1
|
Rivera K, Fernández-Rodríguez D, Bullones J, Gorriño S, Sánchez Espino A, Garcia-Guimarães M, Casanova-Sandoval J, Irigaray P, Costa-Mateu J, Arroyo-Calpe D, Roig-Boira O, Tornel-Cerezo M, Baiget-Pons A, Worner F, Ferreiro JL. Impact of sex differences on the feasibility and safety of distal radial access for coronary procedures: a multicenter prospective observational study. Coron Artery Dis 2024; 35:360-367. [PMID: 38433727 DOI: 10.1097/mca.0000000000001348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
BACKGROUND Conventional transradial access in women is associated with a lower success rate and a higher incidence of spasm compared to men. To date, the effect of sex on the performance of distal radial access (DRA) has not been fully elucidated. The aim of this study was to assess the impact of sex on catheterization success and other performance parameters of DRA procedures. METHODS This is a prospective three-center observational study. From August 2020 to September 2022, data from all consecutive patients who underwent DRA for coronary procedures were collected. RESULTS A total of 868 procedures were registered and stratified into two groups according to sex: women (n = 258) and men (n = 610). Female patients had less favorable baseline characteristics than male patients in terms of absent or weak pulse (29% vs. 17%; P < 0.001), distal radial diameter (2.2 ± 0.3 vs. 2.4 ± 0.4 mm; P < 0.001) and proximal radial diameter (2.5 ± 0.7 vs. 2.7 ± 0.7 mm; P = 0.001). No differences in success rates were found in women compared to men (94.2% vs. 96.6%; P = 0.135), with a higher presence of arterial spasm in women (5.8% vs. 3.0%; P = 0.044). The preprocedural ultrasound evaluation was the only predictor of DRA success [odds ratio = 20.0 (4.739-83.333); P < 0.001]. CONCLUSION In patients undergoing coronary procedures, the success rate of DRA was high regardless of sex, with a higher incidence of arterial spasm in women.
Collapse
Affiliation(s)
- Kristian Rivera
- Department of Cardiology, Arnau de Vilanova University Hospital, Institut Català de la Salut
- Grup de Fisiologia i Patologia Cardíaca, Institut de Recerca Biomèdica de Lleida Fundació Dr. Pifarré, IRBLleida, Lleida
| | - Diego Fernández-Rodríguez
- Department of Cardiology, Arnau de Vilanova University Hospital, Institut Català de la Salut
- Grup de Fisiologia i Patologia Cardíaca, Institut de Recerca Biomèdica de Lleida Fundació Dr. Pifarré, IRBLleida, Lleida
| | - Juan Bullones
- Department of Cardiology, Regional University Hospital, Málaga
| | - Susana Gorriño
- Department of Cardiology, Regional University Hospital, Málaga
| | | | - Marcos Garcia-Guimarães
- Department of Cardiology, Arnau de Vilanova University Hospital, Institut Català de la Salut
- Grup de Fisiologia i Patologia Cardíaca, Institut de Recerca Biomèdica de Lleida Fundació Dr. Pifarré, IRBLleida, Lleida
| | - Juan Casanova-Sandoval
- Department of Cardiology, Arnau de Vilanova University Hospital, Institut Català de la Salut
- Grup de Fisiologia i Patologia Cardíaca, Institut de Recerca Biomèdica de Lleida Fundació Dr. Pifarré, IRBLleida, Lleida
| | - Patricia Irigaray
- Department of Cardiology, Arnau de Vilanova University Hospital, Institut Català de la Salut
- Grup de Fisiologia i Patologia Cardíaca, Institut de Recerca Biomèdica de Lleida Fundació Dr. Pifarré, IRBLleida, Lleida
| | - Joan Costa-Mateu
- Department of Cardiology, Arnau de Vilanova University Hospital, Institut Català de la Salut
| | - David Arroyo-Calpe
- Department of Cardiology, Arnau de Vilanova University Hospital, Institut Català de la Salut
| | - Oriol Roig-Boira
- Department of Cardiology, Arnau de Vilanova University Hospital, Institut Català de la Salut
| | - María Tornel-Cerezo
- Department of Cardiology, Arnau de Vilanova University Hospital, Institut Català de la Salut
| | - Anna Baiget-Pons
- Department of Cardiology, Arnau de Vilanova University Hospital, Institut Català de la Salut
| | - Fernando Worner
- Department of Cardiology, Arnau de Vilanova University Hospital, Institut Català de la Salut
- Grup de Fisiologia i Patologia Cardíaca, Institut de Recerca Biomèdica de Lleida Fundació Dr. Pifarré, IRBLleida, Lleida
| | - José Luis Ferreiro
- Department of Cardiology, Joan XXIII University Hospital - IISPV, CIBER-CV, Tarragona, Spain
| |
Collapse
|
2
|
Starke RM, Abecassis IJ, Saini V, Matouk CC, Hassan AE, Siddiqui AH, Frei DF. Initial experience of using a large-bore (0.096″ inner diameter) access catheter in neurovascular interventions. Interv Neuroradiol 2024; 30:372-379. [PMID: 36114634 PMCID: PMC11310716 DOI: 10.1177/15910199221127074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/31/2022] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION The purpose of this study was to report our initial experience of using a large-bore (0.096″ inner diameter) access catheter in neurovascular interventions. METHODS Data were retrospectively collected from 5 sites in the US for neurovascular procedures performed using a large-bore access catheter. The effectiveness outcome was technical success, defined as the access catheter's successfully reaching its target vessel without conversion to direct carotid puncture or to a smaller-bore access catheter and successfully completing the intended neurointervention. RESULTS One hundred and thirteen procedures performed in 112 patients were included in this study. The mean age of the patients was 67.5 years (SD 16.2), and about half (49.1%) were female. The most common primary access sites were the femoral (64.6%) or radial (32.7%) artery. Challenging anatomic variations included severe vessel tortuosity (26/81, 32.1%), type II aortic arch (17/88, 19.3%), type III aortic arch (14/88, 15.9%), bovine arch (16/104, 15.4%), severe angle (<30°) between the subclavian and target vessel (11/74, 14.9%), and subclavian loop (7/79, 8.9%). The median access time to branch view was 18 min (IQR 11-28, N = 75). The technical success rate was 94.7%. Two dissections (1.8%) were related to the large-bore access catheter. Access site complications occurred in 2 patients (1.8%). Four additional symptomatic periprocedural complications not related to the large-bore access catheter occurred (7.1%). CONCLUSION For neurovascular interventions, a 0.096″ inner diameter access catheter could be used with both femoral and radial arterial approaches, had a high technical success rate, and had a low rate of periprocedural complications.
Collapse
Affiliation(s)
- Robert M Starke
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | | | - Vasu Saini
- Department of Neurology, University of Miami, Miami, FL, USA
| | - Charles C Matouk
- Department of Neurosurgery and Department of Radiology & Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Ameer E Hassan
- Department of Neurology and Radiology, University of Texas Rio Grande Valley at Valley Baptist Medical Center, Harlingen, TX, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo Neurosurgery, Inc., Buffalo, NY, USA
| | | |
Collapse
|
3
|
Hou Q, Zhou B, He J, Chen X, Zuo Y. Complications and related risk factors of transradial access cannulation for hemodynamic monitoring in general surgery: a prospective observational study. BMC Anesthesiol 2023; 23:228. [PMID: 37391714 PMCID: PMC10311751 DOI: 10.1186/s12871-023-02168-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/07/2023] [Indexed: 07/02/2023] Open
Abstract
PURPOSE To examine the short-term complications of arterial cannulation for intraoperative monitoring and their related risk factors. METHODS We included adult inpatients (≥ 18 years old) who underwent an initial transradial access (TRA) cannulation and were scheduled for general surgery between April 8 and November 30, 2020. We used 20G arterial puncture needles for puncturing and manual compression for hemostasis. Demographic, clinical, surgical, anesthetic, and laboratory data were extracted from electronic medical records. Vascular, neurologic, and infectious complications of TRA cannulation were recorded and analyzed. Logistic regression analyses were used to identify risk factors related to TRA cannulation for intraoperative monitoring. RESULTS Among 509 included patients, 174 developed TRA cannulation-related complications. Puncture site bleeding/hematoma and median nerve injury were observed in 158 (31.0%) and 16 (3.1%) patients, respectively. No patient developed cannula-related infections. Logistic regression analysis revealed increased odds of puncture site bleeding/hematoma in women (odds ratio 4.49, 95% CI 2.73-7.36; P < 0.001) and patients who received intraoperative red blood cell (RBC) suspension transfusion ≥ 4U (odds ratio 5.26, 95% CI 1.41-19.57; P = 0.01). No risk factors for nerve injury were identified. CONCLUSION Bleeding/hematoma were a common complication of TRA cannulation for intraoperative hemodynamic monitoring during general surgery. Median nerve injury may be an under recognized complication. Female sex and extensive intraoperative RBC transfusion are associated with an increased risk of bleeding/hematoma; however, the risk factors for nerve injury remain unclear. TRIAL REGISTRATION The study protocol was registered at https://www.chictr.org.cn (ChiCTR1900025140).
Collapse
Affiliation(s)
- Qin Hou
- Department of Anesthesiology, West China Hospital of Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041 P.R. China
| | - Bin Zhou
- Department of Anesthesiology, West China Hospital of Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041 P.R. China
| | - Juanjuan He
- Department of Anesthesiology, West China Hospital of Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041 P.R. China
- Department of Anesthesiology, Jiangsu Integrated Traditional Chinese and Western Medicine Hospital, Nanjing, Jiangsu Province 210028 P.R. China
| | - Xueying Chen
- Department of Anesthesiology, Chengdu Shang Jin Nan Fu Hospital, Chengdu, Sichuan Province, 611730 P.R. China
| | - Yunxia Zuo
- Department of Anesthesiology, West China Hospital of Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041 P.R. China
| |
Collapse
|
4
|
Wintzer-Wehekind J, Lefèvre T, Benamer H, Monsegu J, Tchétché D, Garot P, Honton B, Dumonteil N, Abdellaoui M. A direct wire pacing device for transcatheter heart valve and coronary interventions: a first-in-human, multicentre study of the Electroducer Sleeve. EUROINTERVENTION 2023; 18:1150-1555. [PMID: 36484703 PMCID: PMC9976696 DOI: 10.4244/eij-d-22-00662] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/07/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) and complex percutaneous coronary interventions (PCI) may require cardiac pacing during device delivery, generally requiring the insertion of a temporary pacing lead via an additional venous access site. The purpose-built Electroducer Sleeve device provides direct wire pacing without the need for a temporary venous pacemaker. AIMS This study assessed the safety of temporary cardiac pacing using the novel sleeve device during PCI. METHODS This was a multicentre, non-randomised, prospective, first-in-human, single-arm, pilot study. The primary endpoint was analysis of a safety outcome, defined as the occurrence of haematomas or bleeding complications at the device vascular access site. Secondary endpoints included analyses of effectiveness and qualitative outcomes. RESULTS Sixty patients (mean age: 77.9±9.6 years) from 4 centres in France were included: 39 (65%) underwent TAVI, and 21 (35%) underwent PCI. Procedures were performed using the sleeve with access through the radial (32 patients; 53.3%) or femoral arteries (26; 43.3%), or the femoral vein (2; 3.3%). Primary endpoint analysis revealed that 2 patients (3.3%) developed EArly Discharge After Transradial Stenting of CoronarY Arteries Study (EASY) grade I/Bleeding Academic Research Consortium (BARC) type I haematomas at the device access site. As a measure of effectiveness, a haemodynamic effect was observed after each spike delivery in 54 patients (90%). Analyses of other secondary endpoints showed that 2 patients (6.3%) presented asymptomatic radial artery occlusion. No allergies were reported. CONCLUSIONS This first-in-human trial using the Electroducer Sleeve indicated that this novel, purpose-built, temporary pacing device was safe and effective. Larger prospective studies are required to confirm these findings.
Collapse
Affiliation(s)
- Jérôme Wintzer-Wehekind
- Institut Cardiovasculaire de Grenoble, Grenoble, France
- Médipôle Lyon-Villeurbanne, Villeurbanne, France
| | - Thierry Lefèvre
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Hakim Benamer
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Jacques Monsegu
- Institut Cardiovasculaire de Grenoble, Grenoble, France
- Médipôle Lyon-Villeurbanne, Villeurbanne, France
| | - Didier Tchétché
- Groupe Cardiovasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Benjamin Honton
- Groupe Cardiovasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Nicolas Dumonteil
- Groupe Cardiovasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Mohamed Abdellaoui
- Institut Cardiovasculaire de Grenoble, Grenoble, France
- Médipôle Lyon-Villeurbanne, Villeurbanne, France
| |
Collapse
|
5
|
Ferrante G, Condello F, Rao SV, Maurina M, Jolly S, Stefanini GG, Reimers B, Condorelli G, Lefèvre T, Pancholy SB, Bertrand O, Valgimigli M. Distal vs Conventional Radial Access for Coronary Angiography and/or Intervention: A Meta-Analysis of Randomized Trials. JACC Cardiovasc Interv 2022; 15:2297-2311. [PMID: 36423974 DOI: 10.1016/j.jcin.2022.09.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/30/2022] [Accepted: 09/03/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Emerging evidence from randomized clinical trials (RCTs) comparing distal radial access (DRA) with conventional radial access (RA) is available. OBJECTIVES The aim of this study was to provide a quantitative appraisal of the effects of DRA) vs conventional RA for coronary angiography with or without intervention. METHODS The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for RCT comparing DRA vs conventional RA for coronary angiography and/or intervention. Data were pooled by meta-analysis using a random-effects model. The primary endpoint was radial artery occlusion (RAO) at the longest available follow-up. RESULTS Fourteen studies enrolling 6,208 participants were included. Compared with conventional RA, DRA was associated with a significant lower risk of RAO, either detected at latest follow-up (risk ratio [RR]: 0.36; 95% CI: 0.23-0.56; P < 0.001; number needed to treat [NNT] = 30) or in-hospital (RR: 0.32; 95% CI: 0.19-0.53; P < 0.001; NNT = 28), as well as EASY (Early Discharge After Transradial Stenting of Coronary Arteries) ≥II hematoma (RR: 0.51; 95% CI: 0.27-0.96; P = 0.04; NNT = 107). By contrast, DRA was associated with a higher risk of access site crossover (RR: 3.08; 95% CI: 1.88-5.06; P < 0.001; NNT = 12), a longer time for radial puncture (standardized mean difference [SMD]: 3.56; 95% CI: 0.96-6.16; P < 0.001), a longer time for sheath insertion (SMD: 0.37; 95% CI: 0.16-0.58; P < 0.001), and a higher number of puncture attempts (SMD: 0.59, 95% CI: 0.48-0.69; P < 0.001). CONCLUSIONS Compared with conventional RA, DRA is associated with lower risks of RAO and EASY ≥II hematoma but requires longer time for radial artery cannulation and sheath insertion, more puncture attempts, and a higher access site crossover.
Collapse
Affiliation(s)
- Giuseppe Ferrante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Cardiovascular Medicine, IRCCS-Humanitas Research Hospital, Rozzano, Italy.
| | - Francesco Condello
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Sunil V Rao
- NYU Langone Health System, New York, New York, USA
| | - Matteo Maurina
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Cardiovascular Medicine, IRCCS-Humanitas Research Hospital, Rozzano, Italy
| | - Sanjit Jolly
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Cardiovascular Medicine, IRCCS-Humanitas Research Hospital, Rozzano, Italy
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Cardiovascular Medicine, IRCCS-Humanitas Research Hospital, Rozzano, Italy
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Cardiovascular Medicine, IRCCS-Humanitas Research Hospital, Rozzano, Italy
| | - Thierry Lefèvre
- Institut Cardiovasculaire Paris Sud, Hopital Jacques Cartier, Ramsay Santè, Massy, France
| | - Samir B Pancholy
- Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA; Apex Heart Institute, Ahmedabad, India
| | | | - Marco Valgimigli
- Cardiocentro Institute, Ente Ospedaliero Cantonale, Università della Svizzera Italiana, Lugano, Switzerland
| |
Collapse
|
6
|
Distal Radial Artery Access. JACC Cardiovasc Interv 2022; 15:2312-2314. [DOI: 10.1016/j.jcin.2022.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 09/27/2022] [Indexed: 11/22/2022]
|
7
|
Radial Artery Access Complications: Prevention, Diagnosis and Management. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 40:163-171. [PMID: 34952824 DOI: 10.1016/j.carrev.2021.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 01/04/2023]
Abstract
The transradial approach for cardiac catheterization, coronary angiography, and percutaneous intervention is associated with a lower risk of access site-related complications compared to the transfemoral approach. However, with increasing utilization of transradial access for not only coronary procedures but also peripheral vascular procedures, healthcare personnel are more likely to encounter radial access site complications, which can be associated with morbidity and mortality. There is significant heterogeneity in the reporting of incidence, manifestations, and management of radial access site complications, at least partly due to vague presentation and under-diagnosis. Therefore, physicians performing procedures via transradial access should be aware of possible complications and remain vigilant to prevent their occurrence. Intraprocedural complications of transradial access procedures, which include spasm, catheter kinking, and arterial dissection or perforation, may lead to patient discomfort, increased procedure time, and a higher rate of access site cross over. Post-procedural complications such as radial artery occlusion, hematoma, pseudoaneurysm, arteriovenous fistula, or nerve injury could lead to patient discomfort and limb dysfunction. When radial access site complications occur, comprehensive evaluation and prompt treatment is necessary to reduce long-term consequences. In this report, we review the incidence, clinical factors, and management strategies for radial access site complications associated with cardiac catheterization.
Collapse
|
8
|
Ford TJ, Bamford P, Barlis P, Said C. Radial Artery, Alternative Arm Access, and Related Techniques. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
9
|
Villela MA, Sanina C, Pyo R. Vascular Access Site Complications. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
10
|
Abecassis IJ, Saini V, Crowley RW, Munich SA, Singer J, Osbun JW, Gross BA, Walcott BP, Peebles TR, Bain M, Storey CM, Yavagal DR, Starke RM, Peterson EC. The Rist radial access system: a multicenter study of 152 patients. J Neurointerv Surg 2021; 14:403-407. [PMID: 34344694 DOI: 10.1136/neurintsurg-2021-017739] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/22/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Transradial access (TRA) for neurointervention is becoming increasingly popular as experience with the technique grows. Despite reasonable efficacy using femoral catheters off-label, conversion to femoral access occurs in approximately 8.6-10.3% of TRA cases, due to an inability of the catheter to track into the vessel of interest, lack of support, or radial artery spasm. METHODS This is a multicenter, retrospective case series of patients undergoing neurointerventions using the Rist Radial Access System. We also present our institutional protocol for using the system. RESULTS 152 patients were included in the cohort. The most common procedure was flow diversion (28.3%). The smallest radial diameter utilized was 1.9 mm, and 44.1% were performed without an intermediate catheter. A majority of cases (96.1%) were completed successfully; 3 (1.9%) required conversion to a different radial catheter, 2 (1.3%) required conversion to femoral access, and 1 (0.7%) was aborted. There was 1 (0.7%) minor access site complication and 4 (2.6%) neurological complications. CONCLUSIONS The Rist catheter is a safe and effective tool for a wide range of complex neurointerventions, with lower conversion rates than classically reported.
Collapse
Affiliation(s)
- Isaac Josh Abecassis
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vasu Saini
- Neurology, University of Miami, Miami, Florida, USA
| | - R Webster Crowley
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Stephan A Munich
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Justin Singer
- Neurosurgery, Spectrum Health Michigan State University College of Human Medicine Internal Medicine Residency Program, Grand Rapids, Michigan, USA
| | - Joshua W Osbun
- Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Bradley A Gross
- Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brian P Walcott
- Neurological Surgery, Northshore University Health System & University of Chicago, Evanston, IL, USA
| | - Todd R Peebles
- Radiology Associates of the Fox Valley, Neenah, Wisconsin, USA
| | - Mark Bain
- Neurological Surgery, Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Robert M Starke
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eric C Peterson
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
11
|
Chu HH, Kim JW, Shin JH, Cho SB. Update on Transradial Access for Percutaneous Transcatheter Visceral Artery Embolization. Korean J Radiol 2020; 22:72-85. [PMID: 32901463 PMCID: PMC7772376 DOI: 10.3348/kjr.2020.0209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/09/2020] [Accepted: 05/13/2020] [Indexed: 12/29/2022] Open
Abstract
Transfemoral access (TFA) is a widely used first-line approach for most peripheral vascular interventions. Since its introduction in cardiologic and neurointerventional procedures, several advantages of transradial access (TRA) over TFA have been demonstrated, such as patient preference, lower complication rates, early ambulation, and shorter hospital stay. However, studies reporting the safety and efficacy of this approach for peripheral vascular interventions performed by interventional radiologists are relatively few. This review aimed to summarize the technique and clinical applications of TRA in percutaneous transcatheter visceral artery embolization and the management of complications.
Collapse
Affiliation(s)
- Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Soo Buem Cho
- Department of Radiology, Ewha Womans University College of Medicine, Seoul, Korea
| |
Collapse
|
12
|
Jirous S, Bernat I, Slezak D, Miklik R, Rokyta R. Post-procedural radial artery occlusion and patency detection using duplex ultrasound vs. the reverse Barbeau test. Eur Heart J Suppl 2020; 22:F23-F29. [PMID: 32694950 PMCID: PMC7361668 DOI: 10.1093/eurheartj/suaa095] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The transradial approach is recommended as a first choice in coronary catheterizations and interventions, for among other reasons, the reduction in the number of local complications. A head-to-head comparison of the reverse Barbeau test (RBT) and duplex ultrasonography (DUSG) for the detection of post-procedural radial artery patency and occlusion has not yet been evaluated. In 500 patients from our same-day discharge program (age 65 ± 9.4 years, 148 women), radial artery patency and occlusion, compression time, haematomas, and other local complications were evaluated. Radial artery patency was confirmed in 495 patients (99.0%), and complete radial artery occlusion (RAO) was detected in 2 (0.4%) patients using both methods. In 3 patients (0.6%), the RBT was negative, while incomplete RAO was detected by DUSG. Superficial haematomas (˃ 5 but ≤10 cm) were found in 27 (5.4%) patients. There were no other local complications. Detection of radial artery patency and occlusion using the RBT and DUSG was comparable. The incidence of RAO in our study was extremely low. Thanks to its simplicity, the RBT has the potential to be used as the first method of detection of radial occlusion after coronary catheterizations.
Collapse
Affiliation(s)
- Stepan Jirous
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Charles University, alej Svobody 80, Pilsen, 304 60, Czech Republic
| | - Ivo Bernat
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Charles University, alej Svobody 80, Pilsen, 304 60, Czech Republic
| | - David Slezak
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Charles University, alej Svobody 80, Pilsen, 304 60, Czech Republic
| | - Roman Miklik
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Charles University, alej Svobody 80, Pilsen, 304 60, Czech Republic
| | - Richard Rokyta
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Charles University, alej Svobody 80, Pilsen, 304 60, Czech Republic
| |
Collapse
|
13
|
Marbach JA, Alhassani S, Wells G, Le May M. Radial access first for PCI in acute coronary syndrome : Are we propping up a straw man? Herz 2020; 45:548-556. [PMID: 32548776 DOI: 10.1007/s00059-020-04958-4] [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: 10/24/2022]
Abstract
Coronary angiography and percutaneous coronary intervention (PCI) represent the recommended revascularization strategy for patients presenting with acute coronary syndrome (ACS). However, periprocedural bleeding events, of which up to 50% are related to the access site, remain an important complication of PCI and are associated with higher costs, prolonged hospital stays, and increased mortality. Several randomized trials have demonstrated that PCI performed via radial artery (RA) access is associated with a reduction in bleeding events, and perhaps a reduction in mortality compared with femoral artery (FA) access. As a result, current practice guidelines from the European Society of Cardiology and the Canadian Cardiovascular Society recommend that RA be the default strategy for PCI in patients presenting with ACS. The recently published Safety and Efficacy of Femoral Access vs. Radial Access in ST-Segment Elevation Myocardial Infarction (SAFARI-STEMI) trial challenges the benefits of a default RA approach in a contemporary setting where additional bleeding-reduction strategies (i.e., avoidance of glycoprotein IIb/IIIa inhibitors, routine use of bivalirudin for procedural anticoagulation, and vascular closure devices) were employed. In order to better understand the evidence that has shaped the current recommendations, we present a review of the background studies and major randomized trials comparing RA with FA in patients presenting with ACS.
Collapse
Affiliation(s)
- Jeffrey A Marbach
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, K1Y 4W7, Ottawa, ON, Canada
| | - Saad Alhassani
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, K1Y 4W7, Ottawa, ON, Canada
| | - George Wells
- Division of Statistics and Epidemiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Michel Le May
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, K1Y 4W7, Ottawa, ON, Canada.
| |
Collapse
|
14
|
Raelson C, Ahmed B. Prevention and Management of Radial Access Complications. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-0808-2] [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: 10/24/2022]
|
15
|
Abstract
Transradial access (TRA) is favored over transfemoral access for performing coronary angiography and percutaneous coronary intervention due to the reduced risk for vascular and bleeding complications and the documented survival benefit in ST-segment–elevation myocardial infarction patients who undergo primary percutaneous coronary intervention. TRA complications can be categorized as intra- or postprocedural and further categorized as related to bleeding or nonbleeding issues. Major intra- and postprocedural complications such as radial artery perforation and compartment syndrome are rare following TRA. Their occurrence, however, can be associated with morbid consequences, including requirement for surgical intervention if not identified and treated promptly. Nonbleeding complications such as radial artery spasm and radial artery occlusion are typically less morbid but occur much more frequently. Strategies to prevent TRA complications are essential and include the use of contemporary access techniques that limit arterial injury. This document summarizes contemporary techniques to prevent, identify, and manage TRA complications.
Collapse
Affiliation(s)
- Yader Sandoval
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Malcolm R. Bell
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Rajiv Gulati
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| |
Collapse
|
16
|
Garg N, Umamaheswar KL, Kapoor A, Tewari S, Khanna R, Kumar S, Goel PK. Incidence and predictors of forearm hematoma during the transradial approach for percutaneous coronary interventions. Indian Heart J 2019; 71:136-142. [PMID: 31280825 PMCID: PMC6620468 DOI: 10.1016/j.ihj.2019.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/16/2019] [Accepted: 04/29/2019] [Indexed: 11/28/2022] Open
Abstract
Background The transradial approach for percutaneous coronary intervention (TRA-PCI) reduces vascular complications compared with the transfemoral approach (TFA). Although hematoma formation is less frequent with the TRA than TFA, it is not uncommon, and its presentation ranges from mild hematoma to compartment syndrome. Incidence and predictors of hematoma have not been well studied. Methods and results The present study was conducted to prospectively evaluate the incidence and predictors of forearm hematoma after TRA-PCI. The study population consisted of consecutive patients undergoing TRA-PCI. Baseline and procedural characteristics and clinical outcomes were prospectively collected. All patients were observed for forearm/arm hematoma immediately after procedure, after band removal, before discharge, and whenever the patient complained of pain/swelling in the limb. Logistic regression analysis was performed to determine the predictors for hematoma formation. A total of 520 patients who had successfully completed TRA-PCI were included in the final analysis. The mean age was 55.2 ± 9.5 years, and 24% patients were women. Hematoma occurred in 53 (10.2%) patients. Hematomas were of grade I, II, III, and IV in 22 (4.2%), 9 (1.7%), 18 (3.5%), and 4 (0.8%) patients, respectively. On multivariate logistic regression analysis, age, body mass index, multiple puncture attempt, glycoprotein IIb/IIIa receptor blocker use, nonclopidogrel agent use for dual antiplatelet therapy, and multiple catheter exchanges emerged as independent predictors for hematoma formation. Conclusions Forearm hematoma following TRA-PCI occurs in about 10% patients. Most hematomas occur near the puncture area. The independent predictors for hematoma formation are age, body mass index, multiple puncture attempts, intensive antiplatelet therapy, and multiple catheter exchanges.
Collapse
Affiliation(s)
- Naveen Garg
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
| | | | - Aditya Kapoor
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Satendra Tewari
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Roopali Khanna
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sudeep Kumar
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Pravin Kumar Goel
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
17
|
Koutouzis M, Kaoukis A, Hamilos M, Tsigkas G, Tsiafoutis I, Maniotis C, Tsoumeleas A, Kintis K, Patsilinakos S, Ziakas A, Hahalis G, Giakoumakis T, Davlouros P, Lazaris E. Needle versus cannula over needle for radial artery cannulation during transradial coronary angiography and interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:436-439. [DOI: 10.1016/j.carrev.2017.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 03/06/2017] [Accepted: 03/09/2017] [Indexed: 11/30/2022]
|
18
|
Kang SH, Han D, Kim S, Yoon CH, Park JJ, Suh JW, Cho YS, Youn TJ, Chae IH. Hemostasis pad combined with compression device after transradial coronary procedures: A randomized controlled trial. PLoS One 2017; 12:e0181099. [PMID: 28742134 PMCID: PMC5524363 DOI: 10.1371/journal.pone.0181099] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 06/21/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Arterial access and hemostasis are important processes during percutaneous coronary procedures. In this study, we tested if the use of chitosan-based pads on top of compression devices could improve hemostasis efficacy compared with compression devices alone after transradial coronary angiography or interventions. METHODS This study was a single-center open-label randomized controlled trial. Patients who underwent coronary angiography or intervention with the transradial approach were randomly assigned to the study (compression device and a chitosan-based pad) or control (compression devices alone) group in a 2:1 fashion. The primary endpoint was time to hemostasis, categorized into ≤5, 6-10, 11-20, and >20 minutes. RESULTS Between April and July 2016, 95 patients were enrolled (59 were assigned to the study arm and 36 to the control arm). Time to hemostasis, the primary endpoint, was significantly lower in the study group than in the control group (p<0.001). Both groups showed low rates of vascular complications. CONCLUSIONS This study suggests that the use of a hemostasis pad in combination with rotatory compression devices is a safe and effective hemostasis strategy after radial artery access. TRIAL REGISTRATION ClinicalTrials.gov NCT02954029.
Collapse
Affiliation(s)
- Si-Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Donghoon Han
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sehun Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Chang-Hwan Yoon
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Jin-Joo Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Jung-Won Suh
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Young-Seok Cho
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Tae-Jin Youn
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
- * E-mail:
| |
Collapse
|
19
|
Kaplanoglu H, Beton O. Flow and Diameter Changes of Forearm Arteries During Temporary Unilateral Reciprocal Occlusion: A Prospective Observational Study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:197-203. [PMID: 28164311 DOI: 10.1002/jcu.22440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 11/28/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Transradial and transulnar artery approaches are commonly used for percutaneous interventions, with considerably low risk of developing hand ischemia, for reasons that have not been fully understood. The aim of this study was to evaluate the changes in the diameter, peak systolic flow velocity (PSV), and volume flow (VF) of the radial (RA) and ulnar artery (UA) during unilateral reciprocal temporary occlusion. METHODS A total of 204 extremity arteries of 102 consecutive patients were evaluated using Doppler ultrasonography. At the level of the wrist, RA and UA were consecutively compressed for 60 seconds. The diameter, PSV, and VF parameters of both arteries were evaluated during unilateral reciprocal compression. RESULTS Compared with the baseline values, the median (interquartile range) increases in diameter, PSV, and VF were 0.2 (0.1-0.3) mm, 6.8 (1.7-17.5) cm/s, and 1.9 (0.8-10) ml/min, respectively, for RA, and 0.1 (0.1-0.3) mm, 9.4 (2.6-18.0) cm/s, and 10.0 (0.0-20.0) ml/min, respectively, for UA during reciprocal compression (p < 0.001 for all). CONCLUSIONS Reciprocal compression significantly increased the diameter, PSV, and VF of both arteries during reciprocal compression. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:197-203, 2017.
Collapse
Affiliation(s)
- Hatice Kaplanoglu
- Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, PC: 06100, Ankara, Turkey
| | - Osman Beton
- Department of Cardiology, Heart Center, Cumhuriyet University, Sivas, Turkey
| |
Collapse
|
20
|
Transradial Approach for Hepatic Radioembolization: Initial Results and Technique. AJR Am J Roentgenol 2017; 207:1112-1121. [PMID: 27767350 DOI: 10.2214/ajr.15.15615] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The transradial approach (TRA) has been shown to reduce the morbidity and mortality associated with arterial coronary interventions. Selective internal radiation therapy (SIRT) performed via the TRA can enhance patient comfort, compared with the traditional transfemoral approach (TFA), by allowing immediate ambulation and precluding potential complications associated with the TFA, such as closure device injury or retroperitoneal hematoma. We report our initial experience with and technique for using the TRA for SIRT. MATERIALS AND METHODS Between May 1, 2012, and April 30, 2015, a total of 574 procedures, including planning angiograms (n = 329) and infusions of 90Y (n = 245), were performed for 318 patients (mean age, 64.5 years). Of the 245 patients who received 90Y infusions, 52 had SIRT performed with the use of a permanent single-use implant of 90Y resin microspheres and 193 had SIRT performed with the use of millions of small glass microspheres containing radioactive 90Y. Procedural details, technical success, the radial artery (RA) occlusion rate noted at 30 days (as assessed via pulse examination), and the major and minor adverse events noted at 30 days were evaluated. RESULTS Technical success was achieved in 561 of 574 cases (97.7%). The reasons for crossover to use of the TFA included an RA loop (n = 2), RA occlusion (n = 9), and type D response as determined by use of a Barbeau test (n = 2). Patients had undergone between zero and six previous TRA procedures. The mortality rate at 30 days was 0%. Superficial bruising occurred in 13 of 574 cases (2.3%). A grade 2 hematoma that required a second nonocclusive hemostasis cuff occurred in one case. Transient forearm numbness or pain occurred in two of 574 cases. One patient had a transient convulsive event occur after receiving intraarterial infusion of verapamil. RA occlusion occurred in nine of 574 cases (1.6%). CONCLUSION Use of the TRA for SIRT is safe, feasible, and well tolerated and is associated with high rates of technical success and rare complications.
Collapse
|
21
|
Khoury H, Lavoie L, Welner S, Folkerts K. The Burden of Major Adverse Cardiac Events and Antiplatelet Prevention in Patients with Coronary or Peripheral Arterial Disease. Cardiovasc Ther 2017; 34:115-24. [PMID: 26670723 DOI: 10.1111/1755-5922.12169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Patients with a history of a cardiovascular (CV) disease are at high risk of suffering secondary major adverse cardiac events (MACE), namely death, nonfatal myocardial infarction (MI), stroke, symptomatic pulmonary embolism, CV and all-cause hospitalization, and bleeding. METHODS A comprehensive review of the literature was conducted to review the epidemiology and burden of MACE in patients with coronary or peripheral arterial disease (CAD or PAD) in Europe and other ex-US regions. Relevant articles published between 2003 and 2013 were retrieved from PubMed and other sites. RESULTS MACE incidence and prevalence in patients with CAD or PAD were increased by at least 1.4-fold compared with matched controls with no CV disease. In patients with CAD, MACE mostly occurred within 30 days of primary percutaneous coronary intervention; incidence decreased with time. Increased oxidative stress in coronary and peripheral arteries, diabetes, and chronic kidney disease were identified as the main risk factors for MACE in patients with CAD and PAD. Registry data showed that, although preventive antiplatelet therapy was prescribed at high rates, a large proportion (9-56%) of patients did not receive treatment. Furthermore, adherence to treatment declined over time, potentially leading to disease worsening. CONCLUSION Despite gaps in the literature, this assessment showed that MACE's risk is substantial among patients with CAD or PAD and that the use of preventive therapies is suboptimal. Development of additional preventive therapies for these patients is warranted.
Collapse
|
22
|
Dautov R, Ribeiro HB, Abdul-Jawad Altisent O, Nombela-Franco L, Gibrat C, Nguyen CM, Rinfret S. Effectiveness and Safety of the Transradial 8Fr Sheathless Approach for Revascularization of Chronic Total Occlusions. Am J Cardiol 2016; 118:785-789. [PMID: 27453512 DOI: 10.1016/j.amjcard.2016.06.052] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 06/14/2016] [Accepted: 06/14/2016] [Indexed: 11/30/2022]
Abstract
The experience with the transradial approach in percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) in the United States is limited. We looked at the safety and feasibility of a home-made sheathless transradial technique (STT) with regular 8Fr catheters in CTO PCI. In March 2013, we developed an 8Fr STT for CTO PCI. We compared 119 patients who had the STT versus 122 treated with a standard transradial or transfemoral approach. The primary outcomes of interest were major vascular or bleeding site access complications. In a subgroup of patients with bilateral transradial approach, we assessed and compared radial patency 3 to 6 months after the procedure. Technical success rate of the CTO PCI was 93% in both groups. There were no major vascular or bleeding complications in the STT group. Radial hematomas were frequent but grade III occurred in 4 patients (3%) treated with the STT, not different to the incidence in the other group. The STT did not result in any increase in procedure time, contrast use, or radiation dose. Radial Doppler follow-up in 28 patients revealed 2 occlusions (7.1%) on the 8Fr shealthless side and one on the 6Fr side. In conclusion, our STT with regular 8Fr guides for CTO PCI is feasible, safe, and associated with low complication rate. We show that the hybrid CTO PCI nowadays can be performed through transradial access in the majority, with limited use of transfemoral approach.
Collapse
Affiliation(s)
- Rustem Dautov
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Cardiology Department, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Henrique Barbosa Ribeiro
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Omar Abdul-Jawad Altisent
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Luis Nombela-Franco
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Claire Gibrat
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Can Manh Nguyen
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Stéphane Rinfret
- Cardiology Department, McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
| |
Collapse
|
23
|
Antiplatelet agents in transradial primary PCI: safe enough to be aggressive. Coron Artery Dis 2016; 27:255-6. [PMID: 27104938 DOI: 10.1097/mca.0000000000000361] [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]
|
24
|
Poirier Y, Voisine P, Plourde G, Rimac G, Barria Perez A, Costerousse O, Bertrand OF. Efficacy and safety of preoperative intra-aortic balloon pump use in patients undergoing cardiac surgery: a systematic review and meta-analysis. Int J Cardiol 2016; 207:67-79. [DOI: 10.1016/j.ijcard.2016.01.045] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 11/27/2015] [Accepted: 01/01/2016] [Indexed: 11/16/2022]
|
25
|
Dretzke J, Riley RD, Lordkipanidzé M, Jowett S, O'Donnell J, Ensor J, Moloney E, Price M, Raichand S, Hodgkinson J, Bayliss S, Fitzmaurice D, Moore D. The prognostic utility of tests of platelet function for the detection of 'aspirin resistance' in patients with established cardiovascular or cerebrovascular disease: a systematic review and economic evaluation. Health Technol Assess 2016; 19:1-366. [PMID: 25984731 DOI: 10.3310/hta19370] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The use of aspirin is well established for secondary prevention of cardiovascular disease. However, a proportion of patients suffer repeat cardiovascular events despite being prescribed aspirin treatment. It is uncertain whether or not this is due to an inherent inability of aspirin to sufficiently modify platelet activity. This report aims to investigate whether or not insufficient platelet function inhibition by aspirin ('aspirin resistance'), as defined using platelet function tests (PFTs), is linked to the occurrence of adverse clinical outcomes, and further, whether or not patients at risk of future adverse clinical events can be identified through PFTs. OBJECTIVES To review systematically the clinical effectiveness and cost-effectiveness evidence regarding the association between PFT designation of 'aspirin resistance' and the risk of adverse clinical outcome(s) in patients prescribed aspirin therapy. To undertake exploratory model-based cost-effectiveness analysis on the use of PFTs. DATA SOURCES Bibliographic databases (e.g. MEDLINE from inception and EMBASE from 1980), conference proceedings and ongoing trial registries up to April 2012. METHODS Standard systematic review methods were used for identifying clinical and cost studies. A risk-of-bias assessment tool was adapted from checklists for prognostic and diagnostic studies. (Un)adjusted odds and hazard ratios for the association between 'aspirin resistance', for different PFTs, and clinical outcomes are presented; however, heterogeneity between studies precluded pooling of results. A speculative economic model of a PFT and change of therapy strategy was developed. RESULTS One hundred and eight relevant studies using a variety of PFTs, 58 in patients on aspirin monotherapy, were analysed in detail. Results indicated that some PFTs may have some prognostic utility, i.e. a trend for more clinical events to be associated with groups classified as 'aspirin resistant'. Methodological and clinical heterogeneity prevented a quantitative summary of prognostic effect. Study-level effect sizes were generally small and absolute outcome risk was not substantially different between 'aspirin resistant' and 'aspirin sensitive' designations. No studies on the cost-effectiveness of PFTs for 'aspirin resistance' were identified. Based on assumptions of PFTs being able to accurately identify patients at high risk of clinical events and such patients benefiting from treatment modification, the economic model found that a test-treat strategy was likely to be cost-effective. However, neither assumption is currently evidence based. LIMITATIONS Poor or incomplete reporting of studies suggests a potentially large volume of inaccessible data. Analyses were confined to studies on patients prescribed aspirin as sole antiplatelet therapy at the time of PFT. Clinical and methodological heterogeneity across studies precluded meta-analysis. Given the lack of robust data the economic modelling was speculative. CONCLUSIONS Although evidence indicates that some PFTs may have some prognostic value, methodological and clinical heterogeneity between studies and different approaches to analyses create confusion and inconsistency in prognostic results, and prevented a quantitative summary of their prognostic effect. Protocol-driven and adequately powered primary studies are needed, using standardised methods of measurements to evaluate the prognostic ability of each test in the same population(s), and ideally presenting individual patient data. For any PFT to inform individual risk prediction, it will likely need to be considered in combination with other prognostic factors, within a prognostic model. STUDY REGISTRATION This study is registered as PROSPERO 2012:CRD42012002151. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- Janine Dretzke
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Richard D Riley
- Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | | | - Susan Jowett
- Health Economics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Jennifer O'Donnell
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Joie Ensor
- Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Eoin Moloney
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Malcolm Price
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Smriti Raichand
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - James Hodgkinson
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Susan Bayliss
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - David Fitzmaurice
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - David Moore
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
26
|
Access-site bleeding and radial artery occlusion in transradial primary percutaneous coronary intervention: influence of adjunctive antiplatelet therapy. Coron Artery Dis 2016; 27:267-72. [PMID: 26848534 DOI: 10.1097/mca.0000000000000352] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The aim of this study was to evaluate access-site complications in patients with ST-segment elevation myocardial infarction treated with a transradial primary percutaneous coronary intervention relative to three different P2Y12 platelet inhibitors. PATIENTS AND METHODS We enrolled 334 consecutive patients (76.9% men, age: 59.4±9.1 years) treated by one of the following: clopidogrel (n=118), prasugrel (n=102), and ticagrelor (n=114). The use of the IIb/IIIa inhibitor, abciximab, was left to the operators' discretion. The time needed to achieve patent hemostasis, compression time, and local complications were analyzed. RESULTS The baseline characteristics were similar in all three P2Y12 platelet inhibitor groups. Abciximab was used in 72 (21.6%) patients. Administration of abciximab was associated with a higher incidence of grade II and III hematomas (23.6 vs. 5.0%, P<0.0001, and 5.6 vs. 1.1%, P=0.041, respectively). Among different platelet P2Y12 receptor inhibitor groups, the incidences of hematomas grade II and III were similar in patients who did (P≥0.14) and did not (P≥0.31) receive abciximab. There were no grade IV or V hematomas in any of the groups. Patent hemostasis was achieved faster (24.5±13.4 vs. 43.5±30.0 min, P<0.0001) and compression time was shorter (113.2±53.6 vs. 217.8±115.5 min, P<0.0001) when abciximab was not used. Radial artery occlusion occurred in one (0.3%) patient. CONCLUSION After transradial primary percutaneous coronary intervention, early patent hemostasis and short artery compression times were associated with a higher incidence of local hematomas. The incidence of hematomas was dependent on the use of abciximab, but unrelated to the type of P2Y12 inhibitor used. All hematomas were without clinical consequences.
Collapse
|
27
|
Wang X, Qiu M, Qi J, Li J, Wang H, Li Y, Han Y. Impact of anemia on long-term ischemic events and bleeding events in patients undergoing percutaneous coronary intervention: a system review and meta-analysis. J Thorac Dis 2015; 7:2041-52. [PMID: 26716044 DOI: 10.3978/j.issn.2072-1439.2015.11.56] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Data focused on the ischemic events and bleeding events are still limited. We systematically reviewed the current available literature to investigate whether anemia increase incidence of long-term ischemic events and long-term bleeding events in patients undergoing PCI. METHODS PubMed and Embase were searched for case-control studies regarding the impact of anemia on long-term outcomes in patients undergoing percutaneous coronary intervention (PCI). The primary outcome was long-term ischemic events and long-term bleeding events. Mantel-Haenszel method with random effects model or fixed effects model was used to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Seventeen studies involving 68,528 patients (17,123 anemic patients and 51,405 non-anemic patients) were included. Pooled analysis suggested that anemic patients were at higher risk for long-term composite ischemic events (OR: 1.95, 95% CI, 1.21-3.14, P<0.01, I(2)=84%), long-term reinfarction (0R: 1.63, 95% CI, 1.16-2.28, P<0.01, I(2)=82%) and long-term bleeding events (OR: 2.89, 95% CI, 1.68-4.98, P<0.001, I(2)=89%). Anemia was also associated with long-term mortality (OR: 3.20, 95% CI, 2.72-3.75, P<0.01, I(2)=65%) and major adverse cardiac events (MACE) (OR: 2.06, 95% CI, 1.48-2.86, P<0.01, I(2)=91%). CONCLUSIONS Anemic patients undergoing PCI are at higher risk for both long-term ischemic events and bleeding events, and also at higher risk for long-term mortality and MACE. There's a need for further clarification and consistency regarding dosage, timing and duration of antithrombotic therapy for the prevention of ischemic events and bleeding events in anemic patients.
Collapse
Affiliation(s)
- Xiaoyan Wang
- 1 Graduate school, Dalian Medical University, Dalian 116044, China ; 2 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China
| | - Miaohan Qiu
- 1 Graduate school, Dalian Medical University, Dalian 116044, China ; 2 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China
| | - Jing Qi
- 1 Graduate school, Dalian Medical University, Dalian 116044, China ; 2 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China
| | - Jing Li
- 1 Graduate school, Dalian Medical University, Dalian 116044, China ; 2 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China
| | - Heyang Wang
- 1 Graduate school, Dalian Medical University, Dalian 116044, China ; 2 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China
| | - Yi Li
- 1 Graduate school, Dalian Medical University, Dalian 116044, China ; 2 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China
| | - Yaling Han
- 1 Graduate school, Dalian Medical University, Dalian 116044, China ; 2 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China
| |
Collapse
|
28
|
Safety and Feasibility of Transradial Access for Visceral Interventions in Patients with Thrombocytopenia. Cardiovasc Intervent Radiol 2015; 39:676-682. [PMID: 26696230 DOI: 10.1007/s00270-015-1264-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Transradial access (TRA) has shown lower morbidity and decreased bleeding complications compared to transfemoral access. This study evaluates the safety and feasibility of TRA in thrombocytopenic patients undergoing visceral interventions. METHODS AND MATERIALS Patients who underwent visceral interventions via the radial artery with platelet count less than or equal to 50,000/µL were included in the study. Outcome variables included technical success, access site, bleeding, transfusion, and neurological complications. RESULTS From July 1, 2012, to May 31, 2015, a total of 1353 peripheral interventions via TRA were performed, of which 85 procedures were performed in 64 patients (mean age 62.2 years) with a platelet count <50,000/µL (median 39,000/µL). Interventions included chemoembolization (n = 46), selective internal radiation therapy (n = 30), and visceral embolization (n = 9). Technical success was 97.6% with two cases of severe vessel spasm requiring ipsilateral femoral crossover. There was no major access site, bleeding, or neurological adverse events at 30 days. Minor access site hematomas occurred in five cases (5.9%) and were treated conservatively in all cases. Pre-procedural platelet transfusions were administered in 23 (27.1%) cases. There was no statistically significant difference in access site or bleeding complications between the transfused and nontransfused groups. CONCLUSIONS Transradial visceral interventions in patients with thrombocytopenia are both feasible and safe, possibly without the need for platelet transfusions.
Collapse
|
29
|
Awad H, Quevedo E, Abas M, Brown M, Satiani B, Capers Q, Starr JE. Can the Anesthesiologist Use the Radial Artery for Monitoring After Transradial Artery Catheterization? ACTA ACUST UNITED AC 2015; 4:159-62. [PMID: 26050247 DOI: 10.1213/xaa.0000000000000151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The use of transradial coronary angiography and intervention is growing because of its advantages over the femoral approach. However, the small size of the radial artery can contribute to complications. We present a case of an in situ access complication of transradial coronary artery catheterization. It is important for the anesthesiologist to know about the short-term and long-term consequences of this intervention, which could lead to narrowing of the artery even beyond the site of puncture. Understanding these changes could help anesthesiologists make better decisions about using the radial artery for monitoring after transradial coronary artery catheterization procedures.
Collapse
Affiliation(s)
- Hamdy Awad
- From the *Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio; †Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio; and ‡Division of Cardiovascular Medicine, Department of Medicine, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | | | | | | | | | | | | |
Collapse
|
30
|
TATLI ERSAN, BUTURAK ALI, CAKAR AKIF, VATAN BULENTM, DEGIRMENCIOGLU ALEKS, AGAC TARM, KILIC HARUN, GUNDUZ HUSEYIN, AKDEMIR RAMAZAN. Unusual Vascular Complications Associated with Transradial Coronary Procedures Among 10,324 Patients: Case Based Experience and Treatment Options. J Interv Cardiol 2015; 28:305-12. [DOI: 10.1111/joic.12206] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- ERSAN TATLI
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
| | - ALI BUTURAK
- Department of Cardiology; Acibadem University School of Medicine; Istanbul Turkey
| | - AKIF CAKAR
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
| | - BULENT M. VATAN
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
| | - ALEKS DEGIRMENCIOGLU
- Department of Cardiology; Acibadem University School of Medicine; Istanbul Turkey
| | - TARıK M. AGAC
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
| | - HARUN KILIC
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
| | - HUSEYIN GUNDUZ
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
| | - RAMAZAN AKDEMIR
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
| |
Collapse
|
31
|
Sugimoto A, Iwamoto J, Tsumuraya N, Nagaoka M, Ikari Y. Acute compartment syndrome occurring in forearm with relatively small amount of hematoma following transradial coronary intervention. Cardiovasc Interv Ther 2015; 31:147-50. [PMID: 25855327 DOI: 10.1007/s12928-015-0328-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/05/2015] [Indexed: 01/13/2023]
Abstract
A 59-year-old female with angina pectoris successfully underwent percutaneous coronary intervention via the right radial artery. She complained of right forearm pain and numbness 4.5 h after the procedure. Though the swelling in her right arm seemed relatively mild, pressure measurement showed significant increase of internal forearm pressure. She developed acute compartment syndrome in the right forearm, and fasciotomy was performed immediately. The weight of subcutaneous hematoma in her right arm was approximately 100 g. Symptoms of paralysis and the impairment of perception remained for some time, but had completely recovered 4 months post-surgery.
Collapse
Affiliation(s)
- Atsuhiko Sugimoto
- Department of Cardiology, Ebina General Hospital, 1320 Kawaraguchi, Ebina, Kanagawa, Japan.
| | - Jotaro Iwamoto
- Department of Cardiology, Ebina General Hospital, 1320 Kawaraguchi, Ebina, Kanagawa, Japan
| | - Naoko Tsumuraya
- Department of Cardiology, Ebina General Hospital, 1320 Kawaraguchi, Ebina, Kanagawa, Japan
| | - Masakazu Nagaoka
- Department of Cardiology, Ebina General Hospital, 1320 Kawaraguchi, Ebina, Kanagawa, Japan
| | - Yuji Ikari
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa, Japan
| |
Collapse
|
32
|
Perez AB, Rimac G, Plourde G, Poirier Y, Costerousse O, Bertrand OF. The Transradial Approach and Antithrombotic Therapy: Rationale and Outcomes. Interv Cardiol Clin 2015; 4:213-223. [PMID: 28582052 DOI: 10.1016/j.iccl.2015.01.002] [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: 06/07/2023]
Abstract
This article reviews antithrombotic strategies for percutaneous coronary interventions according to the access site and the current evidence with the aim of limiting ischemic complications and preventing radial artery occlusion (RAO). Prevention of RAO should be part of the quality control of any radial program. The incidence of RAO postcatheterization and interventions should be determined initially using the echo-duplex and then frequently assessed using the more cost-effective pulse oximetry technique. Any evidence of higher risk of RAO should prompt internal analysis and multidisciplinary mechanisms to be put in place.
Collapse
Affiliation(s)
- Alberto Barria Perez
- Quebec Heart-Lung Institute, 2725, Chemin Sainte Foy, Quebec City, Quebec G1V 4G5, Canada
| | - Goran Rimac
- Quebec Heart-Lung Institute, 2725, Chemin Sainte Foy, Quebec City, Quebec G1V 4G5, Canada
| | - Guillaume Plourde
- Quebec Heart-Lung Institute, 2725, Chemin Sainte Foy, Quebec City, Quebec G1V 4G5, Canada
| | - Yann Poirier
- Quebec Heart-Lung Institute, 2725, Chemin Sainte Foy, Quebec City, Quebec G1V 4G5, Canada
| | - Olivier Costerousse
- Quebec Heart-Lung Institute, 2725, Chemin Sainte Foy, Quebec City, Quebec G1V 4G5, Canada
| | - Olivier F Bertrand
- Quebec Heart-Lung Institute, 2725, Chemin Sainte Foy, Quebec City, Quebec G1V 4G5, Canada.
| |
Collapse
|
33
|
Abstract
The transradial approach for coronary angiography has become an increasingly used alternative to the conventional transfemoral approach. Decreased access site complications and bleeding, reduced hospital stays and health care costs, and increased patient satisfaction contribute to the attractiveness of this approach. However, operators must be familiar with the distinct complications associated with the transradial approach. In this article, we discuss the common and less common complications of transradial catheterization, prevention strategies, and management options.
Collapse
|
34
|
Baseline Bleeding Risk and Benefit of Transradial PCI. J Am Coll Cardiol 2014; 64:1565-7. [DOI: 10.1016/j.jacc.2014.06.1202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 06/24/2014] [Indexed: 11/20/2022]
|
35
|
LIU JUN, FU XIANGHUA, XUE LING, WU WEILI, GU XINSHUN, LI SHIQIANG. A Comparative Study of Transulnar and Transradial Artery Access for Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome. J Interv Cardiol 2014; 27:525-30. [PMID: 25250862 DOI: 10.1111/joic.12134] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- JUN LIU
- Department of Cardiology; The 1st Hospital of Hebei Medical University; Shijiazhuang China
| | - XIANG-HUA FU
- Department of Cardiology; The 2nd Hospital of Hebei Medical University; Institute of Hebei Province of Cardio-Cerebrovascular Disease; Shijiazhuang China
| | - LING XUE
- Department of Cardiology; The 2nd Hospital of Hebei Medical University; Institute of Hebei Province of Cardio-Cerebrovascular Disease; Shijiazhuang China
| | - WEI-LI WU
- Department of Cardiology; The 2nd Hospital of Hebei Medical University; Institute of Hebei Province of Cardio-Cerebrovascular Disease; Shijiazhuang China
| | - XIN-SHUN GU
- Department of Cardiology; The 2nd Hospital of Hebei Medical University; Institute of Hebei Province of Cardio-Cerebrovascular Disease; Shijiazhuang China
| | - SHI-QIANG LI
- Department of Cardiology; The 2nd Hospital of Hebei Medical University; Institute of Hebei Province of Cardio-Cerebrovascular Disease; Shijiazhuang China
| |
Collapse
|
36
|
Kwok CS, Rao SV, Myint PK, Keavney B, Nolan J, Ludman PF, de Belder MA, Loke YK, Mamas MA. Major bleeding after percutaneous coronary intervention and risk of subsequent mortality: a systematic review and meta-analysis. Open Heart 2014; 1:e000021. [PMID: 25332786 PMCID: PMC4195929 DOI: 10.1136/openhrt-2013-000021] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/11/2014] [Accepted: 01/18/2014] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES To examine the relationship between periprocedural bleeding complications and major adverse cardiovascular events (MACEs) and mortality outcomes following percutaneous coronary intervention (PCI) and study differences in the prognostic impact of different bleeding definitions. METHODS We conducted a systematic review and meta-analysis of PCI studies that evaluated periprocedural bleeding complications and their impact on MACEs and mortality outcomes. A systematic search of MEDLINE and EMBASE was conducted to identify relevant studies. Data from relevant studies were extracted and random effects meta-analysis was used to estimate the risk of adverse outcomes with periprocedural bleeding. Statistical heterogeneity was assessed by considering the I(2) statistic. RESULTS 42 relevant studies were identified including 533 333 patients. Meta-analysis demonstrated that periprocedural major bleeding complications was independently associated with increased risk of mortality (OR 3.31 (2.86 to 3.82), I(2)=80%) and MACEs (OR 3.89 (3.26 to 4.64), I(2)=42%). A differential impact of major bleeding as defined by different bleeding definitions on mortality outcomes was observed, in which the REPLACE-2 (OR 6.69, 95% CI 2.26 to 19.81), STEEPLE (OR 6.59, 95% CI 3.89 to 11.16) and BARC (OR 5.40, 95% CI 1.74 to 16.74) had the worst prognostic impacts while HORIZONS-AMI (OR 1.51, 95% CI 1.11 to 2.05) had the least impact on mortality outcomes. CONCLUSIONS Major bleeding after PCI is independently associated with a threefold increase in mortality and MACEs outcomes. Different contemporary bleeding definitions have differential impacts on mortality outcomes, with 1.5-6.7-fold increases in mortality observed depending on the definition of major bleeding used.
Collapse
Affiliation(s)
- Chun Shing Kwok
- Cardiovascular Institute, University of Manchester, Manchester, UK
| | - Sunil V Rao
- Department of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Phyo K Myint
- Division of Applied Health Sciences, School of Medicine & Dentistry, University of Aberdeen, Aberdeen, Scotland, UK
| | - Bernard Keavney
- Cardiovascular Institute, University of Manchester, Manchester, UK
| | - James Nolan
- Department of Cardiology, University Hospital North Staffordshire, Stoke-on-Trent, UK
| | - Peter F Ludman
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Mark A de Belder
- Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Mamas A Mamas
- Cardiovascular Institute, University of Manchester, Manchester, UK
| |
Collapse
|
37
|
Bernat I, Horak D, Stasek J, Mates M, Pesek J, Ostadal P, Hrabos V, Dusek J, Koza J, Sembera Z, Brtko M, Aschermann O, Smid M, Polansky P, Al Mawiri A, Vojacek J, Bis J, Costerousse O, Bertrand OF, Rokyta R. ST-segment elevation myocardial infarction treated by radial or femoral approach in a multicenter randomized clinical trial: the STEMI-RADIAL trial. J Am Coll Cardiol 2013; 63:964-72. [PMID: 24211309 DOI: 10.1016/j.jacc.2013.08.1651] [Citation(s) in RCA: 268] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 08/01/2013] [Accepted: 08/06/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVES This study sought to compare radial and femoral approaches in patients presenting with ST-segment elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PCI) by high-volume operators experienced in both access sites. BACKGROUND The exact clinical benefit of the radial compared to the femoral approach remains controversial. METHODS STEMI-RADIAL (ST Elevation Myocardial Infarction treated by RADIAL or femoral approach) was a randomized, multicenter trial. A total of 707 patients referred for STEMI <12 h of symptom onset were randomized in 4 high-volume radial centers. The primary endpoint was the cumulative incidence of major bleeding and vascular access site complications at 30 days. The rate of net adverse clinical events (NACE) was defined as a composite of death, myocardial infarction, stroke, and major bleeding/vascular complications. Access site crossover, contrast volume, duration of intensive care stay, and death at 6 months were secondary endpoints. RESULTS The primary endpoint occurred in 1.4% of the radial group (n = 348) and 7.2% of the femoral group (n = 359; p = 0.0001). The NACE rate was 4.6% versus 11.0% (p = 0.0028), respectively. Crossover from radial to femoral approach was 3.7%. Intensive care stay (2.5 ± 1.7 days vs. 3.0 ± 2.9 days, p = 0.0038) as well as contrast utilization (170 ± 71 ml vs. 182 ± 60 ml, p = 0.01) were significantly reduced in the radial group. Mortality in the radial and femoral groups was 2.3% versus 3.1% (p = 0.64) at 30 days and 2.3% versus 3.6% (p = 0.31) at 6 months, respectively. CONCLUSIONS In patients with STEMI undergoing primary PCI by operators experienced in both access sites, the radial approach was associated with significantly lower incidence of major bleeding and access site complications and superior net clinical benefit. These findings support the use of the radial approach in primary PCI as first choice after proper training. (Trial Comparing Radial and Femoral Approach in Primary Percutaneous Coronary Intervention [PCI] [STEMI-RADIAL]; NCT01136187).
Collapse
Affiliation(s)
- Ivo Bernat
- University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic.
| | - David Horak
- Regional Hospital Liberec, Liberec, Czech Republic
| | - Josef Stasek
- University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Martin Mates
- Na Homolce Hospital Prague, Prague, Czech Republic
| | - Jan Pesek
- University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic
| | - Petr Ostadal
- Na Homolce Hospital Prague, Prague, Czech Republic
| | - Vlado Hrabos
- Regional Hospital Liberec, Liberec, Czech Republic
| | - Jaroslav Dusek
- University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jiri Koza
- University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic
| | | | - Miroslav Brtko
- University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | | | - Michal Smid
- University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic
| | - Pavel Polansky
- University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Abdul Al Mawiri
- University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Vojacek
- University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Josef Bis
- University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | | | | | - Richard Rokyta
- University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic
| |
Collapse
|
38
|
Ng VG, Lansky AJ, Meller S, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie B, Shah R, Mehran R, Stone GW. The prognostic importance of left ventricular function in patients with ST-segment elevation myocardial infarction: the HORIZONS-AMI trial. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 3:67-77. [PMID: 24562805 DOI: 10.1177/2048872613507149] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM Left ventricular (LV) dysfunction during and after hospitalization for ST-segment elevation myocardial infarction (STEMI) is associated with increased mortality. Whether baseline LV dysfunction impacts STEMI outcomes is not well studied. Furthermore, whether bivalirudin and paclitaxel-eluting stents (PES) are beneficial in patients with LV dysfunction is unknown. We studied the impact of left ventricular ejection fraction (LVEF) on outcomes of patients with STEMI in the HORIZONS-AMI trial. METHODS LVEF was determined in 2648 (73.5%) of 3602 enrolled STEMI patients, who were divided into three groups according to LV function: (1) severely impaired (LVEF <40%); (2) moderately impaired (LVEF 40-50%); and (3) normal (LVEF ≥50%). RESULTS Compared to patients with normal LV function, those with severely impaired LVEF had higher 1-year rates of net adverse clinical events (27.1 vs. 14.2%, p<0.0001), major adverse cardiovascular events (20.7 vs. 9.5%, p<0.0001), cardiac death (10.6 vs. 1.2%, p<0.0001), and non-coronary artery bypass graft major bleeding (12.5 vs. 6.6%, p=0.001), differences which persisted after adjustment for baseline characteristics. Among patients with LVEF <40%, treatment with bivalirudin compared to heparin+GPIIb/IIIa inhibitors resulted in reduced 1-year mortality (5.8 vs. 18.3%, p=0.007). Patients with LVEF <40% receiving PES rather than bare metal stents had lower rates of 1-year ischaemia-driven target lesion revascularization (2.9 vs. 12.6%, p=0.02) and reinfarction (4.5 vs. 14.7%, p=0.03). CONCLUSIONS Among patients with STEMI undergoing primary percutaneous coronary intervention, adverse events are markedly increased in those with LVEF <40% during the index revascularization procedure. Nevertheless, these high-risk patients experience substantial clinical benefits from bivalirudin and PES.
Collapse
Affiliation(s)
- Vivian G Ng
- Yale University School of Medicine, New Haven, CT, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Doktorova M, Motovska Z. Clinical review: bleeding - a notable complication of treatment in patients with acute coronary syndromes: incidence, predictors, classification, impact on prognosis, and management. Crit Care 2013; 17:239. [PMID: 24093465 PMCID: PMC4056027 DOI: 10.1186/cc12764] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This article focuses on the incidence, predictors, classification, impact on prognosis, and management of bleeding associated with the treatment of acute coronary syndrome. The issue of bleeding complications is related to the continual improvement of ischemic heart disease treatment, which involves mainly (a) the widespread use of coronary angiography, (b) developments in percutaneous coronary interventions, and (c) the introduction of new antithrombotics. Bleeding has become an important health and economic problem and has an incidence of 2.0% to 17%. Bleeding significantly influences both the short- and long-term prognoses. If a group of patients at higher risk of bleeding complications can be identified according to known risk factors and a risk scoring system can be developed, we may focus more on preventive measures that should help us to reduce the incidence of bleeding.
Collapse
|
40
|
Feldman DN, Swaminathan RV, Kaltenbach LA, Baklanov DV, Kim LK, Wong SC, Minutello RM, Messenger JC, Moussa I, Garratt KN, Piana RN, Hillegass WB, Cohen MG, Gilchrist IC, Rao SV. Adoption of radial access and comparison of outcomes to femoral access in percutaneous coronary intervention: an updated report from the national cardiovascular data registry (2007-2012). Circulation 2013; 127:2295-306. [PMID: 23753843 DOI: 10.1161/circulationaha.112.000536] [Citation(s) in RCA: 376] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Radial access for percutaneous coronary intervention (r-PCI) is associated with reduced vascular complications; however, previous reports have shown that <2% of percutaneous coronary intervention (PCI) procedures in the United States are performed via the radial approach. Our aims were to evaluate temporal trends in r-PCI and compare procedural outcomes between r-PCI and transfemoral PCI. METHODS AND RESULTS We conducted a retrospective cohort study from the CathPCI registry (n=2 820 874 procedures from 1381 sites) between January 2007 and September 2012. Multivariable logistic regression models were used to evaluate the adjusted association between r-PCI and bleeding, vascular complications, and procedural success, using transfemoral PCI as the reference. Outcomes in high-risk subgroups such as age ≥75 years, women, and patients with acute coronary syndrome were also examined. The proportion of r-PCI procedures increased from 1.2% in quarter 1 2007 to 16.1% in quarter 3 2012 and accounted for 6.3% of total procedures from 2007 to 2012 (n=178 643). After multivariable adjustment, r-PCI use in the studied cohort of patients was associated with lower risk of bleeding (adjusted odds ratio, 0.51; 95% confidence interval, 0.49-0.54) and lower risk of vascular complications (adjusted odds ratio, 0.39; 95% confidence interval, 0.31-0.50) in comparison with transfemoral PCI. The reduction in bleeding and vascular complications was consistent across important subgroups of age, sex, and clinical presentation. CONCLUSIONS There has been increasing adoption of r-PCI in the United States. Transradial PCI now accounts for 1 of 6 PCIs performed in contemporary clinical practice. In comparison with traditional femoral access, transradial PCI is associated with lower vascular and bleeding complication rates.
Collapse
Affiliation(s)
- Dmitriy N Feldman
- Weill Cornell Medical College, New York Presbyterian Hospital, Department of Medicine, Greenberg Division of Cardiology, 520 E 70th St, Starr-434 Pavilion, New York, NY 10021, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
|
42
|
Bernat I, Abdelaal E, Plourde G, Bataille Y, Cech J, Pesek J, Koza J, Jirous S, Machaalany J, Déry JP, Costerousse O, Rokyta R, Bertrand OF. Early and late outcomes after primary percutaneous coronary intervention by radial or femoral approach in patients presenting in acute ST-elevation myocardial infarction and cardiogenic shock. Am Heart J 2013; 165:338-43. [PMID: 23453102 DOI: 10.1016/j.ahj.2013.01.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 01/17/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although radial approach is increasingly used in percutaneous coronary interventions (PCIs) including in acute myocardial infarction (MI), patients with cardiogenic shock have been excluded from comparisons with femoral approach. The aim of our study was to compare clinical outcomes in patients undergoing primary PCI with cardiogenic shock by radial and femoral approach. METHODS AND RESULTS From 2,663 patients presenting with ST-elevation MI in 2 large volume radial centers, we identified 197 patients (7.4%) with signs of cardiogenic shock immediately before undergoing primary PCI. Radial approach was used in 55% of cases when at least 1 radial artery was weakly palpable, either spontaneously or after intravenous noradrenaline bolus. Patients in the radial group were older (69 ± 12 vs 64 ± 12 years, P = .010), had less diabetes (13% vs 26%, P = .028), and required less often intubation prior PCI (42% vs 66%, P = .0006) or intraaortic balloon pump (36% vs 55%, P = .0096). Mortality at 1 year was 44% in the radial group and 64% in the femoral group (P = .0044). Independent predictors of late mortality included radial approach (hazard ratio [HR] 0.65, 95% CI 0.42-0.98, P = .041), the use of glycoprotein IIb-IIIa receptor inhibitors (HR 0.63, 95% CI 0.40-0.96, P = .032), baseline creatinine ≥110 μmol/L (HR 3.34, 95% CI 2.20-5.12, P < .0001), initial glycemia >200 mg/dL (HR 2.02, 95% CI 1.34-3.11, P = .0008), and age >65 years (HR 1.80, 95% CI 1.18-2.79, P = .006). CONCLUSION Radial approach was safe and feasible in more than half of the patients with ST-elevation MI and cardiogenic shock treated by primary PCI. After adjustment for baseline and procedural characteristics, radial approach remained associated with better survival. However, prognosis of patients undergoing primary PCI in cardiogenic shock remains poor.
Collapse
|
43
|
|
44
|
Bertrand OF, Patel T. Radial Approach for Primary Percutaneous Coronary Intervention. J Am Coll Cardiol 2012; 60:2500-3. [DOI: 10.1016/j.jacc.2012.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 09/17/2012] [Indexed: 10/27/2022]
|
45
|
Bundhoo SS, Earp E, Ivanauskiene T, Kunadian V, Freeman P, Edwards R, Kinnaird TD, Zaman A, Anderson RA. Saphenous vein graft percutaneous coronary intervention via radial artery access: safe and effective with reduced hospital length of stay. Am Heart J 2012; 164:468-72. [PMID: 23067903 DOI: 10.1016/j.ahj.2012.07.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 07/25/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although percutaneous coronary intervention (PCI) via radial artery access confers many advantages over the femoral artery, PCI to saphenous vein grafts (SVG) is commonly performed via the femoral route. We compared outcomes in patients undergoing SVG PCI from the radial and femoral routes. METHODS We performed a retrospective analysis of patients who underwent SVG PCI between January 2006 and December 2010 in 2 large interventional centers in the United Kingdom. All radial and femoral operators selected for this analysis performed high-volume (>200 PCIs per year) procedures via either vascular route. RESULTS Of 305 patients (260 males) who underwent SVG PCI, 208 (68.2%) had the procedure completed from the femoral route and 97 (32.8%) radially. There was no difference between groups in fluoroscopy time (femoral vs radial 1095 vs 1125 seconds, P nonsgnificant), but radiation doses were greater (43.87 ± 2.83 Gy/cm(2) vs 56.92 ± 4.52 Gy/cm(2), P = .012) as was body mass index in the radial group (27.99 ± 0.33 vs 29.05 ± 0.42, P = .048). Three femoral access patients had vascular access complications, whereas the radial route group had none. There were no differences in no flow/slow flow (femoral 3.86% vs radial 2.54%, P nonsignificant). The mean length of hospital stay was significantly shorter in the radial access cohort (1.09 vs 2.09 days, P < .001). Three patients converted from radial to femoral artery, whereas one converted from femoral to radial after technical failure to complete the procedure. CONCLUSION Saphenous vein graft PCI can be safely and effectively performed via radial artery access with comparable fluoroscopy times but not radiation doses. Of clinical significance, use of the radial artery access was associated with decreased hospital stay and arterial complications. These data suggest that a routine radial approach for SVG PCI is feasible and could offer clinical and economic benefits.
Collapse
Affiliation(s)
- Shantu S Bundhoo
- University Hospital of Wales, Heath Park, Cardiff, Wales, United Kingdom
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
Atherothrombosis is the leading cause of death worldwide and has a large economic impact. It is a pathologic process related to atherosclerosis, which leads to adverse clinical manifestations, including acute coronary syndrome, cerebrovascular disease, and peripheral arterial disease. Patients with atherothrombosis are at heightened risk for recurrent ischemic events or death, and therefore, secondary prevention is an important goal in the treatment of these patients. Antiplatelet therapies available for long-term secondary prevention include aspirin (acetylsalicylic acid), extended-release dipyridamole plus aspirin, and clopidogrel. A number of clinical trials have demonstrated the benefit of combined antiplatelet therapy in secondary prevention, supporting the recommendations made in current published guidelines. Although the efficacy and safety of antiplatelet agents is well established and supported by clinical trials, their utilization rate in patients with atherothrombosis remains suboptimal. Quality improvement initiatives have demonstrated effectiveness in promoting the awareness and implementation of treatment guidelines. This article reviews the benefits and risks of antiplatelet therapy in patients with cardiovascular disease with the aim of spurring greater adherence to treatment recommendations and, thereby, better patient outcomes.
Collapse
|
47
|
|
48
|
Rao SV, Bernat I, Bertrand OF. Remaining challenges and opportunities for improvement in percutaneous transradial coronary procedures. Eur Heart J 2012; 33:2521-6. [DOI: 10.1093/eurheartj/ehs169] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
|
49
|
Amin F, Jolly S. Bleeding complications in patients with acute coronary syndromes: are they important and how can we prevent them? Hosp Pract (1995) 2012; 40:96-103. [PMID: 22615084 DOI: 10.3810/hp.2012.04.975] [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: 06/01/2023]
Abstract
Progress in antithrombotic medications and revascularization procedures has helped to reduce mortality in patients with acute coronary syndromes (ACS). However, these therapies can significantly increase the risk of bleeding. Bleeding complications are important clinical outcomes in patients with ACS. Data from numerous randomized controlled trials and large registries have demonstrated that bleeding is independently associated with a significantly higher risk of mortality in patients with ACS. Furthermore, bleeding complications are associated with an increased risk of recurrent ischemic events. The challenge of preventing bleeding complications while obtaining the optimal antithrombotic benefits of ACS management requires careful consideration of factors associated with patients, pharmacotherapy, and interventional procedures. Clinicians should be able to risk stratify patients for bleeding events just as they would do for recurrent ischemic events in ACS.
Collapse
Affiliation(s)
- Faizan Amin
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | |
Collapse
|
50
|
Bertrand OF, Bélisle P, Joyal D, Costerousse O, Rao SV, Jolly SS, Meerkin D, Joseph L. Comparison of transradial and femoral approaches for percutaneous coronary interventions: a systematic review and hierarchical Bayesian meta-analysis. Am Heart J 2012; 163:632-48. [PMID: 22520530 DOI: 10.1016/j.ahj.2012.01.015] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 01/18/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite lower risks of access site-related complications with transradial approach (TRA), its clinical benefit for percutaneous coronary intervention (PCI) is uncertain. We conducted a systematic review and meta-analysis of clinical studies comparing TRA and transfemoral approach (TFA) for PCI. METHODS Randomized trials and observational studies (1993-2011) comparing TRA with TFA for PCI with reports of ischemic and bleeding outcomes were included. Crude and adjusted (for age and sex) odds ratios (OR) were estimated by a hierarchical Bayesian random-effects model with prespecified stratification for observational and randomized designs. The primary outcomes were rates of death, combined incidence of death or myocardial infarction, bleeding, and transfusions, early (≤ 30 days) and late after PCI. RESULTS We collected data from 76 studies (15 randomized, 61 observational) involving a total of 761,919 patients. Compared with TFA, TRA was associated with a 78% reduction in bleeding (OR 0.22, 95% credible interval [CrI] 0.16-0.29) and 80% in transfusions (OR 0.20, 95% CrI 0.11-0.32). These findings were consistent in both randomized and observational studies. Early after PCI, there was a 44% reduction of mortality with TRA (OR 0.56, 95% CrI 0.45-0.67), although the effect was mainly due to observational studies (OR 0.52, 95% CrI 0.40-0.63, adjusted OR 0.49 [95% CrI 0.37-0.60]), with an OR of 0.80 (95% CrI 0.49-1.23) in randomized trials. CONCLUSION Our results combining observational and randomized studies show that PCI performed by TRA is associated with substantially less risks of bleeding and transfusions compared with TFA. Benefit on the incidence of death or combined death or myocardial infarction is found in observational studies but remains inconclusive in randomized trials.
Collapse
|