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Toledano BRF, Garganera KB, Prado JPA, Sabas ML. Routine preprocedural ultrasound in palpation versus ultrasound guided radial access for cardiac catheterization. Catheter Cardiovasc Interv 2024; 103:722-730. [PMID: 38469945 DOI: 10.1002/ccd.31005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/19/2024] [Accepted: 02/26/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND The radial first approach in cardiac catheterization is preferred for its benefits in patient comfort and recovery time. Yet, challenges persist due to characteristics like small, deep, calcified, and mobile radial arteries. Utilizing ultrasound before and during procedures can improve success rates. However, the adoption of its use is still limited and subject to debate. AIM To utilize routine preprocedural ultrasound (US) and compare US guided with palpation guided radial access, focusing on operator efficiency and outcomes. METHODS AND RESULTS Consenting adult patients undergoing elective radial cardiac catheterization were divided into palpation and US groups. Routine preprocedural assessment of radial artery characteristics was performed using handheld US. Baseline data, US findings, procedural outcomes, and clinical outcomes were compared in 182 participants (91 in each group). US guided radial access had significantly higher first pass success rates (76.92% vs. 49.45%, p 0.0001), fewer number of attempts (1.46 ± 1 vs. 1.99 ± 1.46, p 0.004), and shorter amount of time (93.62 ± 44.04 vs. 120.44 ± 67.1, p 0.002) compared with palpation guidance. The palpation group had significantly higher incidence of spasm (15.38% vs. 3.3%, p 0.0052). Subgroup analysis indicated consistent benefits of US guidance, especially in calcified radial arteries. CONCLUSION This prospective, nonrandomized, single-center study demonstrated that real-time procedural US improved the operator's time and effort and enhanced patient comfort compared with palpation. US guidance use was particularly favorable in the presence of calcifications observed on baseline preoperative US.
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Affiliation(s)
- Bryan Rene F Toledano
- Cardiac Catheterization Department, Cardiovascular Institute, The Medical City Hospital, Pasig City, Philippines
| | - Kristy B Garganera
- Cardiac Catheterization Department, Cardiovascular Institute, The Medical City Hospital, Pasig City, Philippines
| | - Jose Paolo A Prado
- Cardiac Catheterization Department, Cardiovascular Institute, The Medical City Hospital, Pasig City, Philippines
| | - Michelangelo L Sabas
- Cardiac Catheterization Department, Cardiovascular Institute, The Medical City Hospital, Pasig City, Philippines
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Wein B, Zaczkiewicz M, Graf M, Zimmermann O, Gori T, Nef HM, Kastner J, Mehilli J, Richardt G, Wöhrle J, Achenbach S, Riemer T, Hamm C, Torzewski J. No difference in 30-day outcome and quality of life in transradial versus transfemoral access - Results from the German Austrian ABSORB registry (GABI-R). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:144-149. [PMID: 34844868 DOI: 10.1016/j.carrev.2021.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Radial (RA) instead of femoral access (FA) for coronary interventions has become a European Society of Cardiology Class-IA guideline recommendation. But when the decision on the access site is left to the discretion of the operator, differences in adverse event rates mitigate. METHODS We compared the 30-day outcome for RA and FA in all patients recruited for the observational German Austrian ABSORB Registry (GABI-R) in regard to all-cause mortality, stroke, myocardial infarction (MI), TIMI major bleedings (TMB) and quality of life (QoL). All patients were treated with a bioresorbable vascular scaffold. Access site was left to the discretion of the operator. RESULTS In total, 3137 patients included by 92 centers received percutaneous coronary interventions (PCI) for acute MI in 51.5% and non-acute settings in 48.5%. RA was performed in 47.8% and had a higher median radiation exposure (3896 vs. 3082 cGycm2, p < 0.001). There was no difference in the amount of contrast used. There was also no difference in all-cause mortality (0.53% vs. 0.49%, p = 0.86), the combination of death, MI and stroke (1.87% vs. 1.83%, p = 0.94), but a trend towards more TMB (0.47% vs. 1.04%, p = 0.07) with FA. These outcomes were consistent across the subgroups of patients with ST-elevation MI, non-ST-elevation-ACS and stable coronary artery disease. Finally, QoL did not differ between RA and FA. CONCLUSIONS In this contemporary GABI-R cohort, in which access site was left to the discretion of the operator, both access routes were safe and equal concerning QoL (ClinicalTrials.gov; NCT02066623).
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Affiliation(s)
- Bastian Wein
- Medical Department I, University Hospital Augsburg, Augsburg, Germany
| | | | - Matthias Graf
- Cardiovascular Center Oberallgaeu-Kempten, Kempten, Germany
| | | | - Tommaso Gori
- Department of Cardiology I, University Medical Center, Johannes Gutenberg University Mainz and DZHK Site Rhein Main, Germany
| | - Holger M Nef
- University of Giessen, Medizinische Klinik I, Department of Cardiology, Giessen, Germany
| | - Johannes Kastner
- Department of Cardiology, University of Vienna - Medical School, Vienna, Austria
| | - Julinda Mehilli
- Department of Cardiology, Pneumonology and Intensive Care Medicine - LAKUMED Hospital Landshut-Achdorf, Germany
| | - Gert Richardt
- Herzzentrum, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Jochen Wöhrle
- Department of Cardiology, Angiology, Pneumonology and Intensive Care, Medical Campus Bodensee, Friedrichshafen, Germany
| | - Stephan Achenbach
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Medizinische Klinik 2, Erlangen, Germany
| | - Thomas Riemer
- IHF GmbH - Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Christian Hamm
- University of Giessen, Medizinische Klinik I, Department of Cardiology, Giessen, Germany; Kerckhoff Heart and Thorax Centre, Department of Cardiology, Bad Nauheim, Germany
| | - Jan Torzewski
- Cardiovascular Center Oberallgaeu-Kempten, Kempten, Germany.
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Januszek R, Dziewierz A, Siudak Z, Rakowski T, Kameczura T, Tokarek T, Dudek D, Bartuś S. Concomitant multi-vessel disease is associated with a lower procedural death rate in patients treated with percutaneous coronary interventions within the left main coronary artery (from the ORPKI registry). Arch Med Sci 2021; 17:881-890. [PMID: 34336016 PMCID: PMC8314404 DOI: 10.5114/aoms.2019.82666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/11/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION In this study, we aimed to distinguish differences in the procedural complication rate in a group of patients undergoing percutaneous coronary interventions (PCI) of the left main coronary artery (LMCA) between patients with isolated LMCA disease and multi-vessel disease (MVD) with LMCA involvement and to identify their predictors. MATERIAL AND METHODS We assessed 221,187 patients from the Polish Cardiovascular Intervention Society national registry (ORPKI) regarding all PCI procedures performed in Poland in 2015 and 2016. We extracted data of 1,819 patients with isolated LMCA disease and 3,718 patients with MVD and LMCA involvement. We compared those two groups in terms of procedural complications and their predictors. RESULTS The overall rate of procedural complications was significantly higher in patients treated with LMCA PCI both in the group of patients with isolated LMCA (6.5%) and the group with MVD with LMCA involvement (7.3%) compared to the non-LMCA PCI group (1.9%, p = 0.002). Multivariate analysis confirmed that MVD with LMCA involvement is an independent predictor of decreased risk of procedural death in the overall group of patients undergoing PCI of the LMCA (odds ratio: 0.583; 95% confidence interval: 0.4-0.848; p = 0.005). CONCLUSIONS The MVD involvement in patients treated with PCI of the LMCA may play a protective role. Patients with isolated LMCA involvement undergoing PCI should be subjected to special care and protected by various methods, such as devices to support left ventricle function.
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Affiliation(s)
- Rafał Januszek
- Department of Clinical Rehabilitation, University of Physical Education, Krakow, Poland
| | - Artur Dziewierz
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Tomasz Rakowski
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Kameczura
- Chair of Electroradiology, Faculty of Medicine, University of Rzeszow, Rzeszow, Poland
| | - Tomasz Tokarek
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Dariusz Dudek
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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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: 311] [Impact Index Per Article: 62.2] [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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Krishnamurthy A, Keeble C, Anderson M, Somers K, Burton-Wood N, Harland C, Baxter P, McLenachan J, Blaxill J, Blackman DJ, Malkin C, Wheatcroft S, Greenwood J. Real-world comparison of clopidogrel, prasugrel and ticagrelor in patients undergoing primary percutaneous coronary intervention. Open Heart 2019; 6:e000951. [PMID: 31328001 PMCID: PMC6609142 DOI: 10.1136/openhrt-2018-000951] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 05/30/2019] [Indexed: 02/02/2023] Open
Abstract
Background There is a paucity of real-world outcome data comparing clopidogrel, prasugrel and ticagrelor in primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI). We sought to assess the association of choice of oral P2Y12-receptor inhibitor with clinical outcomes following PPCI for STEMI in a large consecutive patient series. Methods Demographic, procedural and 12-month outcome data were prospectively collected for all patients undergoing PPCI in Leeds, UK, between 01 January 2009 and 31 December 2011, and 01 January 2013 and 31 December 2013. Clinical endpoints were 30-day and 12-month all-cause mortality, recurrent MI and 30-day HORIZONS-major bleeding. Logistic regression analyses were undertaken to adjust for confounding factors. Results Prasugrel (n=1244) was associated with lower adjusted 30-day (OR 0.53 (0.34-0.85)) and 12-month (OR 0.55 (0.38-0.78)) mortality, and 12-month MI (OR 0.63 (0.42-0.94)) compared with clopidogrel (n=1648). Importantly, prasugrel was associated with lower adjusted 30-day mortality (OR 0.51 (0.29-0.91)) compared with ticagrelor (n=811). Lower 30-day (OR 0.40 (0.17-0.94)) and 12-month (OR 0.54 (0.32-0.93)) MI were observed in ticagrelor compared with clopidogrel, an association absent in comparison with prasugrel. Adjusted bleeding were not statistically significantly different among the P2Y12-receptor inhibitors. Conclusion In this large consecutive real-world series, prasugrel was associated with lower adjusted 30-day mortality compared with ticagrelor and clopidogrel, and lower adjusted 12-month mortality compared with clopidogrel. Both prasugrel and ticagrelor were associated with lower recurrent MI following PPCI compared with clopidogrel, with no overall increase in adjusted bleeding.
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Affiliation(s)
- Arvindra Krishnamurthy
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Claire Keeble
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Kathryn Somers
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | | | | | - Paul Baxter
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Jim McLenachan
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | | | | | | | - Stephen Wheatcroft
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - John Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Department of Cardiology, Leeds General Infirmary, Leeds, UK
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Li W, Shi H, Li Y. Salvage therapy for subclavian artery perforation resulting in mediastinal hematoma during percutaneous coronary intervention: A case report. Medicine (Baltimore) 2019; 98:e15550. [PMID: 31083214 PMCID: PMC6531119 DOI: 10.1097/md.0000000000015550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Transradial access (TRA) is a widely used technique during percutaneous coronary intervention (PCI). However, mediastinal and cervical hematomas, the rare and severe complications of transradial approach, have extremely high mortality rates. To the best of our knowledge, there were no medical literatures about the successful anticoagulation reversal procedure of mediastinal hematoma in PCI till now. PATIENT CONCERNS We here present a 54-year-old male Han patient who underwent PCI. Immediately after PCI, he reported an episode of neck and chest discomfort, dyspnea, cough recurrence, and cold sweats. Emergency chest computed tomography (CT) revealed a perforation of the subclavian artery resulting in a large mediastinal hematoma with potentially lethal tracheal compression. DIAGNOSIS A diagnosis of the large mediastinal hematoma was made based on the enhanced computed tomography. INTERVENTIONS The patient was successfully managed with palliative therapy of anticoagulation reversal instead of a covered stent graft and surgical operation. OUTCOMES Angiography confirmed the absence of leakage after anticoagulation reversal. The patient had an apparent remission of clinical dyspnea. Follow-up CT confirmed an almost entire absorption of the mediastinal hematoma 35 days postdischarge. LESSONS The current case highlights the importance of anticoagulation reversal as well as careful guidewire and guide catheter manipulation by the radial approach. Early evaluation, prompt identification, appropriate treatment, and close monitoring are all essential for invasive cardiology.
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Affiliation(s)
| | - Hongjian Shi
- Department of Intervention, Affiliated Wujin Hospital of Jiangsu University, Changzhou, Jiangsu, China
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Yee J, Kumar V, Li S, Petraskova T, Pham A, Stys J, Thompson PA, Petrasko M, Stys A, Stys T. Clinical factors associated with physician choice of femoral versus radial access: A real-world experience from a single academic center. J Interv Cardiol 2017; 31:236-243. [PMID: 29277921 DOI: 10.1111/joic.12479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 11/12/2017] [Accepted: 11/14/2017] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To analyze clinical factors associated with operator's preference in selection of femoral versus radial access for angiography and percutaneous intervention (PCI) procedures. BACKGROUND There has been an increase in radial access in cardiac catheterization and PCI in the last few decades. METHODS Data from 11 226 consecutive cardiac catheterization procedures were collected from Sanford University Medical Center (University of South Dakota, Sanford School of Medicine) from 2011 to 2015. RESULTS In the overall cases, clinical factors that favored upfront femoral access include patients presenting as ST-elevation myocardial infarction (STEMI) or emergent, coronary artery bypass graft, body mass index (BMI) <30 kg/m2 and age ≥70 years, whereas morbidly obese patients (BMI ≥35) and age <70 favored upfront radial access. Radial access in the overall group had lower fluoroscopy time (6.5 vs 8.4 min, P < 0.0001) and lower contrast use (68.8 vs 80.6 cc, P < 0.0001). In the PCI group, efficacy of upfront radial access is less evident with radial fluoroscopy time (10.1 vs 11.0 min, P < 0.0028) and contrast use being higher in radial group (113.8 vs 108.2 cc, P < 0.037). Interventional cardiologists were more efficient in diagnostic cases than non-interventional cardiologists. CONCLUSION STEMI or emergent cases and elderly patients favor upfront femoral access. As BMI increases and age decreases, radial access is progressively favored. In diagnostic cases, radial access appears to be superior to femoral access in efficacy, but the distinction is less obvious in PCI and STEMI or emergent cases.
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Affiliation(s)
- Jimmy Yee
- Division of Cardiology, Sanford School of Medicine, Sioux Falls, South Dakota
| | - Vishesh Kumar
- Division of Cardiology, Sanford School of Medicine, Sioux Falls, South Dakota
| | - Shenjing Li
- Division of Cardiology, Sanford School of Medicine, Sioux Falls, South Dakota
| | - Terezia Petraskova
- Research Intern, Division of Cardiology, Sanford School of Medicine, Sioux Falls, South Dakota
| | - Alex Pham
- Research Intern, Division of Cardiology, Sanford School of Medicine, Sioux Falls, South Dakota
| | - Julia Stys
- Research Intern, Division of Cardiology, Sanford School of Medicine, Sioux Falls, South Dakota
| | - Paul A Thompson
- Department of Pediatrics and Internal Medicine, Sanford School of Medicine, Sioux Falls, South Dakota
| | - Marian Petrasko
- Division of Cardiology, Sanford School of Medicine, Sioux Falls, South Dakota
| | - Adam Stys
- Division of Cardiology, Sanford School of Medicine, Sioux Falls, South Dakota
| | - Tomasz Stys
- Division of Cardiology, Sanford School of Medicine, Sioux Falls, South Dakota
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Heshmat H, haddad YE, Farouk M, Abdelmegeed M. Radial Access in Primary PCI for Acute Myocardial Infarction. Interv Cardiol 2017. [DOI: 10.5772/intechopen.69131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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