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Bellamoli M, Venturi G, Pighi M, Pacchioni A. Transradial artery access for percutaneous cardiovascular procedures: state of the art and future directions. Minerva Cardiol Angiol 2020; 69:557-578. [PMID: 33146480 DOI: 10.23736/s2724-5683.20.05391-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The transradial access (TRA) for cardiac catheterization and percutaneous coronary intervention (PCI) has been widely adopted in the last decades since its first description in the late 40s. The transradial approach has been associated with favorable outcomes as compared with transfemoral access (TFA) in several registries and randomized clinical trials, mainly due to the lower incidence of access-site bleedings, vascular complications and improved patient comfort. This review aimed to summarize the body of evidence supporting the use of TRA, to discuss clinical implications, possible technical limitations and future directions, such as the implementation of TRA as the primary access for complex procedures and structural interventions.
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Affiliation(s)
- Michele Bellamoli
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Gabriele Venturi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Pacchioni
- Department of Cardiology, Civil Hospital, Mirano, Venice, Italy -
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Sciahbasi A, Babbaro M, Confessore P, Cera M, Di Russo C, Patrizi R, Fedele S. Vascular access and radiation exposure during percutaneous coronary procedures. Minerva Cardioangiol 2020; 68:592-598. [PMID: 32326678 DOI: 10.23736/s0026-4725.20.05165-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the cardiology community, the use of transradial access for percutaneous coronary procedures is progressively increasing all around the world overtaking the use of transfemoral access. The advantages of the transradial access are based on a significant reduction in bleeding and vascular events compared to the femoral access and on a reduction in mortality in the setting of acute coronary syndromes. However, in recent years a slight but significant increase in radiation exposure for patients and operators associated with the radial approach has been detected, increasing concerns about possible long term increased stochastic risk. In particular interventional cardiologists are among physicians performing interventional procedures using X-rays, those exposed to the highest radiation dose during their activity and this exposure is not without possible long-term clinical consequences in term of deterministic and stochastic effects. All the operators should be aware of these risks and manage to reduce their radiation exposure. In this review we analysed the differences in term of radiation exposure comparing the radial and the femoral access for percutaneous coronary procedures. Then, we discussed the possible clinical consequences of these differences and finally we showed the available tools aimed to reduce the operator radiation exposure. In particular the use of adjunctive protective drapes placed on the patient might reduce operator radiation exposure in up to 81% of the dose.
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Affiliation(s)
- Alessandro Sciahbasi
- Department of Interventional Cardiology, Sandro Pertini Hospital, ASL RM2, Rome, Italy -
| | - Mario Babbaro
- Unit of Cardiology, Sant'Andrea Hospital, Rome, Italy
| | - Pierpaolo Confessore
- Department of Interventional Cardiology, Sandro Pertini Hospital, ASL RM2, Rome, Italy
| | - Maria Cera
- Department of Interventional Cardiology, Sandro Pertini Hospital, ASL RM2, Rome, Italy
| | - Cristian Di Russo
- Department of Interventional Cardiology, Sandro Pertini Hospital, ASL RM2, Rome, Italy
| | - Roberto Patrizi
- Department of Interventional Cardiology, Sandro Pertini Hospital, ASL RM2, Rome, Italy
| | - Silvio Fedele
- Department of Interventional Cardiology, Sandro Pertini Hospital, ASL RM2, Rome, Italy
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Sciahbasi A, Sarandrea A, Rigattieri S, Patrizi R, Cera M, Di Russo C, Zezza L, Fedele S, Ferraiuolo G. Extended Protective Shield Under Table to Reduce Operator Radiation Dose in Percutaneous Coronary Procedures. Circ Cardiovasc Interv 2020; 12:e007586. [PMID: 30732471 DOI: 10.1161/circinterventions.118.007586] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Different tools and devices are effective to reduce operator radiation exposure at thorax level during percutaneous coronary procedures, but the operator radiation dose received at pelvic region still remains high. Our aim was to evaluate the efficacy of under-the-table adjunctive shields to reduce operator radiation exposure during percutaneous coronary procedures Methods and Results: The EXTRA-RAD study (Extended Protective Shield Under Table to Reduce Operator Radiation Dose in Percutaneous Coronary Procedures) is a prospective, single-center, randomized study. Patients who underwent transradial coronary procedures were randomized into 2 groups: group 1 (standard arrangement) and group 2 (adjunctive anti-rx shield under the angiographic table). In group 2, a further randomization was performed to compare 2 different under-the-table shields (a small curtain and a drape). A total of 205 procedures (122 diagnostic coronary angiographies and 83 percutaneous coronary interventions) performed in 157 patients by 4 different operators were included without significant differences in clinical and procedural characteristics between groups. The use of adjunctive shields was associated with lower radiation dose compared with no shield at pelvic region (42 µSv [14-98] in group 1, 13 µSv [5-27] in group 2; P<0.0001) and also at thorax level (4 µSv [1-13] in group 1, 2 µSv [1-4] in group 2; P=0.001). The reduction in dose was observed in all the operators. No significant differences were observed in pelvic dose using the 2 different shields ( P=0.183). CONCLUSIONS The use of adjunctive anti-rx shields under the angiographic table during transradial coronary procedures is associated with a significant lower radiation dose to operators at pelvic and thorax level. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT03259126.
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Affiliation(s)
- Alessandro Sciahbasi
- Interventional Cardiology, Sandro Pertini Hospital, Rome, Italy (A. Sciahbasi, S.R., R.P., M.C., C.D.R., S.F., G.F.)
| | | | - Stefano Rigattieri
- Interventional Cardiology, Sandro Pertini Hospital, Rome, Italy (A. Sciahbasi, S.R., R.P., M.C., C.D.R., S.F., G.F.)
| | - Roberto Patrizi
- Interventional Cardiology, Sandro Pertini Hospital, Rome, Italy (A. Sciahbasi, S.R., R.P., M.C., C.D.R., S.F., G.F.)
| | - Maria Cera
- Interventional Cardiology, Sandro Pertini Hospital, Rome, Italy (A. Sciahbasi, S.R., R.P., M.C., C.D.R., S.F., G.F.)
| | - Cristian Di Russo
- Interventional Cardiology, Sandro Pertini Hospital, Rome, Italy (A. Sciahbasi, S.R., R.P., M.C., C.D.R., S.F., G.F.)
| | - Luigi Zezza
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy (L.Z.)
| | - Silvio Fedele
- Interventional Cardiology, Sandro Pertini Hospital, Rome, Italy (A. Sciahbasi, S.R., R.P., M.C., C.D.R., S.F., G.F.)
| | - Giuseppe Ferraiuolo
- Interventional Cardiology, Sandro Pertini Hospital, Rome, Italy (A. Sciahbasi, S.R., R.P., M.C., C.D.R., S.F., G.F.)
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Abstract
Over the past 2 decades, radial artery access has increasingly become the standard approach for coronary angiography and intervention. Compared with femoral arteries, transradial access is associated with better hemostasis. Transradial access has increased patient preference, facilitates early ambulation, and is cost-effective. An important limitation of transradial access is access site failure, and it carries a crossover rate of 3% to 7% in randomized prospective trials comparing radial with femoral artery access among experienced operators. Crossover rates for failed primary radial artery access can be reduced with ultrasonography guidance and increased familiarity with alternative access sites in the wrist.
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Affiliation(s)
- Sridevi R Pitta
- Cox Health System, University of Missouri School of Medicine, 3800 S National Avenue, Suite # 700, Springfield, MO 65807, USA.
| | - Abhiram Prasad
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA
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Chivot C, Bouzerar R, Yzet T. Transitioning to Transradial Access for Cerebral Aneurysm Embolization. AJNR Am J Neuroradiol 2019; 40:1947-1953. [PMID: 31582386 PMCID: PMC6975100 DOI: 10.3174/ajnr.a6234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/13/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Despite several retrospective studies showing the safety and efficacy of transradial access for cerebral angiography, neurointerventionalists are apprehensive about implementing TRA for neurointerventions. This reluctance is mainly due to anatomic factors, technical factors, and a long learning curve (relative to transfemoral access). We present here our experience of TRA transition for cerebral aneurysm embolization. Our aim was to demonstrate the feasibility and safety of radial access for consecutive embolizations of ruptured and unruptured cerebral aneurysms. MATERIALS AND METHODS We performed a retrospective review of a prospective data base on cerebral aneurysm embolizations. Between April and December 2018, radial access was considered for all consecutive patients referred to our institution for cerebral aneurysm embolization. Technical success was defined as radial access with insertion of the sheath and completion of the intervention without a crossover to conventional femoral access. The primary safety end point was the in-hospital plus 30-day incidence of radial artery occlusion. Secondary end points included intraoperative complications and neurologic complications at discharge and in the following 30 days. RESULTS Seventy-one patients with a cerebral aneurysm underwent 73 embolization procedures at our institution. The first-choice access route was the radial artery in 62 patients (87.3%) and the femoral artery in 9 (12.6%). Thirty-four embolizations were performed using coils, 22 used a balloon-assisted coil technique, 6 used a stent-assisted coil technique, and 2 used a flow diverter. Crossover to femoral access was observed in 2 patients (3.1%). Four patients developed coil-induced thrombi requiring intra-arterial tirofiban injections. In 1 case, an aneurysm ruptured during the operation but did not have a clinical impact. No cases of radial artery occlusion or hand ischemia were observed. CONCLUSIONS A transition to radial access for cerebral aneurysm embolization is feasible and does not increase the level of risk associated with the procedure.
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Affiliation(s)
- C Chivot
- From the Departments of Radiology (C.C., T.Y.)
| | - R Bouzerar
- Image Processing (R.B.), Amiens University Hospital, Amiens, France
| | - T Yzet
- From the Departments of Radiology (C.C., T.Y.)
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Radial Artery Access for Percutaneous Cardiovascular Interventions: Contemporary Insights and Novel Approaches. J Clin Med 2019; 8:jcm8101727. [PMID: 31635342 PMCID: PMC6833028 DOI: 10.3390/jcm8101727] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/12/2019] [Indexed: 12/11/2022] Open
Abstract
Since its introduction, the transradial access for percutaneous cardiovascular procedures has been associated with several advantages as compared to transfemoral approach, and has become the default for coronary angiography and intervention. In the last 30 years, a robust amount of evidence on the transradial approach has been mounted, promoting its diffusion worldwide. This article provides a comprehensive review of radial artery access for percutaneous cardiovascular interventions, including the evidence from clinical trials of transradial vs. transfemoral approach, technical considerations, access-site complications and limitations, alternative forearm accesses (e.g., ulnar and distal radial artery), and ultimately the use of the radial approach for structural interventions.
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