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Desai AM, Desai D, Gan A, Mehta D, Ding K, Gan F, Riangwiwat T, Sethi PS, Mukherjee A, Pai RG, Prasitlumkum N. Stroke risk in radial versus femoral approach in coronary intervention: an updated systematic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2023; 24:642-650. [PMID: 37409665 DOI: 10.2459/jcm.0000000000001485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
AIM Peri-cardiac catheterization (CC) stroke is associated with increased morbidity and mortality. Little is known about any potential difference in stroke risk between transradial (TR) and transfemoral (TF) approaches. We explored this question through a systematic review and meta-analysis. METHODS MEDLINE, EMBASE, and PubMed were searched from 1980 to June 2022. Randomized trials and observational studies comparing radial versus femoral access CC or intervention that reported stroke events were included. A random-effects model was used for analysis. RESULTS The total population in our 41 pooled studies comprised 1 112 136 patients - average age 65 years, women averaging 27% in TR and 31% in TF approaches. Primary analysis of 18 randomized-controlled trials (RCTs) that included a total of 45 844 patients showed that there was no statistical significance in stroke outcomes between the TR approach and the TF approach [odds ratio (OR) 0.71, 95% confidence interval (CI) 0.48-1.06, P -value = 0.013, I2 = 47.7%]. Furthermore, meta-regression analysis of RCTs including procedural duration between those two access sites showed no significance in stroke outcomes (OR 1.08, 95% CI 0.86-1.34, P -value = 0.921, I2 = 0.0%). CONCLUSIONS There was no significant difference in stroke outcomes between the TR approach and the TF approach.
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Affiliation(s)
- Aditya M Desai
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside
| | - Darshi Desai
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside
| | - Arnold Gan
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside
| | - Devanshi Mehta
- Osteopathic Medicine, Western University of Health Sciences, Pomona
| | - Kimberly Ding
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside
| | - Frances Gan
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside
| | - Tanawan Riangwiwat
- Division of Cardiology, University of California, Riverside School of Medicine, Riverside, California, USA
| | - Prabhdeep S Sethi
- Division of Cardiology, University of California, Riverside School of Medicine, Riverside, California, USA
| | - Ashis Mukherjee
- Division of Cardiology, University of California, Riverside School of Medicine, Riverside, California, USA
| | - Ramdas G Pai
- Division of Cardiology, University of California, Riverside School of Medicine, Riverside, California, USA
| | - Narut Prasitlumkum
- Division of Cardiology, University of California, Riverside School of Medicine, Riverside, California, USA
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Gil R, Shim DJ, Kim D, Lee DH, Kim JJ, Lee JW. Prostatic Artery Embolization for Lower Urinary Tract Symptoms via Transradial Versus Transfemoral Artery Access: Single-Center Technical Outcomes. Korean J Radiol 2022; 23:548-554. [PMID: 35506528 PMCID: PMC9081690 DOI: 10.3348/kjr.2021.0934] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the safety and feasibility of prostatic artery embolization (PAE) via transradial access (TRA) compared with transfemoral access (TFA). Materials and Methods This retrospective study included 53 consecutive men with lower urinary tract symptoms (LUTS) who underwent PAE between September 2018 and September 2021. Thirty-one patients (mean age ± standard deviation: 70.6 ± 8.4 years) were treated with TFA, including 14 patients treated before adopting TRA. Since December 2019, TRA has also been attempted with the procedure’s selection criteria of patent carpal circulation and a height ≤ 172 cm, with 22 patients treated via TRA (69.1 ± 9.6 years). Parameters of technical success (defined as successful bilateral embolization), clinical success (defined as LUTS improvement), procedural time, radiation dose, and adverse events were compared between the two groups using the Fisher’s exact test, independent sample t test, Wilcoxon signed-rank test, or Mann-Whitney test. Results All patients received at least one-side PAE. Technical success of PAE was achieved in most patients (TRA, 21/22; TFA, 30/31; p > 0.999). No technical problem-related conversion from TRA to TFA occurred. The clinical success rate was 85% (11/13) in patients with TRA, and 89% (16/18) in patients with TFA for follow-up > 2 weeks post-PAE (median, 3 months) (p > 0.999). The median procedure time was similar in both groups (TRA, 81 minutes vs. TFA, 94 minutes; p = 0.570). No significant dose differences were found between the TRA and TFA groups in the dose-area product (median Gycm2, 95 [range, 44–255] for TRA and 84 [34–255] for TFA; p = 0.678) or cumulative air kerma (median mGy, 609 [236–1584] for TRA and 634 [217–1594] for TFA; p = 0.551). No major adverse events occurred in either of the groups. Conclusion PAE via TRA is a safe and feasible method comparable to conventional TFA. It can be safely implemented by selecting patients with patent carpal circulation and adequate height.
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Affiliation(s)
- Ryun Gil
- Department of Radiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Jae Shim
- Department of Radiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Doyoung Kim
- Department of Radiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Hwan Lee
- Department of Urology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Jun Kim
- Department of Urology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Whee Lee
- Department of Radiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Bajraktari G, Rexhaj Z, Elezi S, Zhubi-Bakija F, Bajraktari A, Bytyçi I, Batalli A, Henein MY. Radial Access for Coronary Angiography Carries Fewer Complications Compared with Femoral Access: A Meta-Analysis of Randomized Controlled Trials. J Clin Med 2021; 10:jcm10102163. [PMID: 34067672 PMCID: PMC8156941 DOI: 10.3390/jcm10102163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND AIM In patients undergoing diagnostic coronary angiography (CA) and percutaneous coronary interventions (PCI), the benefits associated with radial access compared with the femoral access approach remain controversial. The aim of this meta-analysis was to compare the short-term evidence-based clinical outcome of the two approaches. METHODS The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) comparing radial versus femoral access for CA and PCI. We identified 34 RCTs with 29,352 patients who underwent CA and/or PCI and compared 14,819 patients randomized for radial access with 14,533 who underwent procedures using femoral access. The follow-up period for clinical outcome was 30 days in all studies. Data were pooled by meta-analysis using a fixed-effect or a random-effect model, as appropriate. Risk ratios (RRs) were used for efficacy and safety outcomes. RESULTS Compared with femoral access, the radial access was associated with significantly lower risk for all-cause mortality (RR: 0.74; 95% confidence interval (CI): 0.61 to 0.88; p = 0.001), major bleeding (RR: 0.53; 95% CI:0.43 to 0.65; p ˂ 0.00001), major adverse cardiovascular events (MACE)(RR: 0.82; 95% CI: 0.74 to 0.91; p = 0.0002), and major vascular complications (RR: 0.37; 95% CI: 0.29 to 0.48; p ˂ 0.00001). These results were consistent irrespective of the clinical presentation of ACS or STEMI. CONCLUSIONS Radial access in patients undergoing CA with or without PCI is associated with lower mortality, MACE, major bleeding and vascular complications, irrespective of clinical presentation, ACS or STEMI, compared with femoral access.
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Affiliation(s)
- Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (A.B.); (I.B.); (M.Y.H.)
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
- Medical Faculty, University of Prishtina “Hasan Prishtina”, 10000 Prishtina, Kosovo
- UBT College, 10000 Prishtina, Kosovo
- Correspondence:
| | - Zarife Rexhaj
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
| | - Shpend Elezi
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
- Medical Faculty, University of Prishtina “Hasan Prishtina”, 10000 Prishtina, Kosovo
| | - Fjolla Zhubi-Bakija
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
| | - Artan Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (A.B.); (I.B.); (M.Y.H.)
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
| | - Ibadete Bytyçi
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (A.B.); (I.B.); (M.Y.H.)
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
| | - Arlind Batalli
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
- Medical Faculty, University of Prishtina “Hasan Prishtina”, 10000 Prishtina, Kosovo
| | - Michael Y. Henein
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (A.B.); (I.B.); (M.Y.H.)
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Chiarito M, Cao D, Nicolas J, Roumeliotis A, Power D, Chandiramani R, Sartori S, Camaj A, Goel R, Claessen BE, Stefanini GG, Mehran R, Dangas G. Radial versus femoral access for coronary interventions: An updated systematic review and meta‐analysis of randomized trials. Catheter Cardiovasc Interv 2021; 97:1387-1396. [DOI: 10.1002/ccd.29486] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/06/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Mauro Chiarito
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
- Cardio Center Humanitas Clinical and Research Center IRCCS Milan Italy
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Anastasios Roumeliotis
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - David Power
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Rishi Chandiramani
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Anton Camaj
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Ridhima Goel
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Bimmer E. Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | | | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
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Zalocar LAD, Doroszuk G, Goland J. Transradial approach and its variations for neurointerventional procedures: Literature review. Surg Neurol Int 2020; 11:248. [PMID: 32905334 PMCID: PMC7468190 DOI: 10.25259/sni_366_2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/23/2020] [Indexed: 12/20/2022] Open
Abstract
Background: The transfemoral approach (TFA) has been the standard in neuroradiology over the years. However, the transradial approach (TRA) and its variants offer several benefits over the TFA. Methods: Review of the literature about TRA and its variations. We present our results for different neurointerventional procedures at our institution between January 2018 and December 2019. Results: We wrote an educational review describing anatomical and technical aspects, advantages, and complications of this approach. In the past year we increased the percentage of neurointerventional procedures performed through radial or ulnar arteries. Conclusion: There are clearly proven benefits of employing a wrist approach in patients for neurointerventional procedures and its utilization should especially be considered on a daily basis.
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Affiliation(s)
| | - Gustavo Doroszuk
- Neurointervention Section, Hospital El Cruce Néstor Kirchner, Florencio Varela
| | - Javier Goland
- Neurointervention Section, Hospital El Cruce Néstor Kirchner, Florencio Varela.,Department of Neurosurgery, University of Buenos Aires, Buenos Aires, Argentina
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6
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Chugh Y, Bavishi C, Mojadidi MK, Elgendy IY, Faillace RT, Brilakis ES, Tamis‐Holland J, Mamas M, Chugh SK. Safety of transradial access compared to transfemoral access with hemostatic devices (vessel plugs and suture devices) after percutaneous coronary interventions: A systematic review and
meta‐analysis. Catheter Cardiovasc Interv 2020; 96:285-295. [DOI: 10.1002/ccd.29061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/28/2020] [Accepted: 05/24/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Yashasvi Chugh
- Mount Sinai St Luke's Roosevelt Hospital New York New York
| | - Chirag Bavishi
- Rhode Island Hospital Warren Alpert Medical School of Brown University Providence Rhode Island
| | | | - Islam Y. Elgendy
- Massachusetts General Hospital and Harvard Medical School Boston Massachusetts
| | - Robert T. Faillace
- Jacobi Medical Center/Albert Einstein College of Medicine New York New York
| | - Emmanouil S. Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Minneapolis Minnesota
| | | | - Mamas Mamas
- Keele Cardiovascular Research Group Centre for Prognosis Research, Keele University United Kingdom
| | - Sanjay Kumar Chugh
- Jaipur National University Hospital and Medical College Institute for Medical Sciences and Research Center Jaipur India
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7
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Mason PJ, Shah B, Tamis-Holland JE, Bittl JA, Cohen MG, Safirstein J, Drachman DE, Valle JA, Rhodes D, Gilchrist IC. An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association. Circ Cardiovasc Interv 2019; 11:e000035. [PMID: 30354598 DOI: 10.1161/hcv.0000000000000035] [Citation(s) in RCA: 304] [Impact Index Per Article: 60.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Transradial artery access for percutaneous coronary intervention is associated with lower bleeding and vascular complications than transfemoral artery access, especially in patients with acute coronary syndromes. A growing body of evidence supports adoption of transradial artery access to improve acute coronary syndrome-related outcomes, to improve healthcare quality, and to reduce cost. The purpose of this scientific statement is to propose and support a "radial-first" strategy in the United States for patients with acute coronary syndromes. This document also provides an update to previously published statements on transradial artery access technique and best practices, particularly as they relate to the management of patients with acute coronary syndromes.
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8
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Wiemer M, Schäufele T, Schmitz T, Hoffmann S, Comberg T, Eggebrecht H, Langer C. Herzkatheter: Diagnostik und Intervention über die Arteria radialis. DER KARDIOLOGE 2018. [DOI: 10.1007/s12181-018-0264-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gajanana D, Rogers T, Iantorno M, Buchanan KD, Ben-Dor I, Pichard AD, Satler LF, Torguson R, Okubagzi PG, Waksman R. Antiplatelet and anticoagulation regimen in patients with mechanical valve undergoing PCI - State-of-the-art review. Int J Cardiol 2018; 264:39-44. [PMID: 29685692 DOI: 10.1016/j.ijcard.2018.03.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/06/2018] [Accepted: 03/21/2018] [Indexed: 11/29/2022]
Abstract
A common clinical dilemma regarding treatment of patients with a mechanical valve is the need for concomitant antiplatelet therapy for a variety of reasons, referred to as triple therapy. Triple therapy is when a patient is prescribed aspirin, a P2Y12 antagonist, and an oral anticoagulant. Based on the totality of the available evidence, best practice in 2017 for patients with mechanical valves undergoing percutaneous coronary intervention (PCI) is unclear. Furthermore, the optimal duration of dual antiplatelet therapy after PCI is evolving. With better valve designs that are less thrombogenic, the thromboembolic risks can be reduced at a lower international normalized ratio target, thus decreasing the bleeding risk. This review will offer an in-depth survey of current guidelines, current evidence, suggested approach for PCI in this cohort, and future studies regarding mechanical valve patients undergoing PCI.
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Affiliation(s)
- Deepakraj Gajanana
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Toby Rogers
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Micaela Iantorno
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Kyle D Buchanan
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Itsik Ben-Dor
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Augusto D Pichard
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Lowell F Satler
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Rebecca Torguson
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Petros G Okubagzi
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Ron Waksman
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, United States.
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10
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Kolkailah AA, Alreshq RS, Muhammed AM, Zahran ME, Anas El‐Wegoud M, Nabhan AF. Transradial versus transfemoral approach for diagnostic coronary angiography and percutaneous coronary intervention in people with coronary artery disease. Cochrane Database Syst Rev 2018; 4:CD012318. [PMID: 29665617 PMCID: PMC6494633 DOI: 10.1002/14651858.cd012318.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the major cause of mortality worldwide. Coronary artery disease (CAD) contributes to half of mortalities caused by CVD. The mainstay of management of CAD is medical therapy and revascularisation. Revascularisation can be achieved via coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Peripheral arteries, such as the femoral or radial artery, provide the access to the coronary arteries to perform diagnostic or therapeutic (or both) procedures. OBJECTIVES To assess the benefits and harms of the transradial compared to the transfemoral approach in people with CAD undergoing diagnostic coronary angiography (CA) or PCI (or both). SEARCH METHODS We searched the following databases for randomised controlled trials on 10 October 2017: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Web of Science Core Collection. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform in August 2017. There were no language restrictions. Reference lists were also checked and we contacted authors of included studies for further information. SELECTION CRITERIA We included randomised controlled trials that compared transradial and transfemoral approaches in adults (18 years of age or older) undergoing diagnostic CA or PCI (or both) for CAD. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. At least two authors independently screened trials, extracted data, and assessed the risk of bias in the included studies. We contacted trial authors for missing information. We used risk ratio (RR) for dichotomous outcomes and mean difference (MD) or standardised mean difference (SMD) for continuous data, with their 95% confidence intervals (CIs). All analyses were checked by another author. MAIN RESULTS We identified 31 studies (44 reports) including 27,071 participants and two ongoing studies. The risk of bias in the studies was low or unclear for several domains. Compared to the transfemoral approach, the transradial approach reduced short-term net adverse clinical events (NACE) (i.e. assessed during hospitalisation and up to 30 days of follow-up) (RR 0.76, 95% CI 0.61 to 0.94; 17,133 participants; 4 studies; moderate quality evidence), cardiac death (RR 0.69, 95% CI 0.54 to 0.88; 11,170 participants; 11 studies; moderate quality evidence). However, short-term myocardial infarction was similar between both groups (RR 0.91, 95% CI 0.81 to 1.02; 19,430 participants; 11 studies; high quality evidence). The transradial approach had a lower procedural success rate (RR 0.97, 95% CI 0.96 to 0.98; 25,920 participants; 28 studies; moderate quality evidence), but was associated with a lower risk of all-cause mortality (RR 0.77, 95% CI 0.62 to 0.95; 18,955 participants; 10 studies; high quality evidence), bleeding (RR 0.54, 95% CI 0.40 to 0.74; 23,043 participants; 20 studies; low quality evidence), and access site complications (RR 0.36, 95% CI 0.22 to 0.59; 16,112 participants; 24 studies; low quality evidence). AUTHORS' CONCLUSIONS Transradial approach for diagnostic CA or PCI (or both) in CAD may reduce short-term NACE, cardiac death, all-cause mortality, bleeding, and access site complications. There is insufficient evidence regarding the long-term clinical outcomes (i.e. beyond 30 days of follow-up).
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Affiliation(s)
- Ahmed A Kolkailah
- John H. Stroger, Jr. Hospital of Cook CountyDepartment of MedicineChicagoILUSA
| | | | - Ahmed M Muhammed
- Faculty of Medicine, Ain Shams UniversityDepartment of CardiologyCairoEgypt
| | - Mohamed E Zahran
- Faculty of Medicine, Ain Shams UniversityDepartment of CardiologyCairoEgypt
| | - Marwah Anas El‐Wegoud
- Egyptian Center for Evidence Based Medicine (ECEBM)8 Masaken Hayet El Tadrees Ain Shams University, El Khalifa El Maamoun St.CairoEgypt11646
| | - Ashraf F Nabhan
- Ain Shams UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine16 Ali Fahmi Kamel StreetHeliopolisCairoEgypt11351
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11
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Snelling BM, Sur S, Shah SS, Khandelwal P, Caplan J, Haniff R, Starke RM, Yavagal DR, Peterson EC. Transradial cerebral angiography: techniques and outcomes. J Neurointerv Surg 2018; 10:874-881. [DOI: 10.1136/neurintsurg-2017-013584] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/13/2017] [Accepted: 12/19/2017] [Indexed: 11/03/2022]
Abstract
BackgroundDespite several retrospective studies analyzing the safety and efficacy of transradial access (TRA) versus transfemoral access (TFA) for cerebral angiography, this transition for neurointerventional procedures has been gradual. Nonetheless, based on our positive initial institutional experience with TRA for mechanical thrombectomy in acute ischemic stroke patients, we have started transitioning more of our cerebral angiography cases to TRA. Here we present our single institution experience.MethodsWe performed a retrospective review of patients receiving TRA cerebral angiography at our institution between January 2016 and February 2017. We present our experience transitioning from TFA to TRA, including our criteria for patient selection, technical nuances, patient experience, complications, and operator learning curve.ResultsWe included 148 angiograms performed in 141 people by one of four operators. No major complications were observed, and the technical success of the procedures was consistent with those of TFA. Marked improvement in operator efficiency was achieved in a short number of cases during this transition when looking at operator proficiency as a function of angiograms performed and days of exposure to TRA (4.3 vs 3.6 min/vessel, P<0.05).ConclusionsSafety and efficiency can be preserved while transitioning to TRA. While further investigation is necessary to support transition to TRA, these findings should call for a re-evaluation of the role of TRA in catheter cerebral angiography.
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12
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Angiolillo DJ, Goodman SG, Bhatt DL, Eikelboom JW, Price MJ, Moliterno DJ, Cannon CP, Tanguay JF, Granger CB, Mauri L, Holmes DR, Gibson CM, Faxon DP. Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A North American Perspective-2016 Update. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.116.004395. [PMID: 27803042 DOI: 10.1161/circinterventions.116.004395] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The optimal antithrombotic treatment regimen for patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation is an emerging clinical problem. Currently, there is limited evidenced-based data on the optimal antithrombotic treatment regimen, including antiplatelet and anticoagulant therapies, for these high-risk patients with practice guidelines, thus, providing limited recommendations. Over the past years, expert consensus documents have provided guidance to clinicians on how to manage patients with atrial fibrillation undergoing percutaneous coronary intervention. Given the recent advancements in the field, the current document provides an updated opinion of selected North American experts from the United States and Canada on the treatment of patients with atrial fibrillation undergoing percutaneous coronary intervention. In particular, this document provides the current views on (1) embolic/stroke risk, (2) ischemic/thrombotic cardiac risk, and (3) bleeding risk, which are pivotal for discerning the choice of antithrombotic therapy. In addition, we describe the recent advances in pharmacology, stent designs, and clinical trials relevant to the field. Ultimately, we provide expert consensus-derived recommendations, using a pragmatic approach, on the management of patients with atrial fibrillation undergoing percutaneous coronary intervention.
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Affiliation(s)
- Dominick J Angiolillo
- From the Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.); St Michael's Hospital, University of Toronto, and the Canadian Heart Research Centre; Canadian VIGOUR Centre, University of Alberta, Edmonton (S.G.G.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., D.P.F.); Department of Medicine, Population Health Research Institute, Thrombosis & Atherosclerosis Research Institute, Hamilton, ON, Canada (J.W.E.); Division of Cardiovascular Diseases, Scripps Clinic, La Jolla CA (M.J.P.); Division of Cardiovascular Medicine and Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Brigham and Women's Hospital, Harvard Clinical Research Institute, Harvard Medical School, Boston, MA (C.P.C., L.M.); Department of Medicine, Montreal Heart Institute, Université de Montréal, QC, Canada (J.-F.T.); Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Mayo Clinic, Rochester, MN (D.R.H.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.).
| | - Shaun G Goodman
- From the Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.); St Michael's Hospital, University of Toronto, and the Canadian Heart Research Centre; Canadian VIGOUR Centre, University of Alberta, Edmonton (S.G.G.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., D.P.F.); Department of Medicine, Population Health Research Institute, Thrombosis & Atherosclerosis Research Institute, Hamilton, ON, Canada (J.W.E.); Division of Cardiovascular Diseases, Scripps Clinic, La Jolla CA (M.J.P.); Division of Cardiovascular Medicine and Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Brigham and Women's Hospital, Harvard Clinical Research Institute, Harvard Medical School, Boston, MA (C.P.C., L.M.); Department of Medicine, Montreal Heart Institute, Université de Montréal, QC, Canada (J.-F.T.); Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Mayo Clinic, Rochester, MN (D.R.H.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.)
| | - Deepak L Bhatt
- From the Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.); St Michael's Hospital, University of Toronto, and the Canadian Heart Research Centre; Canadian VIGOUR Centre, University of Alberta, Edmonton (S.G.G.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., D.P.F.); Department of Medicine, Population Health Research Institute, Thrombosis & Atherosclerosis Research Institute, Hamilton, ON, Canada (J.W.E.); Division of Cardiovascular Diseases, Scripps Clinic, La Jolla CA (M.J.P.); Division of Cardiovascular Medicine and Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Brigham and Women's Hospital, Harvard Clinical Research Institute, Harvard Medical School, Boston, MA (C.P.C., L.M.); Department of Medicine, Montreal Heart Institute, Université de Montréal, QC, Canada (J.-F.T.); Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Mayo Clinic, Rochester, MN (D.R.H.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.)
| | - John W Eikelboom
- From the Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.); St Michael's Hospital, University of Toronto, and the Canadian Heart Research Centre; Canadian VIGOUR Centre, University of Alberta, Edmonton (S.G.G.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., D.P.F.); Department of Medicine, Population Health Research Institute, Thrombosis & Atherosclerosis Research Institute, Hamilton, ON, Canada (J.W.E.); Division of Cardiovascular Diseases, Scripps Clinic, La Jolla CA (M.J.P.); Division of Cardiovascular Medicine and Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Brigham and Women's Hospital, Harvard Clinical Research Institute, Harvard Medical School, Boston, MA (C.P.C., L.M.); Department of Medicine, Montreal Heart Institute, Université de Montréal, QC, Canada (J.-F.T.); Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Mayo Clinic, Rochester, MN (D.R.H.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.)
| | - Matthew J Price
- From the Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.); St Michael's Hospital, University of Toronto, and the Canadian Heart Research Centre; Canadian VIGOUR Centre, University of Alberta, Edmonton (S.G.G.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., D.P.F.); Department of Medicine, Population Health Research Institute, Thrombosis & Atherosclerosis Research Institute, Hamilton, ON, Canada (J.W.E.); Division of Cardiovascular Diseases, Scripps Clinic, La Jolla CA (M.J.P.); Division of Cardiovascular Medicine and Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Brigham and Women's Hospital, Harvard Clinical Research Institute, Harvard Medical School, Boston, MA (C.P.C., L.M.); Department of Medicine, Montreal Heart Institute, Université de Montréal, QC, Canada (J.-F.T.); Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Mayo Clinic, Rochester, MN (D.R.H.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.)
| | - David J Moliterno
- From the Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.); St Michael's Hospital, University of Toronto, and the Canadian Heart Research Centre; Canadian VIGOUR Centre, University of Alberta, Edmonton (S.G.G.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., D.P.F.); Department of Medicine, Population Health Research Institute, Thrombosis & Atherosclerosis Research Institute, Hamilton, ON, Canada (J.W.E.); Division of Cardiovascular Diseases, Scripps Clinic, La Jolla CA (M.J.P.); Division of Cardiovascular Medicine and Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Brigham and Women's Hospital, Harvard Clinical Research Institute, Harvard Medical School, Boston, MA (C.P.C., L.M.); Department of Medicine, Montreal Heart Institute, Université de Montréal, QC, Canada (J.-F.T.); Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Mayo Clinic, Rochester, MN (D.R.H.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.)
| | - Christopher P Cannon
- From the Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.); St Michael's Hospital, University of Toronto, and the Canadian Heart Research Centre; Canadian VIGOUR Centre, University of Alberta, Edmonton (S.G.G.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., D.P.F.); Department of Medicine, Population Health Research Institute, Thrombosis & Atherosclerosis Research Institute, Hamilton, ON, Canada (J.W.E.); Division of Cardiovascular Diseases, Scripps Clinic, La Jolla CA (M.J.P.); Division of Cardiovascular Medicine and Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Brigham and Women's Hospital, Harvard Clinical Research Institute, Harvard Medical School, Boston, MA (C.P.C., L.M.); Department of Medicine, Montreal Heart Institute, Université de Montréal, QC, Canada (J.-F.T.); Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Mayo Clinic, Rochester, MN (D.R.H.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.)
| | - Jean-Francois Tanguay
- From the Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.); St Michael's Hospital, University of Toronto, and the Canadian Heart Research Centre; Canadian VIGOUR Centre, University of Alberta, Edmonton (S.G.G.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., D.P.F.); Department of Medicine, Population Health Research Institute, Thrombosis & Atherosclerosis Research Institute, Hamilton, ON, Canada (J.W.E.); Division of Cardiovascular Diseases, Scripps Clinic, La Jolla CA (M.J.P.); Division of Cardiovascular Medicine and Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Brigham and Women's Hospital, Harvard Clinical Research Institute, Harvard Medical School, Boston, MA (C.P.C., L.M.); Department of Medicine, Montreal Heart Institute, Université de Montréal, QC, Canada (J.-F.T.); Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Mayo Clinic, Rochester, MN (D.R.H.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.)
| | - Christopher B Granger
- From the Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.); St Michael's Hospital, University of Toronto, and the Canadian Heart Research Centre; Canadian VIGOUR Centre, University of Alberta, Edmonton (S.G.G.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., D.P.F.); Department of Medicine, Population Health Research Institute, Thrombosis & Atherosclerosis Research Institute, Hamilton, ON, Canada (J.W.E.); Division of Cardiovascular Diseases, Scripps Clinic, La Jolla CA (M.J.P.); Division of Cardiovascular Medicine and Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Brigham and Women's Hospital, Harvard Clinical Research Institute, Harvard Medical School, Boston, MA (C.P.C., L.M.); Department of Medicine, Montreal Heart Institute, Université de Montréal, QC, Canada (J.-F.T.); Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Mayo Clinic, Rochester, MN (D.R.H.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.)
| | - Laura Mauri
- From the Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.); St Michael's Hospital, University of Toronto, and the Canadian Heart Research Centre; Canadian VIGOUR Centre, University of Alberta, Edmonton (S.G.G.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., D.P.F.); Department of Medicine, Population Health Research Institute, Thrombosis & Atherosclerosis Research Institute, Hamilton, ON, Canada (J.W.E.); Division of Cardiovascular Diseases, Scripps Clinic, La Jolla CA (M.J.P.); Division of Cardiovascular Medicine and Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Brigham and Women's Hospital, Harvard Clinical Research Institute, Harvard Medical School, Boston, MA (C.P.C., L.M.); Department of Medicine, Montreal Heart Institute, Université de Montréal, QC, Canada (J.-F.T.); Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Mayo Clinic, Rochester, MN (D.R.H.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.)
| | - David R Holmes
- From the Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.); St Michael's Hospital, University of Toronto, and the Canadian Heart Research Centre; Canadian VIGOUR Centre, University of Alberta, Edmonton (S.G.G.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., D.P.F.); Department of Medicine, Population Health Research Institute, Thrombosis & Atherosclerosis Research Institute, Hamilton, ON, Canada (J.W.E.); Division of Cardiovascular Diseases, Scripps Clinic, La Jolla CA (M.J.P.); Division of Cardiovascular Medicine and Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Brigham and Women's Hospital, Harvard Clinical Research Institute, Harvard Medical School, Boston, MA (C.P.C., L.M.); Department of Medicine, Montreal Heart Institute, Université de Montréal, QC, Canada (J.-F.T.); Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Mayo Clinic, Rochester, MN (D.R.H.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.)
| | - C Michael Gibson
- From the Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.); St Michael's Hospital, University of Toronto, and the Canadian Heart Research Centre; Canadian VIGOUR Centre, University of Alberta, Edmonton (S.G.G.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., D.P.F.); Department of Medicine, Population Health Research Institute, Thrombosis & Atherosclerosis Research Institute, Hamilton, ON, Canada (J.W.E.); Division of Cardiovascular Diseases, Scripps Clinic, La Jolla CA (M.J.P.); Division of Cardiovascular Medicine and Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Brigham and Women's Hospital, Harvard Clinical Research Institute, Harvard Medical School, Boston, MA (C.P.C., L.M.); Department of Medicine, Montreal Heart Institute, Université de Montréal, QC, Canada (J.-F.T.); Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Mayo Clinic, Rochester, MN (D.R.H.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.)
| | - David P Faxon
- From the Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.); St Michael's Hospital, University of Toronto, and the Canadian Heart Research Centre; Canadian VIGOUR Centre, University of Alberta, Edmonton (S.G.G.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., D.P.F.); Department of Medicine, Population Health Research Institute, Thrombosis & Atherosclerosis Research Institute, Hamilton, ON, Canada (J.W.E.); Division of Cardiovascular Diseases, Scripps Clinic, La Jolla CA (M.J.P.); Division of Cardiovascular Medicine and Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Brigham and Women's Hospital, Harvard Clinical Research Institute, Harvard Medical School, Boston, MA (C.P.C., L.M.); Department of Medicine, Montreal Heart Institute, Université de Montréal, QC, Canada (J.-F.T.); Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Mayo Clinic, Rochester, MN (D.R.H.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.)
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Snelling BM, Sur S, Shah SS, Marlow MM, Cohen MG, Peterson EC. Transradial access: lessons learned from cardiology. J Neurointerv Surg 2017; 10:487-492. [PMID: 28963366 DOI: 10.1136/neurintsurg-2017-013295] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/15/2017] [Accepted: 09/20/2017] [Indexed: 01/28/2023]
Abstract
Innovations in interventional cardiology historically predate those in neuro-intervention. As such, studying trends in interventional cardiology can be useful in exploring avenues to optimise neuro-interventional techniques. One such cardiology innovation has been the steady conversion of arterial puncture sites from transfemoral access (TFA) to transradial access (TRA), a paradigm shift supported by safety benefits for patients. While neuro-intervention has unique anatomical challenges, the access itself is identical. As such, examining the extensive cardiology literature on the radial approach has the potential to offer valuable lessons for the neuro-interventionalist audience who may be unfamiliar with this body of work. Therefore, we present here a report, particularly for neuro-interventionalists, regarding the best practices for TRA by reviewing the relevant cardiology literature. We focused our review on the data most relevant to our audience, namely that surrounding the access itself. By reviewing the cardiology literature on metrics such as safety profiles, cost and patient satisfaction differences between TFA and TRA, as well as examining the technical nuances of the procedure and post-procedural care, we hope to give physicians treating complex cerebrovascular disease a broader data-driven understanding of TRA.
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Affiliation(s)
- Brian M Snelling
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Samir Sur
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sumedh Subodh Shah
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Megan M Marlow
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mauricio G Cohen
- Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eric C Peterson
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Wongcharoen W, Pinyosamosorn K, Gunaparn S, Boonnayhun S, Thonghong T, Suwannasom P, Phrommintikul A. Vascular access site complication in transfemoral coronary angiography between uninterrupted warfarin and heparin bridging. J Interv Cardiol 2017; 30:387-392. [DOI: 10.1111/joic.12403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 05/31/2017] [Accepted: 06/07/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Wanwarang Wongcharoen
- Department of Internal Medicine, Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
- Northern Cardiac Center, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University; Chiang Mai Thailand
| | - Kittipong Pinyosamosorn
- Department of Internal Medicine, Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Siriluck Gunaparn
- Department of Internal Medicine, Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
- Northern Cardiac Center, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University; Chiang Mai Thailand
| | - Suchada Boonnayhun
- Northern Cardiac Center, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University; Chiang Mai Thailand
| | - Tasalak Thonghong
- Northern Cardiac Center, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University; Chiang Mai Thailand
| | - Pannipa Suwannasom
- Northern Cardiac Center, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University; Chiang Mai Thailand
| | - Arintaya Phrommintikul
- Department of Internal Medicine, Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
- Northern Cardiac Center, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University; Chiang Mai Thailand
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15
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Brener MI, Bush A, Miller JM, Hasan RK. Influence of radial versus femoral access site on coronary angiography and intervention outcomes: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2017; 90:1093-1104. [DOI: 10.1002/ccd.27043] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/25/2017] [Indexed: 12/21/2022]
Affiliation(s)
| | - Aaron Bush
- Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Julie M. Miller
- Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Rani K. Hasan
- Johns Hopkins University School of Medicine; Baltimore Maryland
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16
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Shammas NW, Shammas GA, Jones-Miller S, Gumpert MR, Gumpert MJ, Harb C, Chammas MZ, Shammas WJ, Khalafallah RA, Barzgari A, Bou Dargham B, Daher GE, Rachwan RJ, Shammas AN. Predictors of common femoral artery access site complications in patients on oral anticoagulants and undergoing a coronary procedure. Ther Clin Risk Manag 2017; 13:401-406. [PMID: 28408835 PMCID: PMC5384737 DOI: 10.2147/tcrm.s130624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background It is unclear whether patients on oral anticoagulants (OAC) undergoing a procedure using common femoral artery access have higher adverse events when compared to patients who are not anticoagulated at the time of the procedure. Methods We retrospectively reviewed data from consecutive patients who underwent a cardiac procedure at a tertiary medical center. Patients were considered (group A) fully or partially anticoagulated if they had an international normalized ratio (INR) ≥1.6 on the day of the procedure or were on warfarin or new OAC within 48 h and 24 h of the procedure, respectively. The nonanticoagulated group (group B) had an INR <1.6 or had stopped their warfarin and new OAC >48 h and >24 h preprocedure, respectively. The index primary end point of the study was defined as the composite end point of major bleeding, vascular complications, or cardiovascular-related death during index hospitalization. The 30-day primary end point was defined as the occurrence of the index primary end point and up to 30 days postprocedure. Results A total of 779 patients were included in this study. Of these patients, 27 (3.5%) patients were in group A. The index primary end point was met in 11/779 (1.4%) patients. The 30-day primary composite end point was met in 18/779 (2.3%) patients. There was no difference in the primary end point at index between group A (1/27 [3.7%]) and group B (10/752 [1.3%]; P=0.3155) and no difference in the 30-day primary composite end point between group A (2/27 [7.4%]) and group B (16/752 [2.1%]; P=0.1313). Multivariable analysis showed that a low creatinine clearance (odds ratio [OR] =0.56; P=0.0200) and underweight patients (<60 kg; OR =3.94; P=0.0300) were independent predictors of the 30-day primary composite end point but not oral anticoagulation (P=0.1500). Conclusion Patients on OAC did not have higher 30-day major adverse events than those who were not anticoagulated at index procedure.
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Affiliation(s)
- Nicolas W Shammas
- Midwest Cardiovascular Research Foundation.,Cardiology Division, Genesis Heart Institute, Davenport, IA, USA
| | | | - Susan Jones-Miller
- Midwest Cardiovascular Research Foundation.,Cardiology Division, Genesis Heart Institute, Davenport, IA, USA
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Safety of transradial diagnostic cardiac catheterization in patients under oral anticoagulant therapy. J Cardiol 2017; 69:561-564. [DOI: 10.1016/j.jjcc.2016.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 04/07/2016] [Accepted: 04/26/2016] [Indexed: 11/20/2022]
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Sirker A, Kwok CS, Kotronias R, Bagur R, Bertrand O, Butler R, Berry C, Nolan J, Oldroyd K, Mamas MA. Influence of access site choice for cardiac catheterization on risk of adverse neurological events: A systematic review and meta-analysis. Am Heart J 2016; 181:107-119. [PMID: 27823682 DOI: 10.1016/j.ahj.2016.06.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 06/25/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Stroke is a rare but potentially catastrophic complication of cardiac catheterization. Although some procedural aspects are known to influence stroke risk, the impact of radial versus femoral access site use is unclear. Early observational studies and limited randomized trial data suggested more frequent embolic events with radial access. Subsequently, larger pooled analyses have shown no clear differences in stroke risk but were limited by low event rates. Recent publication of relevant new data prompted our reevaluation of this concern. Therefore, we conducted a systematic review and meta-analysis to evaluate stroke complicating cardiac catheterization with use of transradial versus transfemoral access. METHODS AND RESULTS A search of MEDLINE and EMBASE was undertaken using OVID SP with appropriate search terms. RevMan 5.3.5 was used to conduct a random-effects meta-analysis using the inverse variance method for pooling risk ratios (RRs) or the Mantel-Haenszel method for pooling dichotomous data. Pooled data from >24,000 patients in randomized controlled trials and >475,000 patients from observational studies were used. The risk ratio (RR) for (any) stroke, using randomized controlled trial data, was not significant (RR 0.87, 95% CI 0.58-1.29). Using observational data, a significant difference favoring radial access was seen (RR 0.71, 95% CI 0.52-0.98). CONCLUSIONS Radial access site utilization for cardiac catheterization is not associated with an increased risk of stroke events. These data provide reassurance and should remove another potential barrier to conversion to a "default" radial practice among those who are currently predominantly femoral operators.
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Affiliation(s)
- Alex Sirker
- Department of Cardiology, University College London Hospitals and St. Bartholomew's Hospital, London, United Kingdom
| | - Chun Shing Kwok
- Cardiovascular Research Group, Institutes of Science and Technology in Medicine, University of Keele and Institute of Cardiovascular Sciences, Stoke-on-Trent, United Kingdom; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Rafail Kotronias
- Cardiovascular Research Group, Institutes of Science and Technology in Medicine, University of Keele and Institute of Cardiovascular Sciences, Stoke-on-Trent, United Kingdom
| | - Rodrigo Bagur
- Division of Cardiology, University Hospital, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Olivier Bertrand
- Quebec Heart-Lung Institute, Laval University, Laval, Quebec, Canada
| | - Robert Butler
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - James Nolan
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Keith Oldroyd
- West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Mamas A Mamas
- Department of Cardiology, University College London Hospitals and St. Bartholomew's Hospital, London, United Kingdom; Cardiovascular Research Group, Institutes of Science and Technology in Medicine, University of Keele and Institute of Cardiovascular Sciences, Stoke-on-Trent, United Kingdom.
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Bashir MA, Ray R, Sarda P, Li S, Corbett S. Determination of a safe INR for joint injections in patients taking warfarin. Ann R Coll Surg Engl 2015; 97:589-91. [PMID: 26492905 PMCID: PMC5096611 DOI: 10.1308/rcsann.2015.0044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION With an increase in life expectancy in 'developed' countries, the number of elderly patients receiving joint injections for arthritis is increasing. There are legitimate concerns about an increased risk of thromboembolism if anticoagulation is stopped or reversed for such an injection. Despite being a common dilemma, the literature on this issue is scarce. METHODS We undertook 2,084 joint injections of the knee and shoulder in 1,714 patients between August 2008 and December 2013. Within this cohort, we noted 41 patients who were taking warfarin and followed them immediately after joint injection in the clinic or radiology department, looking carefully for complications. Then, we sought clinical follow-up, correspondence, and imaging evidence for 4 weeks, looking for complications from these joint injections. We recorded International Normalised Ratio (INR) values before injection. RESULTS No complications were associated with the procedure after any joint injection. The radiologists who undertook ultrasound-guided injections to shoulders re-scanned the joints looking for haemarthroses: they found none. A similar outcome was noted clinically after injections in the outpatient setting. CONCLUSION With a mean INR of 2.77 (range, 1.7-5.5) and a maximum INR within this group of 5.5, joint injections to the shoulder and knee can be undertaken safely in primary or secondary care settings despite the patient taking warfarin.
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Affiliation(s)
- M A Bashir
- Department of Orthopaedics, Guy's and St. Thomas' NHS Foundation Trust, , UK
| | - R Ray
- Department of Orthopaedics, Guy's and St. Thomas' NHS Foundation Trust, , UK
| | - P Sarda
- Department of Orthopaedics, Guy's and St. Thomas' NHS Foundation Trust, , UK
| | - S Li
- Department of Orthopaedics, Guy's and St. Thomas' NHS Foundation Trust, , UK
| | - S Corbett
- Department of Orthopaedics, Guy's and St. Thomas' NHS Foundation Trust, , UK
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Koskinas KC, Räber L. Periprocedural oral anticoagulation during percutaneous coronary interventions: more evidence to fuel an uninterrupted debate. EUROINTERVENTION 2015; 11:376-9. [PMID: 26298414 DOI: 10.4244/eijv11i4a77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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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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Bennaghmouch N, Dewilde WJM, Ten Berg JM. Dual antiplatelet therapy in the anticoagulated patient undergoing percutaneous coronary intervention risks, benefits, and unanswered questions. Curr Cardiol Rep 2014; 16:548. [PMID: 25326731 DOI: 10.1007/s11886-014-0548-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A commonly encountered scenario is the patient with atrial fibrillation (AF) on oral anticoagulation (OAC) who either develops an acute coronary syndrome or has to undergo percutaneous coronary intervention with stent placement. In such patients, separate indications suggest combining OAC and dual antiplatelet therapy (DAPT). This approach, however, increases the risk of bleeding as well as thromboembolic risk if bleeding does not occur. For optimal clinical results, the risks and benefits of all possible treatment options should be determined based on the best available data. This review provides an overview of the most recent data regarding the optimal treatment of AF patients with an indication for combined treatment with OAC and DAPT.
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Affiliation(s)
- N Bennaghmouch
- Department of Cardiology, St Antonius Hospital Nieuwegein, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands,
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Capodanno D, Angiolillo DJ. Management of antiplatelet and anticoagulant therapy in patients with atrial fibrillation in the setting of acute coronary syndromes or percutaneous coronary interventions. Circ Cardiovasc Interv 2014; 7:113-24. [PMID: 24550531 DOI: 10.1161/circinterventions.113.001150] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Davide Capodanno
- From the Cardio-thoraco-vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy (D.C.); and Department of Medicine, Division of Cardiology, University of Florida College of Medicine-Jacksonville, FL (D.C., D.J.A)
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Rubboli A, Faxon DP, Juhani Airaksinen KE, Schlitt A, Marín F, Bhatt DL, Lip GYH. The optimal management of patients on oral anticoagulation undergoing coronary artery stenting. The 10th Anniversary Overview. Thromb Haemost 2014; 112:1080-7. [PMID: 25298351 DOI: 10.1160/th14-08-0681] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 09/30/2014] [Indexed: 01/02/2023]
Abstract
Even 10 years after the first appearance in the literature of articles reporting on the management of patients on oral anticoagulation (OAC) undergoing percutaneous coronary intervention with stent (PCI-S), this issue is still controversial. Nonetheless, some guidance for the everyday management of this patient subset, accounting for about 5-8 % of all patients referred for PCI-S, has been developed. In general, a period of triple therapy (TT) of OAC, with either vitamin K-antagonists (VKA) or non-vitamin K-antagonist oral anticoagulants (NOAC), aspirin, and clopidogrel is warranted, followed by the combination of OAC, and a single antiplatelet agent for up to 12 months, and then OAC alone. The duration of the initial period of TT is dependent on the individual risk of thromboembolism, and bleeding, as well as the clinical context in which PCI-S is performed (elective vs acute coronary syndrome), and the type of stent implanted (bare-metal vs drug-eluting). In this article, we aim to provide a comprehensive, at-a-glance, overview of the management strategies, which are currently suggested for the peri-procedural, medium-term, and long-term periods following PCI-S in OAC patients. While acknowledging that most of the evidence has been obtained from patients on OAC because of atrial fibrillation, and with warfarin being the most frequently used VKA, we refer in this overview to the whole population of OAC patients undergoing PCI-S. We refer to the whole population of patients on OAC undergoing PCI-S also when OAC is carried out with NOAC rather than VKA, pointing out, when appropriate, the particular management issues.
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Affiliation(s)
- A Rubboli
- Dr. Andrea Rubboli, FESC, Division of Cardiology, Laboratory of Interventional Cardiology, Ospedale Maggiore, Largo Nigrisoli 2, 40133 Bologna, Italy, Tel.: +39 0516478976, Fax: +39 0516478635, E-mail
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Baker NC, O'Connell EW, Htun WW, Sun H, Green SM, Skelding KA, Blankenship JC, Scott TD, Berger PB. Safety of coronary angiography and percutaneous coronary intervention via the radial versus femoral route in patients on uninterrupted oral anticoagulation with warfarin. Am Heart J 2014; 168:537-44. [PMID: 25262264 DOI: 10.1016/j.ahj.2014.06.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 06/28/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate access site and other bleeding complications associated with radial versus femoral access in patients receiving oral anticoagulation (OAC) with warfarin. BACKGROUND Patients receiving OAC with warfarin undergoing coronary angiography and percutaneous coronary intervention (PCI) may have OAC continued despite the risk of bleeding. To what extent arterial access site impacts bleeding in such patients is not well studied. METHODS Over 6 years, we identified 255 consecutive patients in whom warfarin was continued who underwent coronary angiography with an international normalized ratio >1.8. A total of 97 patients also underwent PCI at the same setting (27% femoral vs 73% radial). The primary outcome was Bleeding Academic Research Consortium bleeds; a secondary end point was frequency of access site complications in the 72 hours post-PCI. Complications were evaluated based on the initial access site attempted. RESULTS Minimal baseline clinical characteristics differences existed between the groups. International normalized ratio was significantly higher in the radial group (2.42 ± 0.67 vs 2.24 ± 0.49, P = .02). Bivalirudin use was greater during radial PCI than femoral (76% vs 42%, P < .05), whereas unfractionated heparin alone was greater during femoral PCI than radial (46% vs 18%, P < .05). No significant difference was seen in the primary end point between femoral (2.8%) and radial (1.6%, P = .54) during coronary angiography alone. However, PCI via the femoral artery had significantly more Bleeding Academic Research Consortium bleeding (19.2% vs 1.4%, P = .005) and transfusions (15% vs 0%, P = .004) than via the radial artery. Patients who underwent PCI using radial access were less likely to have any vascular or bleeding complications (1% vs 23%, P = .001). CONCLUSIONS Patients who underwent coronary angiography during uninterrupted OAC had similar bleeding rates regardless of access site. However, when PCI was performed, radial access was associated with fewer bleeding and vascular complications than the femoral approach. CONDENSED ABSTRACT We retrospectively identified 255 consecutive patients on warfarin who underwent coronary angiography, 97 of whom underwent a percutaneous coronary intervention. The data reveal a reduction in Bleeding Academic Research Consortium bleeds (1.6% vs 8.1%, P = .02) with radial versus femoral access. The radial approach was associated with an overall lower rate of any vascular or bleeding complication than the femoral approach during percutaneous coronary intervention (1% vs 23%, P = .001).
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Affiliation(s)
- Nevin C Baker
- Department of Cardiology, Geisinger Medical Center, Danville, PA
| | - Erik W O'Connell
- Department of General Internal Medicine, Geisinger Medical Center, Danville, PA
| | - Wah Wah Htun
- Department of Cardiology, Geisinger Medical Center, Danville, PA
| | - Haiyan Sun
- Center for Health Research, Geisinger Medical Center, Danville, PA
| | - Sandy M Green
- Department of Cardiology, Geisinger Medical Center, Danville, PA
| | | | | | - Thomas D Scott
- Department of Cardiology, Geisinger Medical Center, Danville, PA
| | - Peter B Berger
- Department of Cardiology, Geisinger Medical Center, Danville, PA; Cardiovascular Center for Clinical Research, Geisinger Medical Center, Danville, PA.
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Lippe CM, Reineck EA, Kunselman AR, Gilchrist IC. Warfarin: Impact on hemostasis after radial catheterization. Catheter Cardiovasc Interv 2014; 85:82-8. [DOI: 10.1002/ccd.25410] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 01/20/2014] [Indexed: 11/09/2022]
Affiliation(s)
| | - Elizabeth A. Reineck
- Division of Cardiology; Department of Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Allen R. Kunselman
- Penn State Public Health Sciences; Pennsylvania State University; Hershey Pennsylvania
| | - Ian C. Gilchrist
- Penn State's Heart and Vascular Institute, Pennsylvania State University; Hershey Pennsylvania
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Frequency of radial artery occlusion after transradial access in patients receiving warfarin therapy and undergoing coronary angiography. Am J Cardiol 2014; 113:211-4. [PMID: 24210677 DOI: 10.1016/j.amjcard.2013.09.043] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 09/21/2013] [Accepted: 09/21/2013] [Indexed: 12/16/2022]
Abstract
The efficacy of warfarin-induced anticoagulation in reducing radial artery occlusion (RAO) after transradial access is not known. The present case-control study compared the incidence of early (24 hours) and late (30 days) RAO in patients undergoing transradial diagnostic coronary angiography during therapeutic warfarin anticoagulation (group 1) with that of a matched (3:1) cohort of patients not receiving warfarin and receiving intraprocedural heparin (group 2). All patients underwent transradial diagnostic coronary angiography using a 5F hydrophilic introducer sheath. The patients in group 2 received an intravenous heparin bolus (50 IU/kg) immediately after sheath insertion. After sheath removal, hemostasis was obtained using the TR-band (Terumo Interventional Systems, Terumo Medical, Tokyo, Japan) and a plethysmography-guided patent hemostasis technique. We included 86 patients receiving warfarin with an international normalized ratio of 2 to 4 in group 1 and 250 matched patients in group 2. No significant differences were present in the demographic and procedural variables between the 2 groups. Early RAO occurred in 18.6% of the patients in group 1 compared with 9.6% of patients in group 2 (p = 0.024). The incidence of late RAO remained significantly higher in group 1 compared with group 2 (13.9% vs 5.2%, p = 0.01). All patients with RAO remained asymptomatic. In conclusion, patients receiving chronic oral anticoagulation with warfarin and undergoing transradial coronary angiography without parenteral anticoagulation had a higher incidence of early and late RAO compared with patients receiving standard intravenous heparin therapy.
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Patel VG, Brayton KM, Kumbhani DJ, Banerjee S, Brilakis ES. Meta-analysis of stroke after transradial versus transfemoral artery catheterization. Int J Cardiol 2013; 168:5234-8. [DOI: 10.1016/j.ijcard.2013.08.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/03/2013] [Indexed: 11/16/2022]
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Conway R, O’Shea FD, Cunnane G, Doran MF. Safety of joint and soft tissue injections in patients on warfarin anticoagulation. Clin Rheumatol 2013; 32:1811-4. [DOI: 10.1007/s10067-013-2350-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 05/27/2013] [Accepted: 07/25/2013] [Indexed: 10/26/2022]
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Menozzi M, Rubboli A, Manari A, De Palma R, Grilli R. Triple antithrombotic therapy in patients with atrial fibrillation undergoing coronary artery stenting: hovering among bleeding risk, thromboembolic events, and stent thrombosis. Thromb J 2012; 10:22. [PMID: 23075316 PMCID: PMC3502192 DOI: 10.1186/1477-9560-10-22] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 10/09/2012] [Indexed: 11/29/2022] Open
Abstract
Dual antiplatelet treatment with aspirin and clopidogrel is the antithrombotic treatment recommended after an acute coronary syndrome and/or coronary artery stenting. The evidence for optimal antiplatelet therapy for patients, in whom long-term treatment oral anticoagulation is mandatory, is however scarce. To evaluate the safety and efficacy of the various antithrombotic strategies adopted in this population, we reviewed the available evidence on the management of patients receiving oral anticoagulation, such as a vitamin-k-antagonists, referred for coronary artery stenting.Atrial fibrillation is the most frequent indication for oral anticoagulation. The need of starting antiplatelet therapy in this clinical scenario raises concerns about the combination to choose: triple therapy with warfarin, aspirin, and a thienopyridine being the most frequent and advised. The safety of this regimen appeared suboptimal because of an increased risk in hemorrhagic complications. On the other hand, the combination of oral anticoagulation and an antiplatelet agent is suboptimal in preventing thromboembolic events and stent thrombosis; dual antiplatelet therapy may be considered only when a high hemorrhagic risk and low thromboembolic risk are perceived. Indeed, the need for prolonged multiple-drug antithrombotic therapy increases the bleeding risks when drug eluting stents are used.Since current evidence derives mainly from small, single-center and retrospective studies, large-scale prospective multicenter studies are urgently needed.
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Affiliation(s)
- Mila Menozzi
- Interventional Cardiology, S. Maria Nuova Hospital; Viale Risorgimento, 80 - 42123 Reggio Emilia, Italy
| | - Andrea Rubboli
- Division of Cardiology & Cardiac Catheterization Laboratory, Maggiore HospitalLargo Nigrisoli, 2 – 40133, Bologna, Italy
| | - Antonio Manari
- Interventional Cardiology, S. Maria Nuova Hospital; Viale Risorgimento, 80 - 42123 Reggio Emilia, Italy
| | - Rossana De Palma
- Regional Agency for Health and Social Care, Viale Aldo Moro, 21 - 40127, Bologna, Italy
| | - Roberto Grilli
- Regional Agency for Health and Social Care, Viale Aldo Moro, 21 - 40127, Bologna, Italy
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Ertel A, Nadelson J, Shroff AR, Sweis R, Ferrera D, Vidovich MI. Radiation Dose Reduction during Radial Cardiac Catheterization: Evaluation of a Dedicated Radial Angiography Absorption Shielding Drape. ISRN CARDIOLOGY 2012; 2012:769167. [PMID: 22988525 PMCID: PMC3439952 DOI: 10.5402/2012/769167] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 07/29/2012] [Indexed: 12/22/2022]
Abstract
Objectives. Radiation scatter protection shield drapes have been designed with the goal of decreasing radiation dose to the operators during transfemoral catheterization. We sought to investigate the impact on operator radiation exposure of various shielding drapes specifically designed for the radial approach. Background. Radial access for cardiac catheterization has increased due to improved patient comfort and decreased bleeding complications. There are concerns for increased radiation exposure to patients and operators. Methods. Radiation doses to a simulated operator were measured with a RadCal Dosimeter in the cardiac catheterization laboratory. The mock patient was a 97.5 kg fission product phantom. Three lead-free drape designs were studied. The drapes were placed just proximal to the right wrist and extended medially to phantom's trunk. Simulated diagnostic coronary angiography included 6 minutes of fluoroscopy time and 32 seconds of cineangiography time at 4 standard angulated views (8 s each), both 15 frames/s. ANOVA with Bonferroni correction was used for statistical analysis. Results. All drape designs led to substantial reductions in operator radiation exposure compared to control (P < 0.0001). The greatest decrease in radiation exposure (72%) was with the L-shaped design. Conclusions. Dedicated radial shielding drapes decrease radiation exposure to the operator by up to 72% during simulated cardiac catheterization.
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Affiliation(s)
- Andrew Ertel
- Division of Cardiology, University of Illinois at Chicago Medical Center, Chicago, IL 60612, USA
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The risk of bleeding of triple therapy with vitamin K-antagonists, aspirin and clopidogrel after coronary stent implantation: Facts and questions. J Geriatr Cardiol 2012; 8:207-14. [PMID: 22783307 PMCID: PMC3390087 DOI: 10.3724/sp.j.1263.2011.00207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 09/05/2011] [Accepted: 09/12/2011] [Indexed: 11/25/2022] Open
Abstract
Background Triple therapy (TT) with vitamin K-antagonists (VKA), aspirin and clopidogrel is the recommended antithrombotic treatment following percutaneous coronary intervention with stent implantation (PCI-S) in patients with an indication for oral anticoagulation. TT is associated with an increased risk of bleeding, but available evidence is flawed by important limitations, including the limited size and the retrospective design of most of the studies, as well as the rare reporting of the incidence of in-hospital bleeding and the treatment which was actually ongoing at the time of bleeding. Since the perceived high bleeding risk of TT may deny patients effective strategies, the determination of the true safety profile of TT is of paramount importance. Methods All the 27 published studies where the incidence of bleeding at various time points during follow-up has been reported separately for patients on TT were reviewed, and the weakness of the data was analyzed. Results The absolute incidence of major bleeding upon discharge at in-hospital, ≤ 1 month, 6 months, 12 months and ≥ 12 months was: 3.3% ± 1.9%, 5.1% ± 6.7%, 8.0% ± 5.2%, 9.0% ± 8.0, and 6.2% ± 7.8%, respectively, and not substantially different from that observed in previous studies with prolonged dual antiplatelet treatment with aspirin and clopidogrel. Conclusions While waiting for the ongoing, large-scale, registries and clinical trials to clarify the few facts and to answer the many questions regarding the risk of bleeding of TT, this treatment should not be denied to patients with an indication for VKA undergoing PCI-S provided that the proper measures and cautions are implemented.
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Bashore TM, Balter S, Barac A, Byrne JG, Cavendish JJ, Chambers CE, Hermiller JB, Kinlay S, Landzberg JS, Laskey WK, McKay CR, Miller JM, Moliterno DJ, Moore JWM, Oliver-McNeil SM, Popma JJ, Tommaso CL. 2012 American College of Cardiology Foundation/Society for Cardiovascular Angiography and Interventions expert consensus document on cardiac catheterization laboratory standards update: A report of the American College of Cardiology Foundation Task Force on Expert Consensus documents developed in collaboration with the Society of Thoracic Surgeons and Society for Vascular Medicine. J Am Coll Cardiol 2012; 59:2221-305. [PMID: 22575325 DOI: 10.1016/j.jacc.2012.02.010] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Ahmed I, Gertner E. Safety of arthrocentesis and joint injection in patients receiving anticoagulation at therapeutic levels. Am J Med 2012; 125:265-9. [PMID: 22340924 DOI: 10.1016/j.amjmed.2011.08.022] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 08/11/2011] [Accepted: 08/16/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Arthrocentesis and joint injections are commonly performed for both diagnostic and therapeutic indications. Because of safety concerns, there is often reluctance to perform these procedures in patients who are receiving anticoagulation at therapeutic levels. This study was undertaken to determine the safety of arthrocentesis and joint injection performed by physicians from different disciplines in patients who are anticoagulated. METHODS We conducted a retrospective review of 640 arthrocentesis and joint injection procedures performed in 514 anticoagulated patients between 2001 and 2009. We assessed the incidence of early and late clinically significant bleeding in or around a joint, infection, and procedure-related pain. We further compared the incidence of these complications in 456 procedures performed in patients with an international normalized ratio 2.0 or greater and 184 procedures performed in patients with an international normalized ratio less than 2.0. RESULTS Only 1 procedure (0.2%) resulted in early, significant, clinical bleeding in the fully anticoagulated group. There was no statistically significant difference in early and late complications between patients who had procedures performed with an international normalized ratio 2.0 or greater and those whose anticoagulation was adjusted to an international normalized ratio less than 2.0. CONCLUSION Arthrocentesis and joint injections in patients receiving chronic warfarin therapy with therapeutic international normalized ratio are safe procedures. There does not seem to be a need for reducing the level of anticoagulation before procedures in these patients.
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Affiliation(s)
- Imdad Ahmed
- Department of Internal Medicine, Regions Hospital, St Paul, MN, USA
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Caputo RP, Tremmel JA, Rao S, Gilchrist IC, Pyne C, Pancholy S, Frasier D, Gulati R, Skelding K, Bertrand O, Patel T. Transradial arterial access for coronary and peripheral procedures: Executive summary by the transradial committee of the SCAI. Catheter Cardiovasc Interv 2011; 78:823-39. [PMID: 21544927 DOI: 10.1002/ccd.23052] [Citation(s) in RCA: 221] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 02/13/2011] [Indexed: 01/21/2023]
MESH Headings
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/methods
- Angioplasty, Balloon, Coronary/standards
- Cardiac Catheterization/adverse effects
- Cardiac Catheterization/methods
- Cardiac Catheterization/standards
- Cardiovascular Diseases/diagnostic imaging
- Cardiovascular Diseases/therapy
- Catheterization, Peripheral/adverse effects
- Catheterization, Peripheral/methods
- Catheterization, Peripheral/standards
- Clinical Competence
- Coronary Angiography/adverse effects
- Coronary Angiography/methods
- Coronary Angiography/standards
- Credentialing
- Endovascular Procedures/adverse effects
- Endovascular Procedures/methods
- Endovascular Procedures/standards
- Humans
- Patient Selection
- Radial Artery
- Risk Assessment
- Risk Factors
- Societies, Medical
- Treatment Outcome
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Affiliation(s)
- Ronald P Caputo
- St. Joseph's Hospital, S.U.N.Y. Upstate Medical School, Syracuse, New York 13203, USA.
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SALLAM MANSOURM, ALI MEHAR, AL-SEKAITI RASHID. Management of Radial Artery Perforation Complicating Coronary Intervention: A Stepwise Approach. J Interv Cardiol 2011; 24:401-6. [DOI: 10.1111/j.1540-8183.2011.00649.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ahmed I, Gertner E, Nelson WB, House CM, Zhu DW. Safety of coronary angiography and percutaneous coronary intervention in patients on uninterrupted warfarin therapy: a meta-analysis. Interv Cardiol 2011. [DOI: 10.2217/ica.10.94] [Citation(s) in RCA: 3] [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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38
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Bibliography-Editors' selection of current word literature. Coron Artery Dis 2010; 22:45-7. [PMID: 21160292 DOI: 10.1097/mca.0b013e328342fc9d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tsai TT. No free lunch: transradial access in patients on coumadin. Catheter Cardiovasc Interv 2010; 76:500-1. [PMID: 20882652 DOI: 10.1002/ccd.22785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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