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Richardson AJ, Kumar J, Richardson K, Bhatia A, Pennix T, Shah K, Maini A, Jalaeian H, Bhatia S. Safety of Prostatic Artery Embolization via Transradial Access versus Transfemoral Access. J Vasc Interv Radiol 2024; 35:541-547. [PMID: 38103863 DOI: 10.1016/j.jvir.2023.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE To compare prostatic artery embolization (PAE) via transradial access (TRA-PAE) versus transfemoral access (TFA-PAE) to assist access selection. MATERIAL AND METHODS Procedural outcomes and adverse events were evaluated in 998 patients who underwent PAE at a single center from April 2014 to August 2022; 821 (82%) underwent TRA-PAE (Group R) and 177 (18%) underwent TFA-PAE (Group F). Mean age and prostate size of Groups R and F were 69.2 years (SD ± 8.4) and 117.4 g (SD ± 63.1) and 75.2 years (SD ± 12.1) and 127.2 g (SD ± 83.6), respectively (P < .01 and P = .16; postpropensity matching: P = .38 and P = .35, respectively). Indications for PAE included lower urinary tract symptoms, acute or chronic urinary retention, and hematuria. Procedural and patient-specific metrics were reviewed. Technical success was defined as bilateral PAE. Adverse events were recorded according to the Society of Interventional Radiology (SIR) adverse events classification. Statistical significance was defined as P < .05. RESULTS Technical success was achieved in 798 (97.2%) patients in Group R and 165 (93.2%) patients in Group F. Mean procedural time, single- and continuous-rotation fluoroscopy time, dose area product, and air kerma were significantly lower in Group R than in Group F (P < .001). Moreover, 6 (0.7%) patients in Group R and 9 (5.5%) patients in Group F had access site ecchymoses, whereas 5 (0.6%) patients in Group R and 6 (3.6%) in Group F had access site hematomas. Two patients experienced transient ischemic attacks (TIAs) after TRA-PAE and recovered without intervention. Two occult radial artery occlusions were noted, but no patient experienced hand ischemia. CONCLUSIONS In a large single interventional radiologist cohort, TRA-PAE demonstrated similar technical success to that of TFA-PAE with lower access site hemorrhagic complications and radiation requirements; however, TIA and occult radial artery occlusions remain a concern.
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Affiliation(s)
- Andrew J Richardson
- Department of Interventional Radiology, Jackson Memorial Hospital, Miami, Florida.
| | - Jessica Kumar
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Kenneth Richardson
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Ansh Bhatia
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Thomas Pennix
- Department of Interventional Radiology, Jackson Memorial Hospital, Miami, Florida
| | - Khushi Shah
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Aneesha Maini
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Hamed Jalaeian
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Shivank Bhatia
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
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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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3
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Tužil J, Matějka J, Mamas MA, Doležal T. Short-term risk of periprocedural stroke relative to radial vs. femoral access: systematic review, meta-analysis, study sequential analysis and meta-regression of 2,188,047 real-world cardiac catheterizations. Expert Rev Cardiovasc Ther 2023; 21:293-304. [PMID: 36877129 DOI: 10.1080/14779072.2023.2187378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To verify whether transradial (TRA) compared to transfemoral (TFA) cardiac catheterization reduces the risk of periprocedural stroke (PS). METHODS We reviewed (CRD42021277918) published real-world cohorts reporting the incidence of PS within 3 days following diagnostic or interventional catheterization. Meta-analyses and meta-regressions of odds ratios (OR) performed using the DerSimonian and Laird method were checked for publication bias (Egger test) and adjusted for false-positive results (study sequential analysis SSA). RESULTS The pooled incidence of PS from 2,188,047 catheterizations (14 cohorts), was 193 (105 to 355) per 100,000. Meta-analyses of adjusted estimates (OR = 0.66 (0.49 to 0.89); p = 0.007; I2 = 90%), unadjusted estimates (OR = 0.63 (0.51 to 0.77; I2 = 74%; p = 0.000)), and a sub-group of prospective cohorts (OR = 0.67 (0.48 to 0.94; p = 0.022; I2 = 16%)) had a lower risk of PS in TRA (without indication of publication bias). SSA confirmed the pooled sample size was sufficient to support these conclusions. Meta-regression decreased the unexplained heterogeneity but did not identify any independent predictor of PS nor any effect modifier. CONCLUSION Periprocedural stroke remains a rare and hard-to-predict adverse event associated with cardiac catheterization. TRA is associated with a 20% to 30% lower risk of PS in real-world/common practice settings. Future studies are unlikely to change our conclusion.
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Affiliation(s)
- Jan Tužil
- Value Outcomes s.r.o., Prague, Czech Republic.,Biomedical informatics, First Medical Faculty, Charles University, Prague, Czech Republic
| | - Jan Matějka
- Department of Cardiology, Hospital of Pardubice, Pardubice, Czech Republic.,Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic.,Academic Department of Internal Medicine, Charles University Faculty of Medicine, Hradec Králové, Czech Republic
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, University of Keele, StokeonTrent, UK
| | - Tomáš Doležal
- Value Outcomes s.r.o., Prague, Czech Republic.,Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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4
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Zakeri SA, Mohammad F, Nowakowska M, Kakani Ebir N, Ananthakrishnan G. A Single-Centre Retrospective Analysis of Radial Versus Femoral Prostate Artery Embolization. Vasc Endovascular Surg 2023; 57:123-128. [PMID: 36189716 DOI: 10.1177/15385744221131175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Purpose: To determine whether route of access, transradial or transfemoral, leads to any discernible differences in patient radiation or contrast medium exposure as well as procedure time in elective prostate artery embolization (PAE).Methods: This retrospective study included sixty patients in total: n = 30 in the radial PAE group, and n = 30 in the femoral PAE group. All procedures were performed in a single angiography suite between May 2018 and January 2021, using a standard kit for each type of vascular access, the same microcatheter/wire combination and embolic agent to super-selectively target and embolize one or both prostate arteries. Outcome measures included dose area product (DAP, µGym2), air kerma (mGy), fluoroscopy time (mins), procedure time (mins) and volume of contrast medium used (mL). Adverse events were also recorded.Results: The radial and femoral groups were matched for age (73.2 ± 7.5 vs 71.3 ± 10.14, P = .41) and body mass index (27.53 ± 5.08 vs 26.41 ± 3.93, P = .38).No significant difference in dose area product, air kerma, fluoroscopy time, procedure time or volume of contrast medium used was found between radial and femoral PAE. No adverse events occurred in either group.Conclusion: Radial PAE is safe and comparable to femoral PAE with respect to patient radiation exposure, contrast medium usage, and procedure duration. Radial access is a useful skill to add to the armament of the interventional radiologist in elective PAE.
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Affiliation(s)
- Simon Arian Zakeri
- Department of Vascular Interventional Radiology, 105551Manchester Royal Infirmary, UK
| | - Fahad Mohammad
- Department of Vascular Interventional Radiology, 105551Manchester Royal Infirmary, UK
| | - Magdalena Nowakowska
- Centre for Primary Care and Health Services Research; Manchester Academic Health Science Centre (MAHSC), 5292The University of Manchester, UK
| | - Nirmal Kakani Ebir
- Department of Vascular Interventional Radiology, 105551Manchester Royal Infirmary, UK
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5
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Ghaith AK, El Naamani K, Mualem W, Ghanem M, Rajjoub R, Sweid A, Yolcu YU, Onyedimma C, Tjoumakaris SI, Bydon M, Jabbour PM. Transradial versus Transfemoral Approaches in Diagnostic and Therapeutic Neuroendovascular Interventions: A Meta-Analysis of Current Literature. World Neurosurg 2022; 164:e694-e705. [PMID: 35580777 DOI: 10.1016/j.wneu.2022.05.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The adoption of the transradial approach (TRA) has been increasing in popularity as a primary method to conduct both diagnostic and therapeutic interventions. As this technique gains broader acceptance and use within the neuroendovascular community, comparing its complication profile with a better-established alternative technique, the transfemoral approach (TFA), becomes more important. This study aimed to evaluate the safety of TRA compared with TFA in patients undergoing diagnostic, therapeutic, and combined neuroendovascular procedures. METHODS A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search of PubMed and other databases was conducted for studies from all available dates. To compare TRA and TFA, we performed an indirect meta-analysis between studies that mentioned the complications of the procedures. RESULTS Our search yielded 532 studies, of which 108 met full inclusion criteria. A total of 54,083 patients (9137 undergoing TRA and 44,946 undergoing TFA) were included. Access site complication rate was lower in TRA (1.62%) compared with TFA (3.31%) (P < 0.01). Neurological complication rate was lower in TRA (1.64%) compared with TFA (3.82%) (P = 0.02 and P < 0.01, respectively). Vascular spasm rate was higher in TRA (3.65%) compared with TFA (0.88%) (P < 0.01). Wound infection complication rate was higher in TRA (0.32%) compared with TFA (0.2%) (P < 0.01). CONCLUSIONS Patients undergoing TFA are significantly more likely to experience access site complications and neurological complications compared with patients undergoing TRA. Patients undergoing TRA are more likely to experience complications such as wound infections and vascular spasm.
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Affiliation(s)
- Abdul Karim Ghaith
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - William Mualem
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Marc Ghanem
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Rami Rajjoub
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmad Sweid
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Yagiz U Yolcu
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Chiduziem Onyedimma
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Stavropoula I Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA.
| | - Pascal M Jabbour
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
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Weinberg JH, Sweid A, Hammoud B, Asada A, Greco-Hiranaka C, Piper K, Gooch MR, Tjoumakaris S, Herial N, Hasan D, Zarzour H, Rosenwasser RH, Jabbour P. A comparative study of transradial versus transfemoral approach for flow diversion. Neuroradiology 2021; 63:1335-1343. [PMID: 33560470 DOI: 10.1007/s00234-021-02672-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Data in neurointerventional literature is extremely limited regarding the safety and efficacy of flow diversion using transradial access (TRA). We aim to demonstrate the safety and efficacy of intracranial aneurysm treatment with the Pipeline Embolization Device (PED) using TRA compared to transfemoral access (TFA). METHODS We conducted a retrospective analysis of a prospectively maintained database and identified 79 consecutive patients who underwent neuroendovascular embolization for cerebral aneurysms using the PED from April 2018 through October 2019. Patients were divided into 2 groups: TRA (32 patients) and TFA (47 patients). A comparative analysis was performed between the two groups. RESULTS There was no significant difference in postoperative intracranial hemorrhage (p>.99), symptomatic ischemic stroke (p=.512), access site complications (p=.268), or other complications (p=.512). However, there was a significant increase in overall complications (14.9% vs. 0.0%, p=.038) and procedure duration (71.4 min ± 31.2 vs. 58.5 ± 20.3, p=.018) in the TFA group. There was no significant difference in complete occlusion at latest follow-up (19/25, 76.0% vs. 35/40, 87.5%; p=.311), 6-month follow-up (17/23, 73.9% vs. 33/38, 86.8%; p=.303), or 12-month follow-up (8/8, 100.0% vs. 5/6, 83.3%; p=.429). There was also no significant difference in rate of retreatment (p>.99), morbidity (p=.512), mortality (p>.99), latest follow-up (p=.985), or loss of follow-up (p=.298). CONCLUSIONS The feasibility and efficacy of flow diversion with the PED via TRA for the treatment of intracranial aneurysms is comparable to TFA. Widespread adoption of this approach may be facilitated by improvements in device navigation and manipulation via radial-specific engineering.
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Affiliation(s)
- Joshua H Weinberg
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Batoul Hammoud
- Department of Pediatric Endocrinology, Children Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ashlee Asada
- Drexel University College of Medicine, Drexel University, Philadelphia, PA, USA
| | | | - Keenan Piper
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nabeel Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - David Hasan
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Hekmat Zarzour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
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Adnan SM, Romagnonli AN, Elansary NN, Martinson JR, Madurska MJ, Dubose JJ, Scalea TM, Morrison JJ. Radial versus femoral arterial access for trauma endovascular interventions: A noninferiority study. J Trauma Acute Care Surg 2020; 89:458-463. [DOI: 10.1097/ta.0000000000002740] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Adnan SM, Romagnoli AN, Martinson JR, Madurska MJ, Dubose JJ, Scalea TM, Morrison JJ. A Comparison of Transradial and Transfemoral Access for Splenic Angio-Embolisation in Trauma: A Single Centre Experience. Eur J Vasc Endovasc Surg 2020; 59:472-479. [DOI: 10.1016/j.ejvs.2019.11.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 10/26/2019] [Accepted: 11/21/2019] [Indexed: 01/29/2023]
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9
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A comparative study of Terumo radial Band® and PreludeSYNC hemostasis compression device after transradial coronary catheterization. Anatol J Cardiol 2020; 25:402-406. [PMID: 34100727 DOI: 10.14744/anatoljcardiol.2020.34694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Novel hemostasis strategies, including PreludeSYNC DISTAL, Merit Medical Systems, Inc. South Jordan, UT, USA (PSD) radial compression device for distal radial artery (DRA) access, have been described for radial access protocols. This study aimed to compare the safety profile of PSD and Terumo radial (TR) Band®. METHODS This prospective interventional study was conducted on patients who underwent coronary interventions via either the DRA or forearm radial artery (FRA). Patients with an arterial diameter of <2 mm, requiring dialysis, with unstable acute coronary syndrome, failed radial cannulation, and sheath insertion were excluded. PSD and TR Band® were used for hemostasis after DRA and FRA access, respectively. The time to hemostasis and complications, including minor/major hematoma, radial artery occlusion (RAO), and neurological symptoms (after 20 days) were recorded. The mean and standard deviation were calculated for age and hemostasis duration. Frequency and percentages were calculated for categorical variables. Independent t-test and Chi-squared test were performed to determine the significance of the differences between the two groups. A p-value of <0.05 was significant. RESULTS Of 139 participants, TR Band® and PSD were used in 76 and 63 patients, respectively. The mean age of the participants was 58.70±10.00 years, and the majority of the patients were men (67.60%). The hemostasis time of both devices was similar (p>0.490). Compared with PSD, TR Band® had more complications (52.63% vs. 23.81%; p=0.020), particularly RAO [odds ratio (OR), 3.17; p=0.018] and neurological problems (OR, 5.33; p=0.005). CONCLUSIONS Although, PSD seems safer in patients with coronary interventions, the device should further be explored in crossover trials for the two access types to determine the overall safety profile.
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Shoji S, Kohsaka S, Kumamaru H, Sawano M, Shiraishi Y, Ueda I, Noma S, Suzuki M, Numasawa Y, Hayashida K, Yuasa S, Miyata H, Fukuda K. Stroke After Percutaneous Coronary Intervention in the Era of Transradial Intervention. Circ Cardiovasc Interv 2019; 11:e006761. [PMID: 30545258 DOI: 10.1161/circinterventions.118.006761] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Periprocedural stroke is a rare but life-threatening complication of percutaneous coronary intervention (PCI). Transradial intervention (TRI) is more beneficial than transfemoral intervention for periprocedural bleeding and acute kidney injuries, but its effect on periprocedural stroke has not been fully investigated. Our study aimed to assess risk predictors of periprocedural stroke according to PCI access site. METHODS AND RESULTS Between 2008 and 2016, 17 966 patients undergoing PCI were registered in a prospective multicenter database. Periprocedural stroke was defined as loss of neurological function caused by an ischemic or hemorrhagic event with residual symptoms lasting at least 24 hours after onset. Periprocedural stroke was observed in 42 patients (0.3%). Stroke patients were older and had a higher incidence of chronic kidney disease, peripheral artery disease, and acute coronary syndrome but were less likely to undergo TRI. Multivariable logistic regression analysis revealed TRI (odds ratio; 0.33; 95% CI, 0.16-0.71; P=0.004) was significantly associated with a lower occurrence of periprocedural stroke. Finally, propensity score-matching analysis showed that TRI was associated with a reduced risk of periprocedural stroke compared with transfemoral intervention (0.1% versus 0.4%; P=0.014). According to our sensitivity analysis, this finding was robust to the presence of an unmeasured confounder in almost all plausible scenarios. CONCLUSIONS TRI was associated with a reduced risk of periprocedural stroke compared with transfemoral intervention. Increased TRI use may reduce overall PCI complications and should be recommended as the optimal access site for both urgent/emergent and elective PCIs.
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Affiliation(s)
- Satoshi Shoji
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S.S., S.K., M.S., Y.S., K.H., S.Y., K.F.)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S.S., S.K., M.S., Y.S., K.H., S.Y., K.F.)
| | - Hiraku Kumamaru
- Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Japan (H.K., H.M.)
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S.S., S.K., M.S., Y.S., K.H., S.Y., K.F.)
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S.S., S.K., M.S., Y.S., K.H., S.Y., K.F.)
| | - Ikuko Ueda
- Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan (I.U.)
| | - Shigetaka Noma
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan (S.N.)
| | - Masahiro Suzuki
- Department of Cardiology, National Hospital Organization Saitama National Hospital, Japan (M.S.)
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan (Y.N.)
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S.S., S.K., M.S., Y.S., K.H., S.Y., K.F.)
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S.S., S.K., M.S., Y.S., K.H., S.Y., K.F.)
| | - Hiroaki Miyata
- Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Japan (H.K., H.M.)
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S.S., S.K., M.S., Y.S., K.H., S.Y., K.F.)
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11
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Radial Approach Expertise and Clinical Outcomes of Percutanous Coronary Interventions Performed Using Femoral Approach. J Clin Med 2019; 8:jcm8091484. [PMID: 31540442 PMCID: PMC6780122 DOI: 10.3390/jcm8091484] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/09/2019] [Accepted: 09/16/2019] [Indexed: 11/30/2022] Open
Abstract
We sought to evaluate the impact of experience and proficiency with radial approach (RA) on clinical outcomes of percutaneous coronary interventions (PCI) performed via femoral approach (FA) in the “real-world” national registry. A total of 539 invasive cardiologists performing PCIs in 151 invasive cardiology centers in Poland between 2014 and 2017 were included. Proficiency threshold was set at >300 PCIs during four consecutive years per individual operator. The majority of operators performed >75% of all PCIs via RA (449 (65.4%)), 143 (20.8%) in 50–75% of cases, 62 (9.0%) in 25–50% and only 33 (4.8%) invasive cardiologists were using RA in <25% of all PCIs. Operators with the highest proficiency in RA were associated with increased risk of periprocedural death, stroke and bleeding complications at access site during angiography via FA. Similarly, higher prevalence of periprocedural mortality during PCI with FA was observed in most experienced radial operators as compared to other groups. The detrimental effect of FA utilization by the most experienced radial operators was observed in both stable angina and acute coronary syndromes. Higher experience and utilization of RA might be linked to worse outcomes of PCIs performed via femoral artery in both stable and acute settings.
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12
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Whitehead N, Williams T, Brienesse S, Ferreira D, Murray N, Inder K, Beautement S, Spratt N, Boyle AJ, Collins N. Contemporary trends in stroke complicating cardiac catheterisation. Intern Med J 2019; 50:859-865. [PMID: 31211489 DOI: 10.1111/imj.14405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 06/08/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Stroke remains an important complication of diagnostic cardiac catheterisation and percutaneous coronary intervention and is associated with high rates of in-hospital mortality. AIMS To evaluate the incidence of stroke over a 10-year period and assess the long-term influence of stroke following cardiac catheterisation and PCI on functional outcomes, based on modified Rankin score and mortality. METHODS The study was performed using a case-control design in a single tertiary referral centre. Patients were identified by correlating those patients undergoing cardiac catheterisation between October 2006 and December 2016 with patients who underwent neuroimaging within 7 days to identify possible cases of suspected stroke or transient ischaemic attack. RESULTS A total of 21 510 patients underwent cardiac catheterisation during the study period. Sixty (0.28%) patients experienced stroke or transient ischaemic attack. Compared to control patients, those who did experience cerebral ischaemic events were older (70.5 vs 64 years; P < 0.001), with higher rates of atrial fibrillation, hypertension and diabetes mellitus. Stroke complicating cardiac catheterisation was associated with an increased risk of readmission, with a significantly higher hazard of readmission for stroke noted. Despite minimal functional impairment based on modified Rankin score, stroke was associated with a significant risk of early and cumulative mortality. Stroke incidence remained stable over the study period despite changes in procedural practice. CONCLUSIONS The incidence and functional severity of stroke remains low despite evolving procedural practice with a stable incidence over time despite changes in procedural practice; however, post-procedural stroke confirms an increased mortality hazard.
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Affiliation(s)
- Nicholas Whitehead
- Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Trent Williams
- Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Health and Biomedical Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Stephen Brienesse
- Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - David Ferreira
- Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Natalia Murray
- School of Health and Biomedical Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Kerry Inder
- Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia.,Neurology Department, John Hunter Hospital, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Stephen Beautement
- Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Neil Spratt
- School of Health and Biomedical Sciences, University of Newcastle, Newcastle, New South Wales, Australia.,Neurology Department, John Hunter Hospital, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Andrew J Boyle
- Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia.,Neurology Department, John Hunter Hospital, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Nicholas Collins
- Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia
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13
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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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14
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Transradial access for visceral endovascular interventions in morbidly obese patients: safety and feasibility. J Vasc Access 2016; 17:256-60. [PMID: 27032454 DOI: 10.5301/jva.5000530] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2016] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Transradial access (TRA) has been shown to lower morbidity and bleeding complications compared to transfemoral access in percutaneous coronary interventions. Morbid obesity, commonly defined as a body mass index (BMI) ≥40 kg/m2, has been shown to be a risk factor for access site complications irrespective of access site. This study evaluates the safety and feasibility of performing visceral endovascular interventions in morbidly obese patients via TRA. METHODS Procedural details, technical success, and 30-day major and minor access site, bleeding, and neurological adverse events were prospectively recorded in a database of 1057 procedures performed via the radial artery. From this database we identified 22 visceral interventions performed with TRA in 17 morbidly obese patients (age: 53 ± 11 years, female: 71%) with a median BMI of 42.7 kg/m2. RESULTS Interventions included radio-embolization (n = 7, 31.8%), chemo-embolization (n = 6, 27.3%), uterine fibroid embolization (n = 4, 18.2%), renal embolization (n = 2, 9.1%), hepatic embolization (n = 1, 4.5%), lumbar artery embolization (n = 1, 4.5%), and renal angioplasty (n = 1, 4.5%). The technical success was 100%. There were no major or minor adverse access site, bleeding, or neurological complications at 30 days. CONCLUSIONS This study suggests visceral endovascular interventions performed in morbidly obese patients are safe and feasible.
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15
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Transradial Approach for Noncoronary Interventions: A Single-Center Review of Safety and Feasibility in the First 1,500 Cases. J Vasc Interv Radiol 2016; 27:159-66. [DOI: 10.1016/j.jvir.2015.10.026] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/13/2015] [Accepted: 10/26/2015] [Indexed: 12/13/2022] Open
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