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Tužil J, Matějka J, Mamas MA, Doležal T. Short-term risk of periprocedural stroke relative to radial vs. femoral access: systematic review, meta-analysis, study sequential analysis and meta-regression of 2,188,047 real-world cardiac catheterizations. Expert Rev Cardiovasc Ther 2023; 21:293-304. [PMID: 36877129 DOI: 10.1080/14779072.2023.2187378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To verify whether transradial (TRA) compared to transfemoral (TFA) cardiac catheterization reduces the risk of periprocedural stroke (PS). METHODS We reviewed (CRD42021277918) published real-world cohorts reporting the incidence of PS within 3 days following diagnostic or interventional catheterization. Meta-analyses and meta-regressions of odds ratios (OR) performed using the DerSimonian and Laird method were checked for publication bias (Egger test) and adjusted for false-positive results (study sequential analysis SSA). RESULTS The pooled incidence of PS from 2,188,047 catheterizations (14 cohorts), was 193 (105 to 355) per 100,000. Meta-analyses of adjusted estimates (OR = 0.66 (0.49 to 0.89); p = 0.007; I2 = 90%), unadjusted estimates (OR = 0.63 (0.51 to 0.77; I2 = 74%; p = 0.000)), and a sub-group of prospective cohorts (OR = 0.67 (0.48 to 0.94; p = 0.022; I2 = 16%)) had a lower risk of PS in TRA (without indication of publication bias). SSA confirmed the pooled sample size was sufficient to support these conclusions. Meta-regression decreased the unexplained heterogeneity but did not identify any independent predictor of PS nor any effect modifier. CONCLUSION Periprocedural stroke remains a rare and hard-to-predict adverse event associated with cardiac catheterization. TRA is associated with a 20% to 30% lower risk of PS in real-world/common practice settings. Future studies are unlikely to change our conclusion.
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Affiliation(s)
- Jan Tužil
- Value Outcomes s.r.o., Prague, Czech Republic.,Biomedical informatics, First Medical Faculty, Charles University, Prague, Czech Republic
| | - Jan Matějka
- Department of Cardiology, Hospital of Pardubice, Pardubice, Czech Republic.,Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic.,Academic Department of Internal Medicine, Charles University Faculty of Medicine, Hradec Králové, Czech Republic
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, University of Keele, StokeonTrent, UK
| | - Tomáš Doležal
- Value Outcomes s.r.o., Prague, Czech Republic.,Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Chivot C, Bouzerar R, Yzet T. A novel technique to perform cerebral angiography via the left radial approach: An 80 patients series. J Neuroradiol 2023; 50:93-98. [PMID: 33450347 DOI: 10.1016/j.neurad.2020.10.004] [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: 08/31/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE To demonstrate that left radial access for diagnostic cerebral angiography with Extra backup and 4F vertebral catheters is feasible and safe. MATERIALS AND METHODS This study is a retrospective review of our prospective database on left radial access for cerebral angiography procedures, using an extra backup catheter associated with a 4Fr vertebral catheter, performed between March and September 2019. Patient demographics, procedural and radiographic metrics as well as clinical data were recorded. RESULTS Seventy five patients with mean age of 51...years (range 21...73) underwent 80 cerebral angiographies. An average of four vessels were catheterized and mean fluoroscopy times per subject and vessel were was of 13.9 and 3.3...min, respectively. One patient required crossover to transfemoral access because of radial artery spasm. There were one asymptomatic distal radial artery occlusion and one patient presenting with asymptomatic skin blanching area on the forearm, just proximal to the tip of the sheath, that spontaneously resolved within an hour. CONCLUSION Diagnostic cerebral angiography via left radial access is feasible and safe and allows to preserve the right radial access for future neurointerventions while providing more comfort to the right handed patient.
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Affiliation(s)
- Cyril Chivot
- Department of Radiology, Amiens University Hospital, Avenue Ren.. Laennec, F-80054 Amiens Cedex 01, France.
| | - Roger Bouzerar
- Image Processing Department, Amiens University Hospital, Avenue Ren.. Laennec, F-80054 Amiens Cedex 01, France
| | - Thierry Yzet
- Department of Radiology, Amiens University Hospital, Avenue Ren.. Laennec, F-80054 Amiens Cedex 01, France
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Sohal S, Khakwani MZ, Sandhu Z, El-Sayed D, Tayal R, Waxman S, Wasty N. Coronary Catheter Course Via the Left Radial Approach Is Diametrically Opposed to the Course Via the Femoral Approach: A Stroke Paradox. CJC Open 2023; 5:164-166. [PMID: 36880072 PMCID: PMC9984880 DOI: 10.1016/j.cjco.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Sumit Sohal
- Division of Cardiology, Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Muhammad Zain Khakwani
- Division of Cardiology, Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Zainab Sandhu
- Division of Cardiology, Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Dina El-Sayed
- Division of Cardiology, Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Rajiv Tayal
- Division of Cardiology, Department of Internal Medicine, The Valley Hospital, Ridgewood, New Jersey, USA
| | - Sergio Waxman
- Division of Cardiology, Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Najam Wasty
- Division of Cardiology, Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, USA
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Comparison between the Right and Left Distal Radial Access for Patients Undergoing Coronary Procedures: A Propensity Score Matching Analysis. J Interv Cardiol 2022; 2022:7932114. [PMID: 35935126 PMCID: PMC9334045 DOI: 10.1155/2022/7932114] [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: 03/09/2022] [Revised: 05/03/2022] [Accepted: 06/21/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Distal radial access for coronary procedures decreases hemostasis time, prevents radial occlusion, and improves patient comfort compared to conventional transradial access. Initially described for left distal radial access (lDRA), the right distal radial access (rDRA) is feasible. However, there are no comparative studies to date. This study aimed to evaluate the impact of the access site on vascular access and procedural performance. Methods From August 2020 to October 2021, coronary procedures performed through distal radial access were prospectively recorded. After propensity score matching, the rDRA and lDRA were compared. The primary endpoint was the proportion of approach success. The secondary endpoints included access time, coronary procedural success, radial spasm, exposition to ionizing radiation, patient comfort, and vascular access-related complications. Results From a total of 385 procedures in 382 patients, after a propensity score matching, 182 procedures were compared between the rDRA and lDRA. There were no differences in the baseline characteristics between the groups. Compared to the lDRA, the rDRA presented similar approach success (96.7% vs. 96.7%, p=1.0), less access time (39 (25–60) sec vs. 50 (29–90) sec, p=0.018), comparable coronary procedural success after sheath placement (100% vs. 100%, p=1.000), and not statistically significant radial spasm (2.19% vs. 6.59%, p=0.148). No differences in dose-area product (32 (20–56.2) Gy.m2 vs. 32.3 (19.4–46.3) Gy.m2; p=0.472) and fluoroscopy time (4.4 (2.5–9.1) min vs. 4.3 (2.4–7.5) min, p=0.251) were detected between the groups. No vascular access-related complications were observed in any group. Conclusions The rDRA, compared to the lDRA, had the same proportion of approach success and procedural performance, with a slight reduction in access time for patients undergoing coronary procedures.
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Ghose T, Kachru R, Dey J, Khan WU, Sud R, Jabeen S, Husain S, Pant A. Safety and Feasibility of Ultrasound-Guided Access for Coronary Interventions through Distal Left Radial Route. J Interv Cardiol 2022; 2022:2141524. [PMID: 35401064 PMCID: PMC8975628 DOI: 10.1155/2022/2141524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/18/2022] [Indexed: 12/14/2022] Open
Abstract
Aims Left distal transradial arterial approach (ldTRA) is a new interventional route that spares right radial artery (RRA) for use in haemodialysis and as bypass graft. Vasant Kunj Left dIstal Transradial ArtEry approach (VKLITE) study aimed to assess the feasibility and safety of ldTRA access during coronary angiography (CAG) and percutaneous coronary intervention (PCI). Methods and Results Between April 2018 and June 2020, 108 patients were enrolled and underwent CAG ± PCI via ultrasound guided ldTRA. Arterial puncture, CAG, and PCI were successful in 96.3% (104/108), 92.1% (93/101), and 94.1% (32/34) patients, respectively. Access site crossover rate was 14/108 (13.0%). Mean puncture, procedure, and haemostasis time (minutes) were 6.7 ± 7.1, 55.7 ± 32.8, and 23.1 ± 11.9. Median total fluoroscopic time was 6.6 minutes (IQR-14.2), and median total radiation dose was 39.2 Gy-cm2 (IQR-97.0). Local haematoma occurred in 11 patients (10.2%) with major haematoma in 1.9%, all recovering within three weeks. Mean pain score was 2.4 ± 2.3, and patient satisfaction score was 9.0 ± 1.3. LdTRA access compared with RRA access (n = 121) showed significantly increased mean procedure time (55.7 ± 32.8 vs. 43.9 ± 26.0 minutes, p = 0.01) and median total fluoroscopic time (6.6 [IQR-14.2] vs. 4.7 [IQR-8.2] minutes, p = 0.02), with similar median total radiation dose (39.2 [IQR-97.0] vs. 43.8 [IQR-54.5] Gy-cm2, p = 0.56). No radial artery loss, dissection, pseudoaneurysm, arteriovenous fistula, or nerve injury was noted. Conclusions LdTRA access is feasible with few complications during CAG/PCI. Patient comfort and satisfaction makes it a desirable route for coronary interventions.
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Affiliation(s)
- Tapan Ghose
- Cardiology, Fortis Flt. Lt. Rajan Dhall Hospital, Sector B, Pocket 1, Aruna Asaf Ali Marg, Vasant Kunj, New Delhi-70, India
| | - Ranjan Kachru
- Cardiology, Fortis Flt. Lt. Rajan Dhall Hospital, Sector B, Pocket 1, Aruna Asaf Ali Marg, Vasant Kunj, New Delhi-70, India
| | - Jaideep Dey
- Non-Invasive Cardiology, BLK MAX Superspeciality Hospital, Pusa Road, Rajendra Place, New Delhi-05, India
| | - Wasi Ullah Khan
- Cardiology, Fortis Flt. Lt. Rajan Dhall Hospital, Sector B, Pocket 1, Aruna Asaf Ali Marg, Vasant Kunj, New Delhi-70, India
| | - Ratna Sud
- Cardiology, Fortis Flt. Lt. Rajan Dhall Hospital, Sector B, Pocket 1, Aruna Asaf Ali Marg, Vasant Kunj, New Delhi-70, India
| | - Suraiya Jabeen
- Cardiology, Fortis Flt. Lt. Rajan Dhall Hospital, Sector B, Pocket 1, Aruna Asaf Ali Marg, Vasant Kunj, New Delhi-70, India
| | - Shahnawaz Husain
- Cardiology, Fortis Flt. Lt. Rajan Dhall Hospital, Sector B, Pocket 1, Aruna Asaf Ali Marg, Vasant Kunj, New Delhi-70, India
| | - Aparna Pant
- Cardiology, Fortis Flt. Lt. Rajan Dhall Hospital, Sector B, Pocket 1, Aruna Asaf Ali Marg, Vasant Kunj, New Delhi-70, India
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Jones J, Rathod KS, Beirne AM, Hamshere SM, Choudry FA, O'Mahony C, Guttmann OP, Knight CJ, Amersey R, Wragg A, Baumbach A, Mathur A, Jones DA. An observational study assessing the predictors of procedural failure from the radial approach. Is right radial access always the best? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 42:86-91. [DOI: 10.1016/j.carrev.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022]
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Goicolea Ruigómez J. Acceso transradial. ¿Debemos seguir mirando a la izquierda? Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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Goicolea Ruigómez J. Transradial access. Should we keep turning left? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:110-111. [PMID: 34785161 DOI: 10.1016/j.rec.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Javier Goicolea Ruigómez
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain.
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Nishida H, Ota T, Onsager D, Grinstein J, Jeevanandam V, Song T. Ten-year, single center experience of ambulatory axillary intra-aortic balloon pump support for heart failure. J Cardiol 2021; 79:611-617. [PMID: 34895789 DOI: 10.1016/j.jjcc.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The axillary intra-aortic balloon pump has an advantage over the femoral intra-aortic balloon pump in terms of mobility. While axillary intra-aortic balloon pump has been widely used recently as a mode of mechanical circulatory support, the number of reported cases is limited. The purpose of this study is to summarize our experience and to evaluate the safety and efficacy of axillary intra-aortic balloon pump support. METHODS Between July 2009 and July 2019, 241 patients underwent axillary intra-aortic balloon pump support for heart failure. The intended therapeutic goals were bridge to heart transplantation (n=146), left ventricular assist device (n=66), and recovery (n=29). Intra-aortic balloon pumps were inserted through a graft sutured onto the axillary artery in 142 patients (58.9%) and percutaneously in 99 patients (41.1%). It was placed from the right axillary artery in 147 patients (61.0%) and left in 94 patients (39.0%). Primary outcome measures of interest included achievement of intended therapeutic goal, hemodynamic data, ambulatory data, intra-aortic balloon pump-related death, and complications. RESULTS Ambulation was possible in 217 patients (90.0%) during support. Hemodynamic parameters improved significantly after axillary intra-aortic balloon pump support. In total, 13 patients (5.4%) died and 10 patients (4.1%) required escalation of mechanical support. There were no deaths directly attributable to intra-aortic balloon pumps. Intra-aortic balloon pump-related stroke occurred in 6 patients (2.5%). Overall, 86.7% were successfully bridged to intended therapy (transplantation 90.4%, left ventricular assist device 90.9%, and recovery 58.6%). CONCLUSIONS Axillary intra-aortic balloon pumps allow most patients to ambulate during support, improve hemodynamics, and lead to the intended goals successfully.
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Affiliation(s)
- Hidefumi Nishida
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
| | - Takeyoshi Ota
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - David Onsager
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Jonathan Grinstein
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | | | - Tae Song
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
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Lee OH, Kim Y, Son NH, Roh JW, Im E, Cho DK, Choi D. Comparison of Distal Radial, Proximal Radial, and Femoral Access in Patients with ST-Elevation Myocardial Infarction. J Clin Med 2021; 10:jcm10153438. [PMID: 34362221 PMCID: PMC8348546 DOI: 10.3390/jcm10153438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 12/19/2022] Open
Abstract
Recent studies have indicated that distal radial access (DRA) is feasible in patients undergoing percutaneous coronary intervention (PCI). The present study aimed to compare DRA, proximal radial access (PRA), and femoral access (FA) in patients with ST-elevation myocardial infarction (STEMI) undergoing PCI. Data were analyzed for 109 patients with STEMI treated via primary PCI from March 2020 to May 2021. The success rate of DRA was 83.3% (35/42), including seven cases of failed puncture (puncture failure = 5, severe radial artery spasm = 2). Primary PCI via the DRA was successful in all 35 patients. After classifying the patients requiring crossover into a separate group, the percentage of the puncture time in the door-to-wiring time was 2.7% [2.2–4.3], 3.3% [2.3–4.0], 2.6% [1.2–4.9], and 27.0% [13.5–29.3] in the DRA (n = 35), PRA (n = 24), FA (n = 26), and crossover (n = 9) groups, respectively (p < 0.01). Only two local hematomas (≤5 cm) occurred in the DRA group, while one patient in the FA group required surgical treatment and a transfusion for an access-site vascular injury. When performed by an experienced operator, DRA may represent a feasible alternative to other access routes in select patients with STEMI undergoing PCI, such as those with a high risk of bleeding.
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Affiliation(s)
- Oh-Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
| | - Yongcheol Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
- Correspondence: ; Tel.: +82-13-5189-8567
| | - Nak-Hoon Son
- Data Science Team (Biostatistician), Center for Digital Health, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Korea;
| | - Ji Woong Roh
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
| | - Eui Im
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
| | - Deok-Kyu Cho
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
| | - Donghoon Choi
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
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What is the best road to the heart? Hellenic J Cardiol 2021; 64:87-89. [PMID: 34314876 DOI: 10.1016/j.hjc.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/15/2021] [Indexed: 11/04/2022] Open
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Lee OH, Roh JW, Im E, Cho DK, Jeong MH, Choi D, Kim Y. Feasibility and Safety of the Left Distal Radial Approach in Percutaneous Coronary Intervention for Bifurcation Lesions. J Clin Med 2021; 10:jcm10102204. [PMID: 34069701 PMCID: PMC8161320 DOI: 10.3390/jcm10102204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/03/2021] [Accepted: 05/18/2021] [Indexed: 12/17/2022] Open
Abstract
Recently, the left distal radial approach (DRA) for percutaneous coronary intervention (PCI) has been shown to be a feasible option, but there are limited data regarding the feasibility of performing bifurcation PCI via the left DRA. Therefore, this study aimed to describe our experience with the contemporary left DRA to perform PCI of bifurcation lesions. Between December 2017 and December 2019, we identified 106 patients treated with bifurcation PCI via the left DRA. We evaluated the success rate of PCI, access-site complications including major bleeding requiring surgery or transfusion, hematoma, distal and forearm radial artery occlusion, and 30-day mortality. Eleven patients (10.4%) treated with left main bifurcation and true bifurcations accounted for 39.6% of cases, with the left anterior descending artery/diagonal branch being the most frequent bifurcation site (57.5%, 61/106). PCI was performed using a 6-French guiding catheter in 101 (95.3%) cases. Successful PCI for bifurcation lesions via the left DRA was achieved in all 106 patients without access-site cross-over. There was no major bleeding, distal and forearm radial artery occlusion, forearm hematoma, or mortality at 30 days. The left DRA is a safe and feasible alternative access site for bifurcation PCI in selected patients.
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Affiliation(s)
- Oh-Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
| | - Ji Woong Roh
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
| | - Eui Im
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
| | - Deok-Kyu Cho
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Korea;
| | - Donghoon Choi
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
| | - Yongcheol Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin 16995, Korea; (O.-H.L.); (J.W.R.); (E.I.); (D.-K.C.); (D.C.)
- Correspondence: ; Tel.: +82-13-5189-8567
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Wang HC, Lu W, Gao ZH, Xie YN, Hao J, Liu JM. Application of a rapid exchange extension catheter technique in type B2/C nonocclusive coronary intervention via a transradial approach. World J Clin Cases 2021; 9:2751-2762. [PMID: 33969058 PMCID: PMC8058684 DOI: 10.12998/wjcc.v9.i12.2751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/29/2021] [Accepted: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In transradial intervention procedures, poor back-up support and noncoaxial alignment of the guide catheter (GC) may result in failure of the balloon or stent to reach the targeted lesion. Methods to provide extra back-up support using the original GC and wire can improve procedural success with reduced complications. A rapid exchange guide extension catheter provides convenient and efficient back-up support while preserving the initial GC and inserted wire.
AIM To evaluate the efficacy and safety of rapid exchange extension catheter in the treatment of type B2/C nonocclusive coronary lesions via the radial access.
METHODS A total of 135 patients with type B2/C nonocclusive lesions who were treated via the transradial approach were enrolled in the study. The clinical characteristics, indications for use of the rapid exchange extension catheter, and procedural details and results were reviewed and analyzed. All procedure-related complications and major adverse cardiovascular events were recorded during the in-hospital stay and follow-up period.
RESULTS The most common indication for the use of a rapid exchange extension catheter was vascular tortuosity (37.8%), followed by heavy calcification (28.9%), long lesions (20.0%), proximal stent (6.7%), in-stent restenosis (5.2%), and coronary origin anomalies (1.5%). The following technologies failed in passing targeted lesions before delivering the rapid exchange catheter: Multiple predilatation technique (57%), buddy wire technique (33.4%), balloon anchoring technique (5.9%), and cutting balloon modification (3.7%). The mean depth of the extension catheter intubation was 20.56 ± 13.05 mm, and the mean rapid exchange catheter service time was 18.9 ± 9.7 min. The mean length and diameter of stents were 33.5 ± 14.4 mm and 2.75 ± 0.45 mm, respectively. The total rate of technique success (balloon or stent successful crossing of the target lesion with this technique) was 94.8%.
CONCLUSION The rapid exchange extension catheter technique showed acceptable safety and efficacy in the transradial coronary interventions of type B2/C nonocclusive coronary lesions. We recommend this technique to assist in complex lesion intervention via radial access.
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Affiliation(s)
- Hong-Chao Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Wei Lu
- Department of Cardiology, The Third Hospital of Shijiazhuang City, Shijiazhuang 050000, Hebei Province, China
| | - Zi-Han Gao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Ya-Nan Xie
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Jie Hao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Jin-Ming Liu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
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14
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Di Santo P, Simard T, Wells GA, Jung RG, Ramirez FD, Boland P, Marbach JA, Parlow S, Kyeremanteng K, Coyle D, Fergusson D, Russo JJ, Chong AY, Froeschl M, So DY, Dick A, Glover C, Labinaz M, Hibbert B, Le May M. Transradial Versus Transfemoral Access for Percutaneous Coronary Intervention in ST-Segment-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis. Circ Cardiovasc Interv 2021; 14:e009994. [PMID: 33685220 DOI: 10.1161/circinterventions.120.009994] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,School of Epidemiology and Public Health (P.D.S., D.C., D.F., G.A.W.), University of Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Trevor Simard
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada.,Department of Cellular and Molecular Medicine (T.S., R.G.J., B.H.), University of Ottawa, Canada
| | - George A Wells
- Cardiovascular Research Methods Centre (G.A.W.), University of Ottawa Heart Institute, Ottawa, Canada.,School of Epidemiology and Public Health (P.D.S., D.C., D.F., G.A.W.), University of Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Richard G Jung
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada.,Department of Cellular and Molecular Medicine (T.S., R.G.J., B.H.), University of Ottawa, Canada
| | - F Daniel Ramirez
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, France (F.D.R.).,LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Bordeaux-Pessac, France (F.D.R.)
| | - Paul Boland
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Jeffrey A Marbach
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Simon Parlow
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Kwadwo Kyeremanteng
- Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada.,Division of Critical Care, Department of Medicine (K.K.), University of Ottawa, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health (P.D.S., D.C., D.F., G.A.W.), University of Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Dean Fergusson
- School of Epidemiology and Public Health (P.D.S., D.C., D.F., G.A.W.), University of Ottawa, Canada
| | - Juan J Russo
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Aun-Yeong Chong
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Michael Froeschl
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Derek Y So
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Alexander Dick
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Christopher Glover
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Marino Labinaz
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada.,Department of Cellular and Molecular Medicine (T.S., R.G.J., B.H.), University of Ottawa, Canada
| | - Michel Le May
- CAPITAL Research Group, Division of Cardiology, Department of Medicine (P.D.S., T.S., R.G.J., F.D.R., P.B., J.A.M., S.P., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine (P.D.S., T.S., G.A.W., R.G.J., P.B., J.A.M., S.P., K.K., D.C., J.J.R., A.-Y.C., M.F., D.Y.S., A.D., C.G., M.L., B.H., M.L.M.), University of Ottawa, Canada
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15
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Rashid M, Nagaraja V, Shoaib A, Curzen N, Ludman PF, Kapadia SR, Palmer N, Elgendy IY, Kalra A, Vachharajani TJ, Anderson HV, Kwok CS, Mohamed M, Banning AP, Mamas MA. Outcomes Following Percutaneous Coronary Intervention in Renal Transplant Recipients: A Binational Collaborative Analysis. Mayo Clin Proc 2021; 96:363-376. [PMID: 33358453 DOI: 10.1016/j.mayocp.2020.04.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/21/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate the clinical and procedural characteristics in patients with a history of renal transplant (RT) and compare the outcomes with patients without RT in 2 national cohorts of patients undergoing percutaneous coronary intervention (PCI). PATIENTS AND METHODS Data from the National Inpatient Sample (NIS) and British Cardiovascular Intervention Society (BCIS) were used to compare the clinical and procedural characteristics and outcomes of patients undergoing PCI who had RT with those who did not have RT. The primary outcome of interest was in-hospital mortality. RESULTS Of the PCI procedures performed in 2004-2014 (NIS) and 2007-2014 (BCIS), 12,529 of 6,601,526 (0.2%) and 1521 of 512,356 (0.3%), respectively, were undertaken in patients with a history of RT. Patients with RT were younger and had a higher prevalence of congestive cardiac failure, hypertension, and diabetes but similar use of drug-eluting stents, intracoronary imaging, and pressure wire studies compared with patients who did not have RT. In the adjusted analysis, patients with RT had increased odds of in-hospital mortality (NIS: odds ratio [OR], 1.90; 95% CI, 1.41-2.57; BCIS: OR, 1.60; 95% CI, 1.05-2.46) compared with patients who did not have RT but no difference in vascular or bleeding events. Meta-analysis of the 2 data sets suggested an increase in in-hospital mortality (OR, 1.79; 95% CI, 1.40-2.29) but no difference in vascular (OR, 1.24; 95% CI, 0.77-2.00) or bleeding (OR, 1.21; 95% CI, 0.86-1.68) events. CONCLUSION This large collaborative analysis of 2 national databases revealed that patients with RT undergoing PCI are younger, have more comorbidities, and have increased mortality risk compared with the general population undergoing PCI.
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Affiliation(s)
- Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK, and Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Vinayak Nagaraja
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK, and Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Nick Curzen
- Department of Cardiology, University Hospital Southampton, and University of Southampton, Southampton, UK
| | - Peter F Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Nick Palmer
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Islam Y Elgendy
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Tushar J Vachharajani
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - H Vernon Anderson
- Department of Internal Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, Houston
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK, and Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Mohamed Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK, and Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Adrian P Banning
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK, and Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK; Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA.
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16
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Ferreira-Martins J, Lim PO. Two-Step Distal Radial Artery Cannulation for Challenging Radial Anatomies. Cardiology 2020; 146:144-150. [PMID: 33326980 DOI: 10.1159/000510293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/15/2020] [Indexed: 11/19/2022]
Abstract
The radial artery is the preferred access site for cardiac catheterization because of patient comfort, early ambulation, and improved survival in acute coronary syndromes, when compared to the femoral artery route. However, it is associated with a high radial artery occlusion (RAO) rate, and patent haemostasis which can reduce this is extremely hard to implement in a busy clinical practice. Smaller sized sheaths are associated with less RAO but are uncommonly used as they could limit procedural prowess and complexity. Alternatively, the distal radial artery (dRA) approach appears to be safer with observed RAO rates of well under 1 percent without compromising benefits offered by the radial artery access. Default dRA can be accessed by palpation alone in most cases with some practice, and this can be improved further with ultrasound guidance. There is a subset of patients, especially in the elderly, where dRA access can be particularly challenging. To mitigate this, we propose a two-step cannulation strategy and illustrate this with a few cases with difficult dRA and radial artery anatomies.
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Affiliation(s)
- João Ferreira-Martins
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Pitt O Lim
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom,
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17
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Stroke rate after endovascular aortic interventions in the Society for Vascular Surgery Vascular Quality Initiative. J Vasc Surg 2020; 72:1593-1601. [DOI: 10.1016/j.jvs.2020.02.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/03/2020] [Indexed: 01/10/2023]
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18
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Shoaib A, Rashid M, Kontopantelis E, Sharp A, Fahy EF, Nolan J, Townend J, Ludman P, Ratib K, Azam ZA, Ahmad A, McEntegart M, Mohamed M, Kinnaird T, Mamas MA. Clinical Characteristics and Outcomes From Percutaneous Coronary Intervention of Last Remaining Coronary Artery. Circ Cardiovasc Interv 2020; 13:e009049. [DOI: 10.1161/circinterventions.120.009049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Patients with complex high-risk coronary anatomy, such as those with a last remaining patent vessel (LRPV), are increasingly revascularized with percutaneous coronary intervention (PCI) in contemporary practice. There are limited data on the outcomes of these high-risk procedures.
Methods:
We analyzed a large longitudinal PCI cohort (2007–2014, n=501 841) from the British Cardiovascular Intervention Society database. Clinical, demographic, procedural, and outcome data were analyzed by dividing patients into 2 groups; LRPV group (n=2432) and all other PCI groups (n=506 691).
Results:
Patients in the LRPV PCI group were older, had more comorbidities, and higher prevalence of moderate-severe left ventricular systolic dysfunction. Mortality was higher in the LRPV PCI group during hospital admission (12 % versus 1.5 %,
P
<0.001), at 30 days (15% versus 2%,
P
<0.001), and at one-year (24% versus 5%,
P
<0.001). In a propensity score matching analysis the adjusted risk of mortality during index admission (odds ratio, 2.05 [95% CI, 1.65–2.44],
P
<0.001), at 30 days (odds ratio, 2.13 [95% CI, 1.78–2.5],
P
<0.001), at 1 year (odds ratio, 1.81 [95% CI, 1.59–2.03],
P
<0.001), and in-hospital major adverse cardiovascular events (odds ratio, 1.8 [95% CI, 1.42–2.19],
P
<0.001) were higher in LRPV PCI group as compared to control group. In sensitivity analyses, similar clinical outcomes were observed irrespective of which major epicardial coronary artery was treated.
Conclusions:
In this contemporary cohort, patients who had PCI to their LRPV had a higher-risk profile and more adverse clinical outcomes, irrespective of the vessel treated.
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Affiliation(s)
- Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom (A.S., M.R., E.F.F., J.N., K.R., A.A., M. Mohamed, M.A.M.)
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom (A.S., M.R., E.F.F., J.N., K.R., A.A., M. Mohamed, M.A.M.)
| | - Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Sciences; Faculty of Biology, Medicine and Health; University of Manchester; United Kingdom (E.K.)
| | - Andrew Sharp
- University Hospital of Wales, Cardiff, United Kingdom (A.S., T.K.)
| | - Eoin F. Fahy
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom (A.S., M.R., E.F.F., J.N., K.R., A.A., M. Mohamed, M.A.M.)
| | - James Nolan
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom (A.S., M.R., E.F.F., J.N., K.R., A.A., M. Mohamed, M.A.M.)
| | - John Townend
- Institute of Cardiovascular Sciences, Birmingham University, United Kingdom (J.T., P.L.)
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, United Kingdom (J.T., P.L.)
| | - Karim Ratib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom (A.S., M.R., E.F.F., J.N., K.R., A.A., M. Mohamed, M.A.M.)
| | - Ziyad A. Azam
- School of Medicine, University of Liverpool, United Kingdom (Z.A.A.)
| | - Ayesha Ahmad
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom (A.S., M.R., E.F.F., J.N., K.R., A.A., M. Mohamed, M.A.M.)
| | - Margaret McEntegart
- Golden Jubilee National Hospital, University of Glasgow, United Kingdom (M. McEntegart)
| | - Mohamed Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom (A.S., M.R., E.F.F., J.N., K.R., A.A., M. Mohamed, M.A.M.)
| | - Tim Kinnaird
- University Hospital of Wales, Cardiff, United Kingdom (A.S., T.K.)
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom (A.S., M.R., E.F.F., J.N., K.R., A.A., M. Mohamed, M.A.M.)
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19
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Gilchrist IC, Lall SK. Risk of Stroke during Cardiac Catheterization: A Function of Access Site or Still a Question to Be Answered? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:888-889. [PMID: 32505487 DOI: 10.1016/j.carrev.2020.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ian C Gilchrist
- Penn State University, College of Medicine, Heart & Vascular Institute, 500 University Drive, C1517, MS Hershey Medical Center, Hershey, PA 17033, United States of America.
| | - Sumeet K Lall
- Penn State University, College of Medicine, Heart & Vascular Institute, 500 University Drive, C1517, MS Hershey Medical Center, Hershey, PA 17033, United States of America
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Kataruka A, Dean LS. Uncommon but devastating: Stroke after percutaneous coronary intervention. Catheter Cardiovasc Interv 2020; 95:893-894. [PMID: 32294326 DOI: 10.1002/ccd.28881] [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: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 11/06/2022]
Abstract
Stroke occurs infrequently following percutaneous coronary intervention (PCI) with 30-day and 1-year cumulative incidence of 0.4 and 1.5%, respectively. Patient comorbidities, acute presentations, and complex coronary lesions are more prevalent among patients who sustain a stroke. The occurrence of stroke is associated with higher short-term and overall mortality compared with bleeding or myocardial infarction.
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Affiliation(s)
- Akash Kataruka
- Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Larry S Dean
- Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
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21
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Marchese N, Copetti M, Inchingolo V, Popolizio T, Fontana A, Simeone A, Vigna C. Cerebral Infarcts After Coronary Angiography and Percutaneous Coronary Intervention: A Prospective Propensity-Score-Adjusted Comparison of Right Radial, Left Radial, and Femoral Approaches. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:882-887. [PMID: 31761638 DOI: 10.1016/j.carrev.2019.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/07/2019] [Accepted: 11/11/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND New cerebral infarcts (CIs) detected at magnetic resonance imaging (MRI) are reported after cardiac procedures. Clinical and procedural aspects are implicated as potential causal factors. The aim of this study was to evaluate the incidence of new CIs after coronary angiography and percutaneous coronary intervention according to the arterial access site. METHODS 180 patients undergoing elective coronary angiography were studied with cerebral MRI the day before and the day after the procedure. Unadjusted and propensity score (PS) analyses were performed comparing the occurrence of CIs in right radial (RR), left radial (LR) and transfemoral (TF) access groups. RESULTS New CIs were observed in 14 patients (7.8% of the total sample, one with neurological sequelae). CIs were detected in 15.5% vs 4.9% vs 3.3% of RR, LR and TF groups, respectively (p = .026). In PS adjusted analyses, the RR approach was associated with more CIs compared with the TF approach (odds ratio [OR] estimate from logistic regression adjusted by PS quartiles: 0.158; 95% confidence interval: 0.031 to 0.814; p = .027) and the LR approach (OR: 0.266; 95% confidence interval: 0.066 to 1.080; p = .064). In a secondary analysis, a comparison of RR vs non-RR approach (TF + LR) was performed, showing that post-procedural CIs were more frequent in the RR group (OR: 0.170; 95% confidence interval: 0.050 to 0.574; p = .004). CONCLUSIONS Our study suggests that the RR approach may be associated with a higher rate of new CIs after coronary angiography compared with LR and TF approaches.
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Affiliation(s)
- Nicola Marchese
- Unit of Cardiology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Vincenzo Inchingolo
- Unit of Neurology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Teresa Popolizio
- Unit of Radiology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Annalisa Simeone
- Unit of Neurology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Carlo Vigna
- Unit of Cardiology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
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22
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Shoji S, Kohsaka S, Kumamaru H, Sawano M, Shiraishi Y, Ueda I, Noma S, Suzuki M, Numasawa Y, Hayashida K, Yuasa S, Miyata H, Fukuda K. Stroke After Percutaneous Coronary Intervention in the Era of Transradial Intervention. Circ Cardiovasc Interv 2019; 11:e006761. [PMID: 30545258 DOI: 10.1161/circinterventions.118.006761] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Periprocedural stroke is a rare but life-threatening complication of percutaneous coronary intervention (PCI). Transradial intervention (TRI) is more beneficial than transfemoral intervention for periprocedural bleeding and acute kidney injuries, but its effect on periprocedural stroke has not been fully investigated. Our study aimed to assess risk predictors of periprocedural stroke according to PCI access site. METHODS AND RESULTS Between 2008 and 2016, 17 966 patients undergoing PCI were registered in a prospective multicenter database. Periprocedural stroke was defined as loss of neurological function caused by an ischemic or hemorrhagic event with residual symptoms lasting at least 24 hours after onset. Periprocedural stroke was observed in 42 patients (0.3%). Stroke patients were older and had a higher incidence of chronic kidney disease, peripheral artery disease, and acute coronary syndrome but were less likely to undergo TRI. Multivariable logistic regression analysis revealed TRI (odds ratio; 0.33; 95% CI, 0.16-0.71; P=0.004) was significantly associated with a lower occurrence of periprocedural stroke. Finally, propensity score-matching analysis showed that TRI was associated with a reduced risk of periprocedural stroke compared with transfemoral intervention (0.1% versus 0.4%; P=0.014). According to our sensitivity analysis, this finding was robust to the presence of an unmeasured confounder in almost all plausible scenarios. CONCLUSIONS TRI was associated with a reduced risk of periprocedural stroke compared with transfemoral intervention. Increased TRI use may reduce overall PCI complications and should be recommended as the optimal access site for both urgent/emergent and elective PCIs.
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Affiliation(s)
- Satoshi Shoji
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S.S., S.K., M.S., Y.S., K.H., S.Y., K.F.)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S.S., S.K., M.S., Y.S., K.H., S.Y., K.F.)
| | - Hiraku Kumamaru
- Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Japan (H.K., H.M.)
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S.S., S.K., M.S., Y.S., K.H., S.Y., K.F.)
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S.S., S.K., M.S., Y.S., K.H., S.Y., K.F.)
| | - Ikuko Ueda
- Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan (I.U.)
| | - Shigetaka Noma
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan (S.N.)
| | - Masahiro Suzuki
- Department of Cardiology, National Hospital Organization Saitama National Hospital, Japan (M.S.)
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan (Y.N.)
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S.S., S.K., M.S., Y.S., K.H., S.Y., K.F.)
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S.S., S.K., M.S., Y.S., K.H., S.Y., K.F.)
| | - Hiroaki Miyata
- Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Japan (H.K., H.M.)
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S.S., S.K., M.S., Y.S., K.H., S.Y., K.F.)
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23
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Outcomes Following Percutaneous Coronary Intervention in Saphenous Vein Grafts With and Without Embolic Protection Devices. JACC Cardiovasc Interv 2019; 12:2286-2295. [DOI: 10.1016/j.jcin.2019.08.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 11/19/2022]
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24
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Shoaib A, Kinnaird T, Curzen N, Kontopantelis E, Ludman P, de Belder M, Rashid M, Kwok CS, Nolan J, Zaman A, Mamas MA. Outcomes Following Percutaneous Coronary Intervention in Non-ST-Segment-Elevation Myocardial Infarction Patients With Coronary Artery Bypass Grafts. Circ Cardiovasc Interv 2019; 11:e006824. [PMID: 30571201 DOI: 10.1161/circinterventions.118.006824] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There are limited data on outcomes of patients with previous coronary artery bypass graft (CABG) presenting with non-ST-segment-elevation myocardial infarction undergoing percutaneous coronary intervention (PCI). We compare clinical characteristics and outcomes in non-ST-segment-elevation myocardial infarction patients undergoing PCI with or without prior CABG surgery in a national cohort. Methods and Results We identified 205 039 patients with non-ST-segment-elevation myocardial infarction who underwent PCI between 2007 and 2014 in the British Cardiovascular Intervention Society database. Clinical, demographic, procedural, and outcome data were analyzed by dividing into 3 groups: group 1, PCI in native coronary arteries and no prior CABG (n=186 670); group 2, PCI in native arteries with prior CABG (n=8825); group 3, PCI in grafts (n=9544). Patients in group 2 and 3 were older and had more comorbidities and higher mortality at 30 days (group 2, 2.6% and group 3, 1.9%) and 1 year (group 2, 8.29% and group 3, 7.08%) as compared with group 1 (1.7% and 4.87%). After multivariable analysis, no significant difference in outcomes was observed in 30-days mortality (odds ratio; group 2=0.87 [CI, 0.69-1.80; P=0.20], group 3=0.91 [CI, 0.71-1.17; P=0.46]), in-hospital major adverse cardiovascular event (odds ratio: group 2=1.08 [CI, 0.88-1.34; P=0.45], group 3=0.97 [CI=0.77-1.23; P=0.82]), and in-hospital stroke (odds ratio: group 2=1.37 [CI, 0.71-2.69; P=0.35], group 3=1.13 [CI, 0.55-2.34; P=0.73]; group 1=reference). Conclusions Patients with prior CABG are presenting with non-ST-segment-elevation myocardial infarction and treated with PCI had more comorbid illnesses, but once these differences were adjusted for, prior CABG did not independently confer additional risk of mortality and major adverse cardiovascular event.
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Affiliation(s)
- Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University (A.S., M.R., C.S.K., J.N., M.A.M.)
| | - Tim Kinnaird
- Cardiology Department, University Hospital of Wales, Cardiff, United Kingdom (T.K.)
| | - Nick Curzen
- Faculty of Medicine, University of Southampton, United Kingdom (N.C.)
| | | | - Peter Ludman
- Cardiology Department, Queen Elizabeth Hospital Birmingham, United Kingdom (P.L.)
| | - Mark de Belder
- Cardiology Department, James Cook University Hospital, Middlesbrough, United Kingdom (M.d.B.)
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University (A.S., M.R., C.S.K., J.N., M.A.M.)
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University (A.S., M.R., C.S.K., J.N., M.A.M.)
| | - James Nolan
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University (A.S., M.R., C.S.K., J.N., M.A.M.)
| | - Azfar Zaman
- Academic Cardiology Department, Newcastle University, United Kingdom (A.Z.)
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University (A.S., M.R., C.S.K., J.N., M.A.M.)
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Same-Day Discharge After Elective Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2019; 12:1479-1494. [DOI: 10.1016/j.jcin.2019.03.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 11/17/2022]
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26
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Access Site and Outcomes for Unprotected Left Main Stem Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2018; 11:2480-2491. [DOI: 10.1016/j.jcin.2018.09.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 11/19/2022]
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Abstract
Due to the steady increase in life expectancy, the number of patients over 80 years of age proposed for coronary angioplasty is increasing significantly. The elderly patient is a patient at high cardiovascular risk and high risk of bleeding; whose severity of prognosis depends of comorbidities. The radial approach presents particularities and technical difficulties that have to be known in this part of the population, but reduce vascular and hemorrhagic complications, as well as mortality. Because of greater safety, the radial approach is therefore the first choice for the elderly.
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Affiliation(s)
- A Rougé
- Institut cardiovasculaire, groupe hospitalier mutualiste, 8, rue Dr Calmette, 38000 Grenoble, France.
| | - M Abdellaoui
- Institut cardiovasculaire, groupe hospitalier mutualiste, 8, rue Dr Calmette, 38000 Grenoble, France.
| | - B Faurie
- Institut cardiovasculaire, groupe hospitalier mutualiste, 8, rue Dr Calmette, 38000 Grenoble, France.
| | - J Monségu
- Institut cardiovasculaire, groupe hospitalier mutualiste, 8, rue Dr Calmette, 38000 Grenoble, France.
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28
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Lee JW, Park SW, Son JW, Ahn SG, Lee SH. Real-world experience of the left distal transradial approach for coronary angiography and percutaneous coronary intervention: a prospective observational study (LeDRA). EUROINTERVENTION 2018; 14:e995-e1003. [PMID: 30222122 DOI: 10.4244/eij-d-18-00635] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS This study aimed to evaluate the feasibility and safety of the left distal transradial approach (ldTRA) as a default route for coronary angiography (CAG) and percutaneous coronary intervention (PCI). METHODS AND RESULTS Between October 2017 and January 2018, 200 consecutive patients were enrolled in a single centre. The left distal radial artery was punctured with a 20-gauge venipuncture catheter needle by three expert left radial approach operators. The success rates of arterial puncture, CAG, and PCI were 95.5% (191/200), 100% (187/187), and 98.9% (86/87), respectively. Four patients scheduled for staged PCI skipped the routine diagnostic CAG. Puncture time and fluoroscopic time were 3.0±2.8 minutes and 11.3±18.4 minutes, respectively. Haemostasis time was 151.8±39.9 minutes. A total of 15 (7.9%) puncture site complications occurred, including 14 (7.4%) minor haematomas and one (0.5%) arterial dissection, in which the artery was patent at one-month follow-up. Two patients complained of left thumb numbness at one-month follow-up. No distal radial artery occlusion, perforation, pseudoaneurysm, or arteriovenous fistula occurred. CONCLUSIONS The success and complication rates of ldTRA support the feasibility and safety of this procedure. Larger randomised comparison studies are needed to support this preliminary evidence.
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Affiliation(s)
- Jun-Won Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Who's a-Gonna Hold Your Hard Luck Hand and Who's a-Gonna Be Your Man: Bob Dylan, "Kingsport Town". JACC Cardiovasc Interv 2018; 11:1034-1035. [PMID: 29778725 DOI: 10.1016/j.jcin.2018.01.264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 01/23/2018] [Indexed: 11/22/2022]
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