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Elwany M, Dawood M, Shakhlab A, Sadaka M, Sobhy M. Current alternatives to traditional radial approach for coronary interventions: A randomized prospective study of the ulnar and distal radial approaches. Catheter Cardiovasc Interv 2024; 104:44-53. [PMID: 38713865 DOI: 10.1002/ccd.31071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/08/2024] [Accepted: 04/25/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND The radial artery is the standard access for coronary intervention; however, it is essential to have alternative accesses as it may be used as a conduit during coronary artery bypass grafting or for dialysis fistula. Ulnar and distal radial artery accesses have emerged as alternative accesses for traditional radial artery. AIM To compare distal radial artery access and ulnar artery access as alternatives to traditional radial artery access regarding safety, efficacy, and success rate. METHODS Two-hundred patients were included (100 traditional radial [TRA], 50 distal radial [DRA] and 50 ulnar). Access artery follow up ultrasound was performed up to 28 days. RESULTS Procedural success rate was 97%, 74%, and 92% in the TRA, DRA and ulnar groups, respectively (p < 0.001). Crossover occurred in 3 patients (3%) in TRA, 13 patients (26%) in DRA and 4 cases (8%) in ulnar group (p < 0.001). The most common cause of crossover was failure of artery cannulation. Regarding cannulation time, the mean access time in seconds was 80.19 ± 25.98, 148.4 ± 29.60, 90.5 ± 21.84 in TRA, DRA and ulnar groups, respectively (p < 0.001). CONCLUSIONS Our study concluded that these new approaches proved to be potential alternatives to traditional radial approach; however, ulnar artery access proved to be superior to distal radial artery access as regards success rate and cannulation time.
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Affiliation(s)
- Moustafa Elwany
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Moustafa Dawood
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Alaa Shakhlab
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Sadaka
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Sobhy
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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2
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Gatt V. Cath Lab nurses and technicians: key contributors to safe, effective, and quality care. Eur J Cardiovasc Nurs 2024; 23:e43-e44. [PMID: 38537626 DOI: 10.1093/eurjcn/zvae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Vincent Gatt
- Department of Cardiology, Ministry for Health and Active Aging, Malta
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3
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Korotkikh AV, Kashtanov MG. Overview of the distal radial access from the radial artery occlusion perspective. J Vasc Access 2024:11297298241250376. [PMID: 38708831 DOI: 10.1177/11297298241250376] [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: 05/07/2024] Open
Abstract
Conventional radial access in endovascular surgery has certain limitations, primarily associated with the presence of local complications and radial artery occlusion. Over the past 7 years, distal radial access has exploded into all areas of endovascular procedures, from interventional cardiology to vascular surgery and interventional oncology. However, puncture of the distal radial artery has its own nuances and features: a learning curve, the use of ultrasound navigation in the initial stages of mastering the access, limitations in patients with acute conditions (acute coronary syndrome and stroke). This review aims to analyze on important aspects of the procedure of distal radial access from preparation for it to hemostasis and to explore all data about the new roles of distal radial access in avoiding but also treating radial artery occlusion, as the first thing to begin with the development and implementation of new access.
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Affiliation(s)
| | - Maksim Gennadievich Kashtanov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Catheterization Laboratory, Tomsk, Russia
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Filho EM, Araujo GN, Machado GP, Padilla L, de Paula JET, Botelho AC, Campos CM, Quesada FLH, Alcantara M, Santiago R, de Los Santos FD, Oliveira MD, Ribeiro MH, Perez L, Pinto ME, Côrtes LA, Piccaro P, Brilakis ES, Quadros AS. Guide catheter extension use are associated with higher procedural success in chronic total occlusion percutaneous coronary interventions. Catheter Cardiovasc Interv 2024; 103:539-547. [PMID: 38431912 DOI: 10.1002/ccd.30987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 11/25/2023] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Guide catheter extensions (GCEs) increase support and facilitate equipment delivery, but aggressive instrumentation may be associated with a higher risk of complications. AIM Our aim was to assess the impact of GCEs on procedural success and complications in patients submitted to chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS We analyzed data from the multicenter LATAM CTO Registry. Procedural success was defined as <30% residual stenosis and TIMI 3 distal flow. Major adverse cardiac and cerebrovascular events (MACCE) was defined as the composite of all-cause death, myocardial infarction, target vessel revascularization, and stroke. Propensity score matching (PSM) was used to compare outcomes with and without GCE use. RESULTS From August 2010 to August 2021, 3049 patients were included. GCEs were used in 438 patients (14.5%). In unadjusted analysis, patients in the GCE group were older and had more comorbidities. The median J-CTO score and its components were higher in the GCE group. After PSM, procedural success was higher with GCE use (87.7% vs. 80.5%, p = 0.007). The incidence of coronary perforation (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.78-2.71, p = 0.230), bleeding (OR: 1.99, 95% CI: 0.41-2.41, p = 0.986), in-hospital death (OR: 1.39, 95% CI: 0.54-3.62, p = 0.495) and MACCE (OR: 1.07, 95% CI: 0.52-2.19, p = 0.850) were similar in both groups. CONCLUSION In a contemporary, multicenter cohort of patients undergoing CTO PCI, GCEs were used in older patients, with more comorbidities and complex anatomy. After PSM, GCE use was associated with higher procedural success, and similar incidence of adverse outcomes.
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Affiliation(s)
| | - Gustavo N Araujo
- Imperial Hospital de Caridade, Florianópolis, Brazil
- Instituto de Cardiologia de Santa Catarina, São José, Brazil
| | | | - Lucio Padilla
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | - Félix D de Los Santos
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
- Centro Medico ABC, Mexico City, Mexico
| | - Marcos D Oliveira
- Hospital São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Marcelo H Ribeiro
- Imperial Hospital de Caridade, Florianópolis, Brazil
- Hospital SOS Cardio, Florianópolis, Brazil
| | - Luiz Perez
- Hospital Clinico Regional Dr Guillermo Grant Benavente, Concepcion, Chile
| | | | | | - Pedro Piccaro
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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5
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Korotkikh AV, Babunashvili AM, Kazantsev AN, Annaev ZS. Distal Radial Access: Is There a Clinical Benefit? Cardiol Rev 2024; 32:110-113. [PMID: 36538417 DOI: 10.1097/crd.0000000000000472] [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: 12/24/2022]
Abstract
For decades, the femoral artery has been the most common vascular access for diagnostic and therapeutic endovascular procedures. However, over the past 20 years, radial access has been gaining popularity, as it is a safer and allows practical access with more benefits. Recently, the new distal radial access has proven to be an equal or perhaps even safer vascular access for diagnostic and therapeutic coronary and noncoronary interventions. Today, this access should be in the arsenal of every interventional surgeon.
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Affiliation(s)
- A V Korotkikh
- From the Cardiac Surgery Clinic, Amur State Medic al Academy, Blagoveshchensk, Russian Federation
| | - A M Babunashvili
- Interventional Cardiology Department, Sechenov University, Moscow, Russian Federation
| | - A N Kazantsev
- Surgery Department, City Alexandrovskaya Hospital, St. Petersburg, Russian Federation
| | - Z S Annaev
- Neurosurgery Department, Novyy Urengoy Central Hospital, Novyy Urengoy, Russia
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6
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Sgueglia GA. Distal Radial Access Evolution: From Randomized Controlled Trials to the Real World and Beyond. JACC Cardiovasc Interv 2024; 17:341-344. [PMID: 38355262 DOI: 10.1016/j.jcin.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 02/16/2024]
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7
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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:55-161. [PMID: 37740496 DOI: 10.1093/ehjacc/zuad107] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
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8
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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023; 44:3720-3826. [PMID: 37622654 DOI: 10.1093/eurheartj/ehad191] [Citation(s) in RCA: 661] [Impact Index Per Article: 661.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Jiang F, Fan WL, Zheng W, Wu X, Hu H. Distal radial artery access is a safe and feasible technique in the anatomical snuffbox for visceral intervention. Medicine (Baltimore) 2023; 102:e33987. [PMID: 37327275 PMCID: PMC10270534 DOI: 10.1097/md.0000000000033987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/22/2023] [Indexed: 06/18/2023] Open
Abstract
Regarding the site of arterial access during the intervention, transracial intervention can reduce the risk of bleeding and vessel-related complications as well as improve patient comfort. Importantly, the distal radial artery (DRA) approach may reduce the incidence of radial artery occlusion and digital ischemia, but the feasibility and safety of DRA in performing subdiaphragmatic vascular interventions remain unclear. From January 2018 to December 2019, 106 patients were admitted to our department for visceral angiography and intervention by left distal radial artery accessing in an anatomical snuffbox. In total, 152 times of vascular interventions were performed during this period. Patients demographics, procedure details, technical success, and access site-related complications were recorded and evaluated. The mean age was 58.9 (range 22-86) years. Males accounted for 80.2%. Thirty-five patients (33%) had 2 or more procedures via the DRA approach. Technical success was achieved for 96.1% of procedures (146 cases) and 3.9% of cases failed to perform the intended procedure via the DRA approach (6 cases). The 4-Fr sheath was used in 86.8% of cases, and the 5 Fr sheath was used in the rest of the 13.2% of procedures. The rate of asymptomatic radial artery occlusion was 5.7% (6 of 106 patients). No patient suffered from distal limb ischemia after a long-time follow-up. Eight patients suffered postoperative local pain, transient numbness, or local bruised in the anatomical snuffbox without major complications. Patients with postoperative complications recovered quickly by using nonsteroidal anti-inflammatory drugs or without further treatment. Left distal radial artery access is safe and feasible as a new technique for visceral angiography and intervention.
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Affiliation(s)
- Feng Jiang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wen-Long Fan
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Weiliang Zheng
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xia Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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10
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Korotkikh A, Babunashvili A, Kaledin A, Akhramovich R, Derkach V, Portnov R, Kartashov D, Kazantsev A. Distal Radiation Access as an Alternative to Conventional Radial Access for Coronary Angiography and Percutaneous Coronary Interventions (According to TENDERA Trial). Curr Probl Cardiol 2023; 48:101546. [PMID: 36535496 DOI: 10.1016/j.cpcardiol.2022.101546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
The aim of this study was to assess the immediate and medium-term (3 months) results of the safety and efficacy of distal radial access (DRA) in coronary interventions compared with conventional transradial radial access (TRA). TRA is the recommended access for coronary procedures because of increased safety: fewer local complications, large and small bleeding. Recently, DRA has emerged as a promising alternative access to minimize radial artery occlusion (RAO) risk, as well as other complications. A large-scale, international, randomized trial comparing medium-term results with TRA and DRA is lacking. An analysis of 776 patients of the prospective randomized TENDERA trial was carried out: the distal artery access group (DRA) - 391, the transradial access group (TRA) - 385. Statistically more often the crossover access was in the DRA group (5.1% and 0.8%, P < 0.001). The primary endpoint was early or late thrombosis/occlusion of the radial artery (RA). Secondary endpoints: (1) composite complications from access vessels; (2) access parameters. Statistically significant differences were obtained for the primary endpoint: DRA 2.7% (n = 10), TRA 6.8% (n = 26), P = 0.008. Occlusion of the distal radial artery (DRAt), with patent RA: DRA 1.3% (n = 5), TRA 0 (0), P = 0.023. At the secondary composite endpoint, statistically significant differences were obtained for the following groups of complications: BARC type I bleeding (DRA: 3.8% (n = 14), TRA: 21.7% (n = 83), P < 0.001); hematoma larger than 5 cm on day 1 (DRA: 10% [n = 37], TRA: 25.9% [n = 98], P < 0.001); hematoma larger than 5 cm on day 7 (DRA: 12.4% [n = 45], TRA: 34.6% [n = 132], P < 0.001). Of the access parameters, the following statistically significantly differed: puncture time DRA 19.0 (8.0; 50), TRA 13.5 (5.0; 29), P < 0.001; insertion of introducer DRA 42.0 (26.0; 84.0), TRA 35.0 (23.0; 55.0), P < 0.001, access artery hemostasis duration (min.) DRA 180.0 (120.0; 480.0), TRA 155.0 (115.0; 195.0), P < 0.001. The duration of the procedure and fluoroscopy, radiation dose, RA spasm in both groups had no statistically significant differences. In the TENDERA trail, DRA demonstrated efficacy and safety in interventional coronary interventions compared with TRA in the medium-term follow-up period: a statistically significant lower incidence of RA occlusion and local complications.
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Affiliation(s)
- A Korotkikh
- Cardiac Surgery Department, Cardiac Surgery Clinic, Amur State Medical Academy, Blagoveshchensk, Russia.
| | - A Babunashvili
- Endovascular Surgery Department, Center for Endosurgery and Lithotripsy, Moscow, Russia; Department of Interventional Cardioangiology, Sechenov University, Moscow, Russia
| | - A Kaledin
- Endovascular Surgery Department, Northwestern State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia
| | - R Akhramovich
- Endovascular Surgery Department, Mytishchi City Clinical Hospital, Mytishchi, Russia
| | - V Derkach
- Endovascular Surgery Department, Clinic of Innovative Surgery, Klin, Russia
| | - R Portnov
- Endovascular Surgery Department, Clinic of Innovative Surgery, Klin, Russia
| | - D Kartashov
- Endovascular Surgery Department, Center for Endosurgery and Lithotripsy, Moscow, Russia; End ovascular Surgery Department, Center for Endosurgery and Lithotripsy, Moscow Regional Research Clinical Institute named after M. F. Vladimirsky, Moscow, Russia
| | - A Kazantsev
- Vascular Surgery Department, Kostroma Regional Clinical Hospital named after E. I. Korolev, Kostroma, Russia
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de Oliveira Cardoso C, de Moraes CV, Teixeira JV, Cardoso CR, Baldissera F, de Mattos EI, Siqueira MJ, Fischer L, Sebben JC, Santos Silva B, Broetto G, Antônio Mascia Gottschall C, Sarmento-Leite R. Randomized Noninferiority Trial of Radiation Exposure During Coronary Angiography: the Transradial and Transfemoral Approach by EXPERienced Operators in Daily rouTine (EXPERT) Trial. Tex Heart Inst J 2023; 50:491654. [PMID: 36944120 PMCID: PMC10178642 DOI: 10.14503/thij-22-7930] [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: 03/23/2023]
Abstract
BACKGROUND The transradial approach (TRA) to coronary angiography reduces vascular complications but is associated with greater radiation exposure than the transfemoral approach (TFA). It is unknown whether exposure remains higher when TRA is performed by experienced operators. METHODS Patients were randomly, prospectively assigned to TRA or TFA. The primary end point was patient radiation dose; secondary end points were the physician radiation dose and 30-day major adverse cardiac event rate. Coronary angiography was performed by experienced operators using a standardized protocol. RESULTS Clinical and procedural characteristics were similar between the TRA (n = 150) and TFA (n = 149) groups, and they had comparable mean (SD) radiation doses for patients (616.51 [252] vs 585.57 [225] mGy; P = .13) and physicians (0.49 [0.3] vs 0.46 [0.29] mSv; P = .32). The mean (SD) fluoroscopy time (3.52 [2.02] vs 3.13 [2.46] min; P = .14) and the mean (SD) dose area product (35,496.5 [15,670] vs 38,313.4 [17,764.9] mGy·cm2; P = .2) did not differ. None of the following factors predicted higher radiation doses: female sex (hazard ratio [HR], 0.69 [95% CI, 0.38-1.3]; P = .34), body mass index >25 (HR, 0.84 [95% CI, 0.43-1.6]; P = .76), age >65 years (HR, 1.67 [95% CI, 0.89-3.1]; P = .11), severe valve disease (HR, 1.37 [95% CI, 0.52-3.5]; P = .68), or previous coronary artery bypass graft (HR, 0.6; 95% CI, 0.2-1.8; P = .38). CONCLUSION TRA for elective coronary angiography is noninferior to TFA when performed by experienced operators.
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Affiliation(s)
- Cristiano de Oliveira Cardoso
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Program in Health Sciences (Cardiology - PPG), University Foundation of Cardiology, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cláudio Vasques de Moraes
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Julio Vinícius Teixeira
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carlos Roberto Cardoso
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Felipe Baldissera
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eduardo Ilha de Mattos
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcio José Siqueira
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Leandro Fischer
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Juliana Cañedo Sebben
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Bruna Santos Silva
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gabriel Broetto
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carlos Antônio Mascia Gottschall
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Program in Health Sciences (Cardiology - PPG), University Foundation of Cardiology, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rogério Sarmento-Leite
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Program in Health Sciences (Cardiology - PPG), University Foundation of Cardiology, Porto Alegre, Rio Grande do Sul, Brazil
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12
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Khan MA, Dodo-Williams TS, Janssen C, Patel RJ, Mahmud E, Malas MB. Comparing Outcomes of Transfemoral Versus Transbrachial or Transradial Approach in Carotid Artery Stenting (CAS). Ann Vasc Surg 2023:S0890-5096(23)00053-5. [PMID: 36758939 DOI: 10.1016/j.avsg.2023.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND While Transfemoral Carotid Artery Stenting (TFCAS) is a valid minimally invasive option for patients who also might be suitable for carotid endarterectomy (CEA) or transcarotid artery revascularization (TCAR), alternative access sites such as transbrachial (TB) or transradial (TR) are only utilized when anatomic factors preclude direct carotid or transfemoral access. In this study, we aimed to evaluate the outcomes of TR/TB access in comparison to TF for percutaneous carotid artery revascularization. METHODS All patients undergoing non-TCAR carotid artery stenting (CAS) from January 2012 to June 2021 in the Vascular Quality Initiative (VQI) Database were included. Patients were divided into 2 groups based on the access site for CAS: TF or TR/TB. Primary outcomes included stroke/death, technical failure and access site complications (hematoma, stenosis, infection, pseudoaneurysm and AV fistula). Secondary outcomes included stroke, TIA, MI, death, non-home discharge, extended length of postoperative stay (LOS) (>1 day), and composite endpoints of stroke/MI and stroke/death/MI. Univariable and multivariable logistic regression models were used to assess postoperative outcomes, and results were adjusted for relevant potential confounders including age, gender, race, degree of stenosis, symptomatic status, anesthesia, comorbidities, and preoperative medications. RESULTS Out of the 23,965 patients, TR/TB approach was employed in 819 (3.4%) while TF was used in 23,146 (96.6%). Baseline characteristics found men were more likely to undergo revascularization using TR/TB approach (69.4% vs. 64.9%, P = 0.009). Patients undergoing TR/TB approach were also more likely to be symptomatic (49.9% vs. 28.6%, P < 0.001). Guideline directed medications were more frequently used with TR/TB including P2Y12 inhibitor (80.3% vs. 74.7%, P < 0.01), statin (83.8% vs. 80.6%), and aspirin (88.3% vs. 84.5%, P = 0.003) preoperatively. On univariate analysis, patients with TB/TR approach experienced higher rates of adverse outcomes. After adjusting for potential confounders, TR/TB patients had no significant increase in the risk of stroke/death [aOR 1.10 (0.69-1.76), P = 0.675]; however, the use of TR/TB access was associated with a more than 2-fold increase in risk for in-hospital MI [aOR 2.39 (1.32-4.30), P = 0.004] and 2-fold increase in risk of technical failure [aOR 2.21 (1.31-3.73) P = 0.003]. The use of TR/TB access was also associated with a 50% reduction in the risk of access site complications [aOR 0.53 (0.32-0.85), P = 0.009]. CONCLUSIONS This study confirms that although technically more challenging, TR or TB approach serves as a reasonable alternative with lower access site complications for CAS particularly in patients where anatomic factors preclude revascularization by TFCAS or TCAR. However, TR/TB is associated with an increased risk of technical failure and myocardial infarction, which requires further study.
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Affiliation(s)
- Maryam Ali Khan
- Division of Vascular and Endovascular Surgery, University of California San Diego Health, La Jolla, CA
| | - Taiwo S Dodo-Williams
- Division of Vascular and Endovascular Surgery, University of California San Diego Health, La Jolla, CA
| | - Claire Janssen
- Division of Vascular and Endovascular Surgery, University of California San Diego Health, La Jolla, CA
| | - Rohini J Patel
- Division of Vascular and Endovascular Surgery, University of California San Diego Health, La Jolla, CA
| | - Ehtisham Mahmud
- Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, CA
| | - Mahmoud B Malas
- Division of Vascular and Endovascular Surgery, University of California San Diego Health, La Jolla, CA.
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13
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Wu R, Peters GL, Charles H, Kokabi N, Bercu ZL, Majdalany BS. Transradial Uterine Artery Embolization Complicated by Stroke. Semin Intervent Radiol 2022; 39:591-595. [PMID: 36561802 PMCID: PMC9767778 DOI: 10.1055/s-0042-1759700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Richard Wu
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Gail L. Peters
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Hearns Charles
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Nima Kokabi
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Zachary L. Bercu
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Bill S. Majdalany
- Department of Radiology, The University of Vermont Medical Center, Burlington, Vermont
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14
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Wen-fei H, Zi-jing L, Peng-yuan C, Yuan-hui L, Chong-yang D, Li-huan Z, Ze-huo L, Zhi-qiang G, Jian-fang L. Association between high-sensitivity C-reactive protein and bleeding in non-ST-segment elevation acute coronary syndrome: A multicentre cohort of Chinese population.. [DOI: 10.21203/rs.3.rs-2241865/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
Background
The association between high-sensitivity C-reactive protein (hs-CRP) and bleeding risk in acute coronary syndrome (ACS) patients remains unclear. This study aimed to examine the association between bleeding events and different hs-CRP levels in patients with non-ST elevation ACS (NSTE-ACS).
Methods
This study retrospectively included 2583 adults with NSTE-ACS between January 1, 2010, and December 31, 2014, at 5 medical centres in China. The primary outcome was major bleeding, defined by the Bleeding Academic Research Consortium definition (grades 3–5).
Results
Fifty-three (2.1%) patients experienced major bleeding in the hospital. Patients with hs-CRP levels greater than 8.20 mg/L had the highest incidence of in-hospital major bleeding (25 (3.9%), P < 0.001) compared with the other groups. Multivariable analysis indicated that hs-CRP was an independent factor associated with in-hospital major bleeding (continuous: adjusted OR = 1.01, 95% CI: 1.01–1.02, P < 0.001; quartiles: adjusted OR for quartile 4 (referring to quartile 1) = 3.71, 95% CI: 1.35 ~ 10.23, P = 0.011), which was further confirmed by subgroup analysis and receiver operating characteristic curves. The restricted cubic spline analysis demonstrated an S-shaped association between hs-CRP and major bleeding. During the 5-year follow-up, there was a significantly high risk of bleeding in patients with higher hs-CRP levels.
Conclusion
Higher hs-CRP level at admission in NSTE-ACS patients is associated with high risk of in-hospital major bleeding. An S-shaped association was found between hs-CRP and bleeding events. Further studies are warranted to optimize antithrombotic drug therapy in high-bleeding risk patients during follow-up.
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Affiliation(s)
- He Wen-fei
- Guangdong Provincial People’s Hospital’s Nanhai Hospital, the Second People’s Hospital of Nanhai District
| | | | - Chen Peng-yuan
- Guangdong Provincial People’s Hospital’s Nanhai Hospital, the Second People’s Hospital of Nanhai District
| | - Liu Yuan-hui
- Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences
| | | | - Zeng Li-huan
- Guangdong Provincial People’s Hospital’s Nanhai Hospital, the Second People’s Hospital of Nanhai District
| | | | - Guo Zhi-qiang
- Guangdong Provincial People’s Hospital’s Nanhai Hospital, the Second People’s Hospital of Nanhai District
| | - Luo Jian-fang
- Guangdong Provincial People’s Hospital’s Nanhai Hospital, the Second People’s Hospital of Nanhai District
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15
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Hannan EL, Zhong Y, Ling FSK, LeMay M, Jacobs AK, King SB, Berger PB, Venditti FJ, Walford G, Tamis-Holland J. Relation of Operator Volume and Access Site to Short-Term Mortality in Radial Versus Femoral Access for Primary Percutaneous Coronary Intervention. Am J Cardiol 2022; 176:30-36. [PMID: 35613952 DOI: 10.1016/j.amjcard.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/06/2022] [Accepted: 04/14/2022] [Indexed: 11/01/2022]
Abstract
The relation between operator volume and mortality of primary percutaneous coronary intervention (PPCI) procedures for ST-elevation myocardial infarction has not been studied comprehensively. This study included patients who underwent PPCI between 2010 and 2017 in all nonfederal hospitals approved to perform PCI in New York State. We compared risk-adjusted in-hospital/30-day mortality for radial access (RA) and femoral access (FA) and the relation between risk-adjusted mortality and procedure volume for each access site. In 44,540 patients in the study period, the use of RA rose from 8% in 2,010% to 43% in 2017 (p <0.0001). There was no significant change in PPCI risk-adjusted mortality during the period (p=0.27 for trend). RA was associated with lower mortality when imposing operator exclusion criteria used in recent trials. There was a significant operator inverse volume-mortality relation for FA procedures but not for RA procedures. FA procedures performed by lower volume FA operators (lowest quartile) were associated with higher risk-adjusted mortality compared with RA procedures (3.71% vs 3.06%, p = 0.01) or compared with FA procedures performed by higher volume FA operators (3.71% vs 3.16%, p = 0.01). In conclusion, in patients with ST-elevation myocardial infarction referred for primary PCI in New York State, there was a significant uptake in the use of RA along with relatively constant in-hospital/30-day mortality. There was a significant inverse operator volume-mortality relation for FA procedures accompanied by higher mortality for FA procedures performed by low volume FA operators than for all other primary PCI procedures. In conclusion, this information underscores the need for operators to remain vigilant in maintaining FA skills and monitoring FA outcomes.
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Affiliation(s)
- Edward L Hannan
- University at Albany, State University of New York, Albany, New York.
| | - Ye Zhong
- University at Albany, State University of New York, Albany, New York
| | | | - Michel LeMay
- University of Ottawa Heart Institute, Ottawa, Canada
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16
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Kinkori T, Watanabe K, Ishikawa K, Sakuma T, Sato Y, Suzuki K, Kawaguchi N. Bilateral Distal Transradial Approach for Coiling of Basilar Artery Aneurysm: A Technical Note. Neurol Med Chir (Tokyo) 2022; 62:384-389. [PMID: 35753762 PMCID: PMC9464480 DOI: 10.2176/jns-nmc.2022-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Distal transradial approach (dTRA) for neuroendovascular procedures has received much attention in recent years as a newer and less invasive alternative to the conventional transfemoral or transradial approaches. We present the case of an 89-year-old woman with a basilar artery aneurysm requiring simultaneous catheterization of the bilateral vertebral arteries who was successfully embolized using bilateral dTRA. The aneurysm was accessed from the right vertebral artery using the right dTRA. Control angiograms during the procedure were performed from the left vertebral artery via the left dTRA. The operator's posture was ergonomically comfortable, and the catheters were easy to handle during the procedure. To the best of our knowledge, this is the first case of a bilateral dTRA used for neuroendovascular procedures. Bilateral dTRA is a safe and minimally invasive method for patients and ergonomically comfortable for operators.
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Affiliation(s)
| | | | | | | | - Yusuke Sato
- Department of Neurosurgery, Okazaki City Hospital
| | - Keita Suzuki
- Department of Neurosurgery, Okazaki City Hospital
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17
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Doll JA, Beaver K, Naranjo D, Waldo SW, Maynard C, Helfrich CD, Rao SV. Trends in Arterial Access Site Selection and Bleeding Outcomes Following Coronary Procedures, 2011-2018. Circ Cardiovasc Qual Outcomes 2022; 15:e008359. [PMID: 35272504 DOI: 10.1161/circoutcomes.121.008359] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Prior studies of radial access for cardiac catheterization have focused on early adopters of the technique, and some have described a risk/treatment paradox of low radial access use among high bleeding risk patients. This study aimed to determine (1) trends in radial access use over time, (2) if increasing use of radial access is driven by new invasive and interventional cardiologists (operators) or existing operators changing their practice, and (3) if increasing radial rates are associated with lower bleeding rates and elimination of the risk/treatment paradox. METHODS In this cross-sectional study using data from the Clinical Assessment, Reporting, and Tracking Program, we calculated radial access rates and risk-adjusted postprocedural bleeding rates of patients undergoing diagnostic angiography or percutaneous coronary intervention (PCI) between 2011 and 2018 in Veterans Affairs hospitals. We used separate bleeding risk models for diagnostic angiography and PCI and assessed temporal trends with the Kendall Tau-b test. RESULTS Among 253 179 diagnostic angiograms and 93 614 PCIs, radial access rates increased over time for both diagnostic (17.5%-60.4%; P<0.01)) and PCI procedures (14.0%-51.8%; P<0.01). Existing operators and new operators increased their use at similar rates, but new operators entered practice with higher baseline rates. Nearly all operators used radial access at least once in 2018. Overall adjusted rates of bleeding declined, a trend that was significant for diagnostic angiography (2.4%-1.4%, P=0.02) but not PCI (3.4%-2.5%, P=0.20). Femoral access patients had a higher predicted risk for bleeding. CONCLUSIONS A steady rise in radial access for diagnostic angiography and PCI was driven by increasing use among existing operators and high use by new operators. While this was associated with decreasing bleeding rates, a risk/treatment paradox for access site selection persists; patients at higher bleeding risk were still more likely to receive femoral access.
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Affiliation(s)
- Jacob A Doll
- Health Services Research & Development (HSR&D), Seattle-Denver Center of Innovation (COIN) for Veteran-Centered Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System, WA (J.A.D., K.B., C.M., C.D.H.).,Division of Cardiology, Department of Medicine (J.A.D.), University of Washington, Seattle.,CART Program, VHA Office of Quality and Patient Safety, Washington DC (J.A.D., S.W.W.)
| | - Kristine Beaver
- Health Services Research & Development (HSR&D), Seattle-Denver Center of Innovation (COIN) for Veteran-Centered Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System, WA (J.A.D., K.B., C.M., C.D.H.)
| | | | - Stephen W Waldo
- CART Program, VHA Office of Quality and Patient Safety, Washington DC (J.A.D., S.W.W.).,VA Eastern Colorado Health Care System, Aurora, CO (S.W.W.).,Division of Cardiology, Department of Medicine, University of Colorado, Aurora (S.W.W.)
| | - Charles Maynard
- Health Services Research & Development (HSR&D), Seattle-Denver Center of Innovation (COIN) for Veteran-Centered Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System, WA (J.A.D., K.B., C.M., C.D.H.)
| | - Christian D Helfrich
- Health Services Research & Development (HSR&D), Seattle-Denver Center of Innovation (COIN) for Veteran-Centered Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System, WA (J.A.D., K.B., C.M., C.D.H.).,Department of Health Services, School of Public Health (C.D.H.), University of Washington, Seattle
| | - Sunil V Rao
- US Department of Veterans Affairs (VA) Health Care System, Durham, NC (S.V.R.)
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18
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Sanhoury MI, Sobhy MA, Saddaka MA, Nassar MA, Elwany MN. Distal radial approach between theory and clinical practice.. Time to go distal! Egypt Heart J 2022; 74:8. [PMID: 35122566 PMCID: PMC8818067 DOI: 10.1186/s43044-022-00243-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/17/2022] [Indexed: 11/24/2022] Open
Abstract
Background Transradial access (TRA), which has a minimal risk of problems such as radial artery occlusion (RAO), hemorrhage, spasm, and so on, is now considered the standard procedure for cardiac catheterization. The aim of the study is to present the distal transradial access (d-TRA) as a possible promising novel technique in the field of cardiac coronary interventions comparing it to the standard conventional TRA using primary and secondary endpoints, exploring its benefits and drawbacks as a new experience in Alexandria University. One hundred cases with variable indications for coronary interventions were randomized to two arms using systematic random sampling method, coronary interventions in the first one were done via d-TRA (50 patients) and in the second arm via conventional TRA group (50 patients).
Results Technically, there were highly statistically significant differences between the two arms in favor of TRA regarding procedural success, number of punctures taken, Access time, Total procedural time, vasodilator used, and crossover to another access site; meanwhile safety profile parameters have showed statistically significant differences in favor of d-TRA regarding post-operative hematoma, AV fistula, post-operative pain and compression time, and there were no statistically significant differences regarding RAO although it occurred more in TRA group.
Conclusions In the realm of cardiac intervention, the distal radial approach is a promising technique. When compared to TRA, we found it to be a viable and safe method for coronary angiography and interventions and it could be a real option for the interventionists in the near future, with a lower risk of radial artery blockage and no significant differences in wrist hematoma and radial artery spasm. The success rate of d-TRA is proportional to the steepness of the operator's learning curve and the quality of the examples chosen.
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Affiliation(s)
- Mohamed I Sanhoury
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed A Sobhy
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed A Saddaka
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed A Nassar
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Mostafa N Elwany
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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19
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Duan KI, Helfrich CD, Rao SV, Neely EL, Sulc CA, Naranjo D, Wong ES. Cost analysis of a coaching intervention to increase use of transradial percutaneous coronary intervention. Implement Sci Commun 2021; 2:123. [PMID: 34706775 PMCID: PMC8554885 DOI: 10.1186/s43058-021-00219-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 09/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The transradial approach (TRA) to cardiac catheterization is safer than the traditional transfemoral approach (TFA), with similar clinical effectiveness. However, adoption of TRA remains low, representing less than 50% of catheterization procedures in 2015. Peer coaching is one approach to facilitate implementation; however, the costs of this strategy for cardiac procedures such as TRA are unclear. METHODS We conducted an activity-based costing analysis (ABC) of a multi-center, hybrid type III implementation trial of a coaching intervention designed to increase the use of TRA. We identified the key activities of the intervention and determined the personnel, resources, and time needed to complete each activity. The personnel cost per hour and the activity duration were then used to estimate the cost of each activity and the total variable cost of the implementation. Fixed costs related to designing and running the implementation were calculated separately. All costs are reported in 2019 constant US dollars. RESULTS The total cost of the coaching intervention implementation was $374,863. Of the total cost, $367,752 were variable costs due to travel, preparatory work, in-person coaching, post-intervention evaluation, and administrative time. We estimated fixed costs of $7112. The mean marginal cost of implementing the intervention at only one additional medical center was $52,536. CONCLUSIONS We provide granular cost estimates of a conceptually rooted implementation strategy designed to increase the uptake of TRA for cardiac catheterization. We estimate that implementation costs stemming from the coaching approach would be offset after the conversion of approximately 409 to 1363 catheterizations from TFA to TRA. Our estimates provide benchmarks of the expected costs of implementing evidence-based, but expertise-intensive, cardiac procedures. TRIAL REGISTRATION ISRCTN, ISRCTN66341299 . Registered 7 July 2020-retrospectively registered.
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Affiliation(s)
- Kevin I Duan
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA. .,Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, 1959 Northeast Pacific Street, Box 356522, Seattle, WA, 98195, USA.
| | - Christian D Helfrich
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Sunil V Rao
- Durham VA Health Care System, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Emily L Neely
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Christine A Sulc
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Diana Naranjo
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Edwin S Wong
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
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20
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Didagelos M, Pagiantza A, Zegkos T, Papanastasiou C, Zarra K, Angelopoulos V, Kouparanis A, Peteinidou E, Sianos G, Karvounis H, Ziakas A. Low-molecular-weight-heparin in radial artery occlusion treatment: the LOW-RAO randomized study. Future Cardiol 2021; 18:91-100. [PMID: 34397270 DOI: 10.2217/fca-2021-0067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Radial artery occlusion (RAO) is the commonest complication of transradial catheterization. There is no evidence-based therapy, in the frame of a randomized control study, for the treatment of RAO. The purpose of the LOW-RAO study is to question the hypothesis if low-molecular-weight heparin is effective in the treatment of RAO after transradial coronary catheterization (both angiography and percutaneous coronary intervention). It is a prospective, open label, randomized controlled trial that will randomize 60 patients with RAO, irrespective of symptoms, into two groups, one receiving anticoagulation with low-molecular-weight heparin and the other receiving no treatment. The primary end point is improvement in radial artery patency rate at 4 weeks after the procedure. Trial registration number: NCT04196309 (ClinicalTrials.gov).
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Affiliation(s)
- Matthaios Didagelos
- 1st Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Areti Pagiantza
- 1 Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Zegkos
- 1 Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Papanastasiou
- 1 Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantina Zarra
- 1 Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Angelopoulos
- 1 Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Kouparanis
- 1 Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanouela Peteinidou
- 1 Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Sianos
- 1 Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Haralambos Karvounis
- 1 Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Ziakas
- 1 Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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21
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Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale CP, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis BS, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten FH, Sibbing D, Siontis GC. Guía ESC 2020 sobre el diagnóstico y tratamiento del síndrome coronario agudo sin elevación del segmento ST. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Zafirovska B, Jovkovski A, Vasilev I, Taravari H, Kitanoski D, Petkoska D, Paljoskovska S, Kostov J, Ho KKL, Kedev S. Ipsilateral transulnar artery approach catheterizations after failure of the radial approach-Are two sheaths in the same arm safe? Catheter Cardiovasc Interv 2021; 99:411-417. [PMID: 34047429 DOI: 10.1002/ccd.29778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/09/2021] [Indexed: 11/11/2022]
Abstract
AIMS To assess the safety and feasibility of ipsilateral transulnar access (TUA) after failure of radial access (TRA), with two sheaths placed in the radial and ulnar arteries (RA and UA) in the same arm. MATERIALS AND METHODS All consecutive patients with TUA due to inability to cross from ipsilateral TRA in the period from March 2011 until September 2020 were included in the study. We examined clinical and procedure characteristics, access site bleeding and ischemic complications and failure mode of initial TRA. Patients were assessed by duplex ultrasound post-procedure (at an average of 56 ± 31 months) and followed clinically (functional and pain assessment). RESULTS In this period, out of 51,866 patients 112 (0.2%) had a transulnar artery approach due to inability to cross from ipsilateral radial approach. Mean age of patients was 65 ± 11 years with 44% females. Cause for crossover to ipsilateral TUA was inability to cross a RA anomaly in 107 (95%) patients, mostly due to the presence of a "360°" RA loop in 88 patients. Type 3 and 4 EASY Score hematoma was present in 3 patients (2.6%). Six (5.3%) of the patients had new ipsilateral radial artery occlusion noted on duplex on follow up. There were no ulnar artery occlusions detected. There were no clinical or ischemic hand complications seen during a median 4.3 years of follow up. CONCLUSION Ipsilateral transulnar artery access following failed radial artery access crossing is safe and successful for coronary angiography and intervention with low rates of complications.
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Affiliation(s)
- Biljana Zafirovska
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Aleksandar Jovkovski
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Ivan Vasilev
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Hajber Taravari
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Darko Kitanoski
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Danica Petkoska
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Savetka Paljoskovska
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Jorgo Kostov
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Kalon K L Ho
- Interventional Cardiology Department, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Sasko Kedev
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
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23
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Changal K, Syed MA, Atari E, Nazir S, Saleem S, Gul S, Salman FNU, Inayat A, Eltahawy E. Transradial versus transfemoral access for cardiac catheterization: a nationwide pilot study of training preferences and expertise in The United States. BMC Cardiovasc Disord 2021; 21:250. [PMID: 34020605 PMCID: PMC8139069 DOI: 10.1186/s12872-021-02068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective was to assess current training preferences, expertise, and comfort with transfemoral access (TFA) and transradial access (TRA) amongst cardiovascular training fellows and teaching faculty in the United States. As TRA continues to dominate the field of interventional cardiology, there is a concern that trainees may become less proficient with the femoral approach. METHODS A detailed questionnaire was sent out to academic General Cardiovascular and Interventional Cardiology training programs in the United States. Responses were sought from fellows-in-training and faculty regarding preferences and practice of TFA and TRA. Answers were analyzed for significant differences between trainees and trainers. RESULTS A total of 125 respondents (75 fellows-in-training and 50 faculty) completed and returned the survey. The average grade of comfort for TFA, on a scale of 0 to 10 (10 being most comfortable), was reported to be 6 by fellows-in-training and 10 by teaching faculty (p < 0.001). TRA was the first preference in 95% of the fellows-in-training compared to 69% of teaching faculty (p 0.001). While 62% of fellows believed that they would receive the same level of training as their trainers by the time they graduate, only 35% of their trainers believed so (p 0.004). CONCLUSION The shift from TFA to radial first has resulted in significant concern among cardiovascular fellows-in training and the faculty regarding training in TFA. Cardiovascular training programs must be cognizant of this issue and should devise methods to assure optimal training of fellows in gaining TFA and managing femoral access-related complications.
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Affiliation(s)
- Khalid Changal
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA.
| | | | - Ealla Atari
- College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Salik Nazir
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
| | - Sameer Saleem
- Department of Cardiovascular Medicine, University of Kentucky, Bowling Green, USA
| | - Sajjad Gul
- Internal Medicine, St. Francis Medical Center, University of Illinois at Peoria, Peoria, USA
| | - F N U Salman
- Internal Medicine, Mercy St. Vincent Medical Center, Toledo, OH, USA
| | - Asad Inayat
- Department of Medicine, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Ehab Eltahawy
- Professor and Program Director of Cardiovascular Medicine and Interventional Cardiology, University of Toledo, 3000 Arlington Ave., MS 1118, Toledo, 43614, OH, USA.
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24
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Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale CP, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis BS, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten FH, Sibbing D, Siontis GCM. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021; 42:1289-1367. [PMID: 32860058 DOI: 10.1093/eurheartj/ehaa575] [Citation(s) in RCA: 2719] [Impact Index Per Article: 906.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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25
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Distal Radial Access: Consensus Report of the First Korea-Europe Transradial Intervention Meeting. JACC Cardiovasc Interv 2021; 14:892-906. [PMID: 33888235 DOI: 10.1016/j.jcin.2021.02.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/28/2021] [Accepted: 02/09/2021] [Indexed: 01/14/2023]
Abstract
Among patients undergoing percutaneous coronary procedures, transradial access, compared with transfemoral access, is associated with a reduced risk for complications including mortality, especially in higher risk patients. However, transradial access is limited by radial artery occlusion (RAO) that despite being mostly asymptomatic because of the extensive anastomoses between the forearm arteries restricts future use of the same radial artery. Distal radial access (DRA) in the anatomic snuffbox or on the dorsum of the hand has recently gained global popularity as an alternative access route for vascular procedures. A strong anatomic and physiological rationale yields potential for significantly reduced risk for RAO and positive impact on procedural outcome for better patient care. Indeed, currently published studies buttress very low rates of RAO after DRA, hence supporting its development. The authors provide an analysis of the foundation of DRA, provide historical background, and offer a critical review of its current status and future directions. Also, given the limited evidence currently available to properly perform DRA in the real world, consensus opinion on what is considered optimal practice is also presented to supplement this document and enhance the implementation of DRA while minimizing its complications.
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Janella BL, Matsuda CN, Pereira RD, Magalhães JM, Silva MAD. Double-blind, single-center, randomized study evaluating the effectiveness of Isosorbide Mononitrate in preventing radial artery occlusion compared to placebo in patients undergoing elective percutaneous coronary procedure: study protocol. REVISTA CIÊNCIAS EM SAÚDE 2021. [DOI: 10.21876/rcshci.v11i1.1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives: The primary objective of this study will be to evaluate the efficacy of subcutaneous and peri-arterial isosorbide mononitrate in preventing occlusion of the radial artery (ORA) after percutaneous coronary procedures (PCP) performed by the transradial approach (TRA). As secondary objectives, define the incidence of ORA in the institution and assess variables related to the risk of occlusion. Methods: Single-center, double-blind, randomized study, including in- and outpatients from a high complexity hospital, admitted to performing PCP, diagnostic or therapeutic, by TRA, in stable coronary conditions (elective) or acute coronary syndrome. The sample will be randomly divided into a group that will receive the medication and a control group. All participants will be submitted to palpatory assessment of radial artery patency and the Barbeau inverse test within 24 h and seven days after the procedure. This will be the first study to evaluate isosorbide mononitrate as an accessible and inexpensive pharmacological method for preventing OAR after PCP by VTR.
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27
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Vu HTT, Norman R, Pham NM, Pham HM, Nguyen HTT, Nguyen QN, Do LD, Huxley RR, Lee CMY, Hoang TM, Reid CM. Access route selection for percutaneous coronary intervention among Vietnamese patients: Implications for in-hospital costs and outcomes. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 9:100116. [PMID: 34327437 PMCID: PMC8315555 DOI: 10.1016/j.lanwpc.2021.100116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/01/2021] [Accepted: 02/07/2021] [Indexed: 10/29/2022]
Abstract
Background Little is known about rates of access site (transradial (TRI) or transfemoral (TFI)) preference for percutaneous coronary intervention (PCI) and in-hospital costs of patients undergoing these procedures in lower-and middle-countries. Here, we report on access site use, in-hospital costs and outcomes of patients undergoing PCI in Vietnam. Methods Information from 868 patients were included in the cohort of 1022 patients recruited into the first PCI registry in Vietnam. The total hospital costs and in-hospital outcomes of patients undergoing TRI and TFI were compared. Hospital costs were obtained from the hospital admission system, and major adverse cardiac events, major bleeding events and length of stay were identified through review of medical records. Findings TRI was the dominant access site for interventionists (694/868 patients). The TFI group reported more lesions of the left main artery, more previous coronary artery bypass grafts and previous PCI in comparison with the TRI group (all p < 0.05). The TRI group was associated with a lower overall cost of admission (the adjusted difference was -1526.3 USD, 95% confident interval CI (-1996.2; -1056.3), shorter length of hospital stay (-2 days, CI (-2.8; -1.2)) and lower rates of major bleeding post-procedure. Procedural factors such as radial access site, left main disease, PCI ≥2 stents, and PCI ≥ 2 lesions having the most impact on the in-hospital cost of patients undergoing PCI. Interpretations Among patients undergoing PCI, TRI was associated with lower costs and favourable clinical outcomes relative to TFI. Funding This research received partial financial support from Curtin University, Australia.
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Affiliation(s)
- Hoa T T Vu
- Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam.,School of Public Health, Curtin University, Perth, Australia
| | - Richard Norman
- School of Public Health, Curtin University, Perth, Australia
| | - Ngoc M Pham
- Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam.,School of Public Health, Curtin University, Perth, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Hung M Pham
- Vietnam National Heart Institute, Hanoi, Vietnam
| | | | | | - Loi D Do
- Vietnam National Heart Institute, Hanoi, Vietnam
| | - Rachel R Huxley
- School of Public Health, Curtin University, Perth, Australia.,Faculty of Health, Deakin University, Melbourne, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Crystal M Y Lee
- School of Public Health, Curtin University, Perth, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia
| | - Tu M Hoang
- Thai Nguyen National Hospital, Thai Nguyen, Vietnam
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Should Transulnar Access Gain the Upper Hand in 2021? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 26:46-47. [PMID: 33632639 DOI: 10.1016/j.carrev.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 11/22/2022]
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29
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Al-Makhamreh H, Shaban A, Elfawair M, Noori S, Al-Khaleefa F, Rahahleh L, AlRamahi B. Rate of late radial artery occlusion following cardiac catheterization at Jordan University Hospital. Future Cardiol 2021; 17:1225-1232. [PMID: 33586481 DOI: 10.2217/fca-2020-0159] [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: 11/21/2022] Open
Abstract
Background: A recanalizing-process might decrease the incidence of radial artery occlusion (RAO) at a late assessment postcatheterization opposed to an early assessment. In this study, we evaluated the rate of RAO at a late postcatheterization period. Materials & methods: A retrospective case-control design was adapted including 148 patients who underwent trans-radial cardiac catheterization 7 to 18 months ago. The primary outcome was to assess RAO at the mentioned period while the secondary outcomes were to assess risk factors and symptoms associated with occlusion. RAO was assessed by Doppler ultrasound. Result: Thirteen patients (8.8%) had RAO in a median follow-up time of 13 months. Hand disability as measured by QuickDash score was significantly associated with RAO. Conclusion: This study adds a new insight on late RAO after coronary catheterization in Jordan and the region. Our findings support an ischemic mechanism contributing to long-term hand dysfunction.
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Affiliation(s)
- Hanna Al-Makhamreh
- Cardiovascular Medicine Department, School of Medicine, University of Jordan, Amman, Jordan
| | - Ala Shaban
- School of Medicine, University of Jordan, Amman, Jordan
| | | | - Shams Noori
- School of Medicine, University of Jordan, Amman, Jordan
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Anchan R, Venturini J, Larsen P, Lee L, Fernandez C, Besser SA, Kalathiya R, Paul J, Blair J, Nathan S. Safe and rapid radial hemostasis achieved using a novel topical hemostatic patch: Results of a first-in-human pilot study using hydrophobically modified polysaccharide-chitosan. Catheter Cardiovasc Interv 2021; 99:786-794. [PMID: 33576564 DOI: 10.1002/ccd.29529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/17/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND The transradial approach (TRA) for catheter interventions decreases vascular complications and bleeding versus transfemoral approach. Reducing time to hemostasis and preventing radial artery occlusion (RAO) following TRA are important and incompletely realized aspirations. OBJECTIVES This first-in-human study sought to evaluate the efficacy of a novel, topically applied compound (hydrophobically modified polysaccharide-chitosan, hm-P) plus minimal required pneumatic compression, to achieve rapid radial arterial hemostasis in post-TRA procedures compared with de facto standards. MATERIALS AND METHODS About 50 adult patients undergoing 6 French diagnostic TRA procedures were prospectively enrolled. At procedure completion, a topical hm-P impregnated patch was placed over the dermotomy and TR Band (TRB) compression was applied to the access site. This patch was used as part of a novel rapid deflation protocol with a primary outcome of time to hemostasis. Photographic and vascular ultrasound evaluation of the radial artery was performed to evaluate the procedural site. RESULTS Time to hemostasis was 40.5 min (IQR: 38-50 min) with the majority of patients (n = 39, 78%) not requiring reinflation. Patients with bleeding requiring TRB reinflation were more likely to have low body weight and liver dysfunction, with absence of hypertension and LV dysfunction. The rate of RAO was 0% with predischarge radial artery patency documented in all patients using vascular ultrasound. One superficial hematoma was noted. No late bleeding events or cutaneous reactions were reported in the study follow-up. CONCLUSIONS Topical application of hm-P in conjunction with pneumatic compression was safe and resulted in rapid and predictable hemostasis at the arterial puncture site.
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Affiliation(s)
- Rajeev Anchan
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Joseph Venturini
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Paul Larsen
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Linda Lee
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Christopher Fernandez
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Stephanie A Besser
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Rohan Kalathiya
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Jonathan Paul
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - John Blair
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Sandeep Nathan
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
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Chiarito M, Cao D, Nicolas J, Roumeliotis A, Power D, Chandiramani R, Sartori S, Camaj A, Goel R, Claessen BE, Stefanini GG, Mehran R, Dangas G. Radial versus femoral access for coronary interventions: An updated systematic review and meta‐analysis of randomized trials. Catheter Cardiovasc Interv 2021; 97:1387-1396. [DOI: 10.1002/ccd.29486] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/06/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Mauro Chiarito
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
- Cardio Center Humanitas Clinical and Research Center IRCCS Milan Italy
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Anastasios Roumeliotis
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - David Power
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Rishi Chandiramani
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Anton Camaj
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Ridhima Goel
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Bimmer E. Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | | | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
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Aoi S, Gonzalez C, Chan D, Kwan T. Transulnar Catheterization in Patients with Failed Ipsilateral Transradial Access: Novel TR Band Modification for Dual-Site Hemostasis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 22:84-88. [DOI: 10.1016/j.carrev.2020.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 11/29/2022]
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Distal Transradial Access for Coronary Angiography and Interventions. Curr Probl Cardiol 2020; 46:100714. [PMID: 33071036 DOI: 10.1016/j.cpcardiol.2020.100714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 11/22/2022]
Abstract
Coronary angiography is one of the most common procedures done in the United States and in other developed countries. For decades, the femoral artery has been the most common vascular access site utilized for this procedure. However, the radial access has been gaining popularity for being a safer and yet practical vascular access with substantial benefits. More recently, the novel distal transradial approach has proven to be an equally or perhaps safer vascular access for diagnostic and interventional coronary and noncoronary procedures. This technique should be in every interventional cardiologist's arsenal.
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Sawant AC, Rizik DG, Rao SV, Pershad A. Algorithms for challenging scenarios encountered in transradial intervention. Indian Heart J 2020; 73:149-155. [PMID: 33865510 PMCID: PMC8065373 DOI: 10.1016/j.ihj.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/21/2020] [Accepted: 09/10/2020] [Indexed: 11/26/2022] Open
Abstract
Transradial intervention (TRI) was first introduced by Lucien Campeau in 1989 and since then has created a lasting impact in the field of interventional cardiology. Several studies have demonstrated that TRI is associated with fewer vascular site complications, offer earlier ambulation and greater post-procedural comfort. Patients presenting with ST Segment Elevation Myocardial Infarction (STEMI) have experienced survival benefit and higher quality-of-life metrics as well with TRI. While both the updated scientific statement by the American Heart Association and the 2017 European Society of Cardiology guidelines recommend a “radial first” approach there appears to be a lag in physicians adapting TRI as the preferred vascular access. We present a review focusing on identification and management of TRA related challenges and complications using a systematic algorithmic approach.
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Affiliation(s)
| | - David G Rizik
- HonorHealth and the Scottsdale-Lincoln Health Network, Scottsdale, AZ, USA
| | - Sunil V Rao
- Division of Cardiology, Duke Clinical Research Institute, Duke University, Durham, NC, USA
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35
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Milford BM, Cohen MG. Coronary Cannulation: Tips for Success in Transradial Angiography and Interventions. Interv Cardiol Clin 2020; 9:21-31. [PMID: 31733738 DOI: 10.1016/j.iccl.2019.08.010] [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] [Indexed: 11/18/2022]
Abstract
Transradial artery access (TRA) is associated with reduced bleeding risk, length of stay, costs, and increased patient satisfaction. Approximately one-third of TRA failures are due to lack of guiding catheter support. Catheter selection and engagement technique are crucial for obtaining good-quality angiograms and successfully completing percutaneous coronary intervention. The maneuvers required for catheter manipulation and coronary engagement differ between TRA and transfemoral arterial access. One of the advantages of TRA is the ability to use a universal catheter, saving time, radiation, and contrast. This review discusses practical learning points to improve operator understanding of catheter selection and coronary engagement technique.
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Affiliation(s)
- Brett M Milford
- Cardiovascular Division, Department of Medicine, Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospital and Clinics, UHealth Tower, 1400 Northwest 12th Avenue, Suite 864, Miami, FL 33136, USA
| | - Mauricio G Cohen
- Cardiovascular Division, Department of Medicine, Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospital and Clinics, UHealth Tower, 1400 Northwest 12th Avenue, Suite 864, Miami, FL 33136, USA.
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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.
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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.
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A case of radial artery pseudoaneurysm which is a rare complication of transradial coronary angiography. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2020. [DOI: 10.21673/anadoluklin.722102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Vergara-Garcia D, Gomez-Paz S, Robinson TM, Moore J, Ogilvy CS, Thomas AJ. Transition to Radial Approach for Neurovascular Procedures is Safe and Convenient: Characterization of a Learning Experience. Oper Neurosurg (Hagerstown) 2020; 19:489-494. [DOI: 10.1093/ons/opaa133] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/18/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
The transradial access for endovascular procedures has become a popular access point of preference for both patients and for many neuro-endovascular practitioners.
OBJECTIVE
To describe a single-center experience on the transition to a radial-first approach for neurovascular procedures, focused on diagnostic angiographies, and to compare the differences in terms of length of procedure within the first 5 mo of its execution.
METHODS
We performed a retrospective review of a prospective maintained cerebrovascular registry at an academic institution within the United States, to identify the expected adoption curve required to transition to a transradial route first approach focused mainly on diagnostic procedures. The 5 mo of experience were divided into 4 quartiles evenly distributed in time. The primary outcome was the total length of procedure. Secondary outcomes were access failure, radiation dose, the usefulness of ultrasound assistance and complications.
RESULTS
A total of 121 transradial procedures were performed: 113 diagnostic angiographies (93%) and 8 therapeutic interventions (7%). We identified 6 access failures (5%) and 1 complication (1%). The mean length for diagnostic angiographies was 24 ± 10 min, and for therapeutic procedures was 58 ± 19 min. A multivariate regression analysis demonstrated a significant decrease in the total length of procedures after the first quartile.
CONCLUSION
The transradial route shows to be a safe and convenient approach. The total length of procedure starts decreasing as providers gain experience and become more confident with this route, as seen in our 5-mo experience.
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Affiliation(s)
| | | | - Timothy M Robinson
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Justin Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Musumeci G, Baralis G. Coronary total occlusion and minimalist approach: When less is more. Catheter Cardiovasc Interv 2020; 95:E150-E151. [PMID: 31957923 DOI: 10.1002/ccd.28682] [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: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Giuseppe Musumeci
- SC Cardiology, Azienda Ospedaliera S Croce e Carle, Cuneo, CN, Italy
| | - Giorgio Baralis
- SC Cardiology, Azienda Ospedaliera S Croce e Carle, Cuneo, CN, Italy
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40
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Radial Artery Remodeling following Transradial Percutaneous Coronary Intervention in Men and Women: Insights from Serial Ultrahigh Frequency Ultrasonography. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:286-292. [DOI: 10.1016/j.carrev.2019.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 04/29/2019] [Accepted: 05/07/2019] [Indexed: 11/19/2022]
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Cardiovascular Risk Assessment in Renal and Liver Transplant Candidates: A Multidisciplinary Institutional Standardized Approach. Cardiol Rev 2020; 27:286-292. [PMID: 31584469 DOI: 10.1097/crd.0000000000000282] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the modern era, renal and liver transplant candidates present with a greater medical complexity driven in part by a higher prevalence of cardiovascular conditions, including coronary artery disease, valvular heart disease, and cardiomyopathies. In fact, cardiovascular disease is the most common cause of death after kidney transplantation worldwide. Similarly, an increase in the number of patients being listed with end-stage liver disease from nonalcoholic steatohepatitis and a rising model for end-stage liver disease scores at the time of liver transplant in the United States parallel an increasing cardiovascular disease risk profile for liver transplant candidates. A large degree of variation exists among clinical practice guidelines and transplant center practice patterns regarding patient selection for routine cardiac testing and the choice of testing modalities. Here, we review the clinical practice guidelines established at our center by a multidisciplinary group, including transplant nephrology, hepatology, and surgery, as well as general and interventional cardiology, with the goal of improving patient selection and reducing adverse cardiac events posttransplant.
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Distal Radial and Ulnar Arteries: the Alternative Forearm Access. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020; 22:1. [DOI: 10.1007/s11936-020-0801-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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43
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Akl E, Rashid MK, Alshatti A, Jolly SS. Transradial Angiography and Intervention in Acute Coronary Syndromes. Interv Cardiol Clin 2020; 9:33-40. [PMID: 31733739 DOI: 10.1016/j.iccl.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Considerable evidence supports transradial angiography and intervention in patients with acute coronary syndrome, with an emphasis on decreasing major bleeding and access site vascular complications. Patients undergoing invasive treatment are at greatest risk of bleeding and have the most to gain. The radial advantage has consistently been shown to translate into reduced mortality in pooled data analyses. The benefits of transradial access have been demonstrated across the acute coronary syndrome spectrum and in both sexes. A radial-first strategy should be the default approach and continuous efforts should be made to increase operator expertise of transradial access in these patients.
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Affiliation(s)
- Elie Akl
- Department of Medicine, Division of Cardiology, McMaster University, Room C3-118, DBCVSRI Building, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Mohammed K Rashid
- Department of Medicine, Division of Cardiology, McMaster University, Room C3-118, DBCVSRI Building, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Ahmad Alshatti
- Department of Medicine, Division of Cardiology, McMaster University, Room C3-118, DBCVSRI Building, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Sanjit S Jolly
- Department of Medicine, Division of Cardiology, McMaster University, Room C3-118, DBCVSRI Building, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada; Population Health Research Institute, Hamilton, Ontario, Canada.
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Soomro NA, Khan MN, Naseeb K, Batra MK, Majeed H, Bhatti U, Ashraf T, Karim M. Outcomes of Primary Percutaneous Coronary Intervention through a Transradial Approach in a Tertiary Care Cardiac Center. Cureus 2019; 11:e6484. [PMID: 32025407 PMCID: PMC6984168 DOI: 10.7759/cureus.6484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 12/27/2019] [Indexed: 11/05/2022] Open
Abstract
Background Transradial approach for percutaneous coronary intervention (PCI) is gaining popularity due to lesser bleeding and other access site related complications. This study aims to determine the in-hospital outcomes of primary PCI through a transradial approach in a tertiary care cardiac center. Methods Consecutive patients with ST-segment elevation myocardial infarction presenting within 12 hours with symptoms without a previous history of thrombolytic therapy, coronary angioplasty, or cardiac surgery were included in the study. All patients underwent a diagnostic angiogram followed by primary PCI of the infarct-related artery through a radial route and were kept under observation during the hospital stay for forearm hematoma or mortality. Results A total of 180 patients were included in this study, with a mean age of 52.04±7.31 years. Majority (87.2%) of the patients were male, and diabetes (72.8%) was the most commonly observed co-morbid condition followed by hypertension (67.2%). Hospital mortality rate was 3.9% (7 patients), and post-procedure forearm hematoma was noted in 5.6% (10 patients). An increased mortality rate was found to be associated with age above 50 years (7.1% vs. 0.0%; p=0.012) and non-hypertension (8.5% vs. 1.7%; p=0.026). An increased incidence of forearm hematoma was found to be associated with age above 50 years (10.2% vs. 0.0%; p=0.002), diabetic mellitus (7.6% vs. 0.0%; p=0.047), hyperlipidemia (11% vs. 0.0%; p=0.001), and non-smoking (10.2% vs. 0.0%; p=0.003). Conclusion Our study showed that primary PCI through a transradial approach is a safe option with excellent success rates in terms of both mortality rates and morbidity such as forearm hematoma.
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Affiliation(s)
| | - Muhammad N Khan
- Interventional Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Khalid Naseeb
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Mahesh K Batra
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), karachi, PAK
| | - Haris Majeed
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Usman Bhatti
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Tariq Ashraf
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Musa Karim
- Statistician, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
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Huang IKH, Tan RY, Kwan J, Lim GHT, Quek LHH, Pua U. Are cerebral ischaemic complications more likely to occur in elderly patients undergoing transradial non-coronary intervention: A single-centre retrospective review. J Med Imaging Radiat Oncol 2019; 64:27-34. [PMID: 31876092 DOI: 10.1111/1754-9485.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/10/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Transradial artery access (TRA) is an established technique employed by interventional cardiologists for diagnostic and therapeutic coronary interventions. The use of TRA has gained increasing traction amongst interventional radiologists in recent years. In transradial, non-coronary interventions, the aorta has to be traversed. With increasing age, atherosclerotic changes in the aorta posed a theoretical risk of catheter-related emboli. Currently, there is limited literature available on the cerebral ischaemic complication rates in transradial non-coronary interventions. METHODS Between November 2015 and December 2017, 150 transradial non-coronary interventions were performed on 95 patients. Intra-procedural, in-hospital, 30-day and 6-month complications (ischaemic stroke, transient ischaemic attack and death, and minor complications, such as puncture site haematoma, pseudoaneurysm, thrombosis, dissection and perforation) were compared between the two age groups (≤65 and >65 years old). RESULTS The patients were predominantly male (87.0%) with age ≤65 (N = 69; 46.0%) and age >65 (N = 81; 54.0%). There were no ischaemic strokes at all time points in both groups, except for one case of ischaemic stroke at 6 months in the age ≤65 group(1.4% vs. 0.0%; P = 0.462). On multivariable analysis, age >65 was associated with lower in-hospital death rates (OR 0.251; 95% CI 0.013-3.09), at 30 days (OR 0.608; 95% CI 0.77-4.805) and at 6 months (OR 0.514; 95% CI 0.169-1.558) with no deaths intra-procedurally in both groups. Minor complications include puncture site grade I haematoma formation (2.9% vs. 2.5%; P = 0.999) and pseudoaneurysm (2.9% vs. 0.0%; P = 0.210). In our study, the overall major and minor complications rates are low and no statistically significant difference exists between the two groups. CONCLUSION Transradial non-coronary interventions are safe in elderly patients, who are likely to have more atherosclerotic disease of the aorta. Of note, no complication of ischaemic strokes within 30 days of the procedure is documented in all patients.
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Affiliation(s)
| | - Ray Yueh Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Justin Kwan
- Department of Radiology, Tan Tock Seng Hospital, Singapore City, Singapore
| | - Gavin Hock Tai Lim
- Department of Radiology, Tan Tock Seng Hospital, Singapore City, Singapore
| | | | - Uei Pua
- Department of Radiology, Tan Tock Seng Hospital, Singapore City, Singapore
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Villablanca PA, Frisoli T, O'Neill W, Eng M. Using the Arm for Structural Interventions: Case Selection or Wave of the Future. Interv Cardiol Clin 2019; 9:63-74. [PMID: 31733742 DOI: 10.1016/j.iccl.2019.08.007] [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: 10/25/2022]
Abstract
The transradial approach has emerged as the preferred alternative to the traditional transfemoral approach owing to the increased evidence of its safety and efficacy. The field of structural heart disease is rapidly evolving; however, periprocedural complications related to access site remain a major determinant of morbidity and mortality. The transradial approach as primary or secondary access site in structural heart interventions like transcatheter aortic valve replacement, balloon aortic valvuloplasty, alternative access, alcohol septal ablations, paravalvular leak, valve snaring, coronary protection, and ventricular septal defect is feasible, safe, with lower vascular complications and high procedural success.
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Affiliation(s)
- Pedro A Villablanca
- Center for Structural Heart Disease, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
| | - Tiberio Frisoli
- Center for Structural Heart Disease, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - William O'Neill
- Center for Structural Heart Disease, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Marvin Eng
- Center for Structural Heart Disease, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
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Kiang SC, Nasiri AJ, Strilaeff RR, Prasad VS, Bharadwaj AS, Miller PA, Abou-Zamzam AM, Tomihama RT. Analysis of Subjective and Objective Screening Techniques as Predictors of Safety for Radial Artery Intervention. Ann Vasc Surg 2019; 65:33-39. [PMID: 31726202 DOI: 10.1016/j.avsg.2019.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND There is no currently accepted standard in safety evaluation for radial artery intervention. We sought to compare the accuracy of various subjective and objective screening techniques in predicting safety for radial artery intervention. METHODS Fifty-four patients in a prospective cohort study at a single institution underwent subjective Allen's test, objective Barbeau test, and several objective hand ultrasound techniques to assess safety for radial artery intervention. These results were then compared to the gold standard of conventional hand angiography to document complete palmar arch. Statistical analysis including sensitivity, specificity, positive predictive values, negative predictive values, and accuracy were calculated. RESULTS Compared to hand angiography, the subjective Allen's test and the objective Princeps Pollicis Artery ultrasound demonstrated the comparable levels of sensitivity (100% vs. 96.7%, respectively), specificity (100% vs. 100%, respectively), and accuracy (97.2% vs. 97.1%, respectively). The objective Barbeau test demonstrated similar results (sensitivity of 100%, accuracy of 98.2%) with the exception of a lower specificity (50%). CONCLUSIONS There is no currently accepted standard in safety evaluation for radial artery intervention. However, preliminary data suggest that certain subjective and objective techniques such as Allen's testing, Princeps Pollicis artery ultrasound, and Barbeau testing are comparable options in predicting palmar arch patency.
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Affiliation(s)
- Sharon C Kiang
- Division of Vascular Surgery, Department of Surgery, Linda University School of Medicine, Loma Linda, CA; Division of Vascular Surgery, Department of Surgery, VA Loma Linda Healthcare System, Loma Linda, CA
| | - Arian J Nasiri
- Department of Radiology, Section of Vascular and Interventional Radiology, Linda University School of Medicine, Loma Linda, CA
| | - Ryan R Strilaeff
- Department of Radiology, Section of Vascular and Interventional Radiology, Linda University School of Medicine, Loma Linda, CA
| | - Vinoy S Prasad
- Division of Cardiology, Department of Medicine, Linda University School of Medicine, Loma Linda, CA
| | - Aditya S Bharadwaj
- Division of Cardiology, Department of Medicine, Linda University School of Medicine, Loma Linda, CA
| | - Paul A Miller
- Division of Vascular Surgery, Department of Surgery, VA Loma Linda Healthcare System, Loma Linda, CA
| | - Ahmed M Abou-Zamzam
- Division of Vascular Surgery, Department of Surgery, Linda University School of Medicine, Loma Linda, CA
| | - Roger T Tomihama
- Department of Radiology, Section of Vascular and Interventional Radiology, Linda University School of Medicine, Loma Linda, CA.
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Left Distal Transradial Approach for Coronary Intervention: Insights from Early Clinical Experience and Future Directions. Cardiol Res Pract 2019; 2019:8671306. [PMID: 31781385 PMCID: PMC6874980 DOI: 10.1155/2019/8671306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/17/2019] [Accepted: 09/05/2019] [Indexed: 12/21/2022] Open
Abstract
Left distal transradial approach is a novel technique for coronary intervention. This technique is convenient for specialists to operate and welcomed for right-handed patients. The anatomical snuffbox and the first intermetacarpal are two available puncture sites on the basis of hand anatomy. In technical aspects, main differences between left distal transradial approach and conventional transradial approach are patient's special position, puncture procedure, sheath choice, and hemostasis methods. According to the preliminary data, this technique is feasible and safe and it has low rate of complications including radial artery occlusion in forearm. Left distal transradial approach is a quite promising strategy of coronary intervention and deserves further exploration. In this review article, we describe the main technical characteristics and the results obtained from early clinical experiences. We also discuss the main challenges and future perspectives on this novel technique.
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Geraiely B, Sattarzadeh Badkoubeh R, Jalalsafari M, Shahmansouri N, Tavousi A, Nazari N, Mortazavi SH. Effect of Showing Angiograms to Patients After Elective Percutaneous Coronary Intervention on Anxiety and Illness Perception: A Randomized, Blinded, Controlled Clinical Trial. Galen Med J 2019; 8:e1556. [PMID: 34466528 PMCID: PMC8344156 DOI: 10.31661/gmj.v8i0.1556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/15/2019] [Accepted: 06/20/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND As an invasive modality, a coronary angioplasty may cause a great deal of anxiety in patients and affect their mental health and general well-being. Accordingly, we sought to assess whether showing patients the video of their elective percutaneous coronary intervention (angiogram) could affect their illness perception and anxiety level. MATERIALS AND METHODS In this randomized clinical trial, the patients undergoing angioplasty, were randomly divided into two groups of 30 patients. Angiograms were shown only to the intervention group postprocedurally. A checklist comprising demographic data and clinical presentations as well as the Beck anxiety questionnaire and the Brief Illness Perception Questionnaire (BIPQ) was completed for each patient immediately after the intervention and one month later. The differences in the patients' anxiety level and illness perception were analyzed. RESULTS In the intervention group, the mean anxiety score before and after watching the angiograms was 34.26 ± 8.1 and 24.4 ± 8.56, respectively. While in the control group, the score before and after angioplasty was 34.46 ± 9.34 and 26.6 ± 9.44, respectively. Thus, watching angiograms led to a significant decrease in the anxiety score in the intervention group, whereas there was no such difference in the control group. There was also a considerable difference in the anxiety score between the two groups. Further, there was a significant decrease in the BIPQ score of the intervention group after watching the angioplasty videos. CONCLUSION Educating cardiovascular patients about diagnostic and therapeutic procedures may confer such good outcomes as alleviated anxiety, enhanced satisfaction, and ultimately, fewer anxiety-related complications.
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Affiliation(s)
- Babak Geraiely
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Jalalsafari
- Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Shahmansouri
- Department of Psychiatry, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Tavousi
- Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Nazari
- Department of Anesthesiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Fan Y, Wei Q, Cai J, Wang Y, Fu X. Comparison of long-term radial artery occlusion following trans-radial coronary intervention using 6-french versus 7-french sheaths. Cardiol J 2019; 28:49-57. [PMID: 31478556 DOI: 10.5603/cj.a2019.0085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/30/2019] [Accepted: 08/20/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of this study was to explore the impact of 6-Fr and 7-Fr sheaths on the incidence of long-term radial artery occlusion (RAO) after trans-radial coronary intervention (TRI). METHODS From September 2013 to January 2016, patients with ischemic heart disease including acute myocardial infarction and true bifurcation lesions were randomly assigned to 6-Fr group and 7-Fr group immediately after coronary angiography in a 1:1 ratio. The radial artery diameters were observed by ultrasound examination one day prior to TRI as well as at 30 days and 1 year after TRI. The primary endpoint was the incidence of RAO at 1-year after TRI. The secondary endpoints were the incidence of local vascular complications during hospitalization and changes of radial artery diameters within 1-year after TRI between the two groups. Additionally, multivariate logistic regression analysis was used to explore potential factors related to the incidence of long-term RAO after TRI. RESULTS A total of 214 patients were enrolled and randomly assigned to 6-Fr group (n = 105) or 7-Fr group (n = 109). There was no significant difference in the incidence of RAO at 1-year after TRI (8.57% vs. 12.84%, p = 0.313). Moreover, no significant difference was observed in the incidence of local vascular complications during hospitalization (20% vs. 24.77%, p = 0.403). After 1-year follow-up, no significant difference was found in radial artery diameters (2.63 ± 0.31 mm vs. 2.64 ± 0.27 mm, p = 0.802). Multivariate logistic analysis revealed that repeated TRI was an independent risk factor of long-term RAO 1 year after TRI (OR = 10.316, 95% CI 2.928-36.351, p = 0.001). CONCLUSIONS Compared to 6-Fr sheath, 7-Fr sheath did not increase short-term or long-term incidence of RAO after TRI.
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Affiliation(s)
| | | | | | - Yanbo Wang
- The Second Hospital of Hebei Medical University
| | - Xianghua Fu
- The Second Hospital of Hebei Medical University.
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