESULTS TRA was independently associated with a 35% reduction in 30-day mortality risk (odds ratio [OR]: 0.65 [95% confidence interval (CI): 0.59 to 0.72]; p < 0.0001), with the magnitude of mortality reduction related to baseline bleeding risk (MMRS <10, OR: 0.73 [95% CI: 0.62 to 0.86]; MMRS ≥20, OR: 0.53 [95% CI: 0.47 to 0.61]). In patients with an MMRS <10, TRA was used in 71,771 (43.2%) of 166,083 PCI procedures; TRA was used in 8,655 (40.1%) of 21,559 PCI procedures in patients with an MMRS ≥20, illustrating that TRA was used less in those at highest risk from bleeding complications (p < 0.0001). CONCLUSIONS TRA was independently associated with reduced 30-day mortality, and the magnitude of this effect was related to baseline bleeding risk; those at highest risk of bleeding complications gained the greatest benefit from adoption of TRA during PCI.
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Affiliation(s)
- Mamas A Mamas
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom; Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; Farr Institute, University of Manchester, Manchester, United Kingdom.
| | - Simon G Anderson
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom; Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Matthew Carr
- Institute of Population Health, University of Manchester, Manchester, United Kingdom
| | - Karim Ratib
- University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom
| | - Iain Buchan
- Farr Institute, University of Manchester, Manchester, United Kingdom; Institute of Population Health, University of Manchester, Manchester, United Kingdom
| | - Alex Sirker
- The Heart Hospital, University College London Hospitals, London, United Kingdom
| | - Douglas G Fraser
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Mark de Belder
- The James Cook University Hospital, Middlesbrough, United Kingdom
| | | | - James Nolan
- University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom
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146
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Yang J, Wang N, Tong X, Ye X, Zhou L, Tong G, Shen Y, Lv S. Impact of guidewire selection and operator expertise on radiation exposure in transradial angiography. J Cardiothorac Surg 2014; 9:194. [PMID: 25477256 PMCID: PMC4265418 DOI: 10.1186/s13019-014-0194-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Indexed: 11/17/2022] Open
Abstract
Background Several studies have implied that the time of radiation exposure for patients and operators during the transradial approach for coronary angiography (TRA) is associated with the use of different guidewire or catheter and operator’s finesse. This study aimed to assess the effects of non-hydrophilic or hydrophilic guidewire and operator expertise on fluoroscopy time and procedure time of TRA and further effects on the procedure safety. Methods A total of 1035 consecutive patients undergoing TRA were recruited prospectively and respectively divided into non-hydrophilic guidewire and hydrophilic guidewire group, or well-experienced group and less-experienced group. The primary endpoints were fluoroscopy time and procedure time. Secondary endpoints included contrast volume, cost, guidewire exchange, switchover and complications. Results TRA by non-hydrophilic guidewire group showed shorter fluoroscopy time and procedure time compared with hydrophilic guidewire group, similar results were found between well-experienced group and less-experienced group. Moreover, using of non-hydrophilic guidewire significantly reduced the incidence of hematoma and abnormal guidewie advancement, well-experienced group showed less dosage of contrast volume, lower incidence of radial artery spasm and frequency of guidewire exchange. Conclusions TRA by non-hydrophilic guidewire and well-experienced operator can decrease radiation exposure of patients and operators through reducing the fluoroscopy time and procedure time and further increase procedure safety. These will contribute to the optimization of TRA procedure and promote its widely application. Electronic supplementary material The online version of this article (doi:10.1186/s13019-014-0194-5) contains supplementary material, which is available to authorized users.
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147
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Hindoyan A, Clavijo L. Anticoagulants in an acute myocardial infarction: should we adopt a ‘back to the future’ strategy? Interv Cardiol 2014. [DOI: 10.2217/ica.14.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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148
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Allende R, Urena M, Cordoba JG, Ribeiro HB, Amat-Santos I, DeLarochellière R, Paradis JM, Doyle D, Mohammadi S, Côté M, Abdul-Jawad O, del Trigo M, Ortas MR, Laflamme L, Laflamme J, DeLarochellière H, Dumont E, Rodés-Cabau J. Impact of the use of transradial versus transfemoral approach as secondary access in transcatheter aortic valve implantation procedures. Am J Cardiol 2014; 114:1729-34. [PMID: 25439451 DOI: 10.1016/j.amjcard.2014.09.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 09/06/2014] [Accepted: 09/06/2014] [Indexed: 12/20/2022]
Abstract
No data exist on the impact of vascular complications related to the secondary access site in transcatheter aortic valve implantation (TAVI). The objectives of this nonrandomized study were to determine the rate of vascular complications related to the secondary access site in TAVI procedures and to evaluate the clinical impact of using the radial versus femoral approach as a secondary access in such procedures. A total of 462 consecutive patients (mean age 79 ± 9 years, 50% men) who underwent TAVI were included. The femoral approach (FA) was used as the secondary access (for the insertion of a 5F pigtail catheter) in 335 patients and the radial approach (RA) in 127 patients. Thirty-day events were prospectively collected. There were no baseline differences between groups, except for a higher prevalence of women and peripheral disease in the FA group (p <0.05 for both). A total of 74 vascular access site complications occurred in 70 patients (15%), and 23% of them (29% in the FA group) were related to the secondary access. The use of FA as secondary access was associated with a higher rate of vascular complications (5.0% vs 0% in the RA group, p = 0.005, adjusted p = 0.014). All major vascular complications related to the secondary access occurred in the FA group (3% vs 0% in the RA group, p = 0.040, adjusted p = 0.049), and this translated into a higher rate of major and/or life-threatening bleeding events related to the secondary access in the FA group (3% vs 0% in the RA group, p = 0.040, adjusted p = 0.049). In conclusion, about 1/4 of vascular access site complications in TAVI are related to the secondary access. The use of the RA as a secondary access was associated with a major reduction in vascular complications. These results highlight the impact of secondary access vascular complications in TAVI procedures and support the use of the RA as the preferred secondary access.
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149
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Charalambous MA, Constantinides SS, Talias MA, Soteriades ES, Christou CP. Repeated transradial catheterization: feasibility, efficacy, and safety. Tex Heart Inst J 2014; 41:575-8. [PMID: 25593518 DOI: 10.14503/thij-13-4000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Transradial access is an alternative to the transfemoral approach in coronary interventions. It results in less access-site bleeding, shorter hospital stays, lower costs, and less pain for the patient. However, some authors have suggested that the transradial approach might lead to radial artery occlusion, which precludes repeated same-artery catheterizations. Using data from our center, we evaluated the feasibility, safety, and efficacy of repeated transradial catheterization. We reviewed the 3,006 transradial catheterizations performed at our center from 2006 through 2009. Patients who had undergone at least one repeated transradial catheterization were identified, their cases monitored through 2012, and their baseline characteristics and other factors, including procedural sequelae, were analyzed. Seventy-nine patients underwent repeated right radial artery catheterizations, for a total of 92 repeated procedures. Repeated access to the right radial artery was not achieved in 4 attempts (failure rate, 4.3%), because of poor pulses or the operator's inability to advance the wire. No major sequelae were noted. The average times between the 1st to 2nd, 2nd to 3rd, and 3rd to 4th catheterizations were 406, 595, and 401 days, respectively. Our procedural success rate of 95.7% in performing repeated transradial catheterizations with no major sequelae provides support for the efficacy and safety of such procedures.
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150
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Gupta S, Cigarroa JE. A stitch in time. Catheter Cardiovasc Interv 2014; 84:772-3. [PMID: 25322715 DOI: 10.1002/ccd.25659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Saurabh Gupta
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health & Sciences University, Portland, Oregon
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