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Incidence and predictors of radial artery occlusion after transradial coronary catheterization. Egypt Heart J 2019; 71:12. [PMID: 31659526 PMCID: PMC6821412 DOI: 10.1186/s43044-019-0008-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 07/16/2019] [Indexed: 02/07/2023] Open
Abstract
Background Radial artery occlusion (RAO) is considered the most common and devastating complication of transradial approach (TRA). It has been described as the “Achilles’ heel” of the transradial technique. Our aim was to assess the incidence and predictors of radial artery occlusion after transradial coronary catheterization. Results This was a prospective study enrolling 164 patients undergoing percutaneous coronary interventions (PCI) via the transradial approach (TRA) using 6-F catheters. Doppler ultrasonography assessment of the radial artery (RA) was conducted on day 1 and 6 months following the procedure. The studied group included 104 male (63.4%) and 60 female (36.6%) patients with a mean age of 57.7 ± 8.8 years and a mean RA diameter of 2.8 ± 0.5 mm. On day 1, Doppler examination revealed RAO in 54 patients (32.9%). After 6 months, RAO was detected in 49 patients (29.9%). Interestingly, only 1 new case (0.9%) of RAO was noted, and 6 patients (11.1%) had regained their RA patency. On multivariate analysis, female gender, age, manual compression, and RA diameter emerged as independent predictors of RAO. Using TR band for hemostasis for only 2 h was recognized as a potent independent predictor of RA patency on day 1 and 6 months after the procedure (n = 2, 3.7% in the RAO group, vs. n = 23, 20.9% in the non-RAO group, p = 0.004). Conclusion RAO, although clinically a silent issue, has been the main complication following TRA. In patients with high predictors of RAO, careful management and close follow-up are required to ensure radial artery long-term patency.
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Transradial approach for coronary angiography and intervention in the elderly: A meta-analysis of 777,841 patients. Int J Cardiol 2017; 228:45-51. [DOI: 10.1016/j.ijcard.2016.11.207] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/06/2016] [Indexed: 01/11/2023]
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Hernández-Pérez FJ, Blasco-Lobo A, Goicolea L, Muñiz-Lozano A, Fernandez-Díaz JA, Domínguez JR, Goicolea-Ruigómez J. Use of the radial approach in primary angioplasty: results in 1029 consecutive patients and analyses in unfavorable subgroups. ACTA ACUST UNITED AC 2014; 67:45-51. [PMID: 24774263 DOI: 10.1016/j.rec.2013.06.015] [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: 11/30/2012] [Accepted: 06/19/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES The transradial approach is associated with a reduction in vascular access-related complications after primary percutaneous coronary interventions. The purpose of this study was to examine the feasibility of the routine use of transradial access in primary angioplasty and to evaluate how it affects subgroups with less favorable characteristics. METHODS We analyzed 1029 consecutive patients with an ST-segment elevation acute coronary syndrome treated with primary angioplasty. RESULTS Transradial access was the primary approach in 93.1% of the patients. The success rate of primary angioplasty was 95.9%, and 87.6% of the patients were event-free 30 days after the procedure. Crossover was required in 3.0% of the patients with primary transradial access, and this rate remained stable over the years. Predictors of the need for crossover were age older than 75 years (odds ratio=2.50, 95% confidence interval, 1.09-5.71; P=.03) and a history of ischemic heart disease (odds ratio=2.65; 95% confidence interval, 1.12-6.24; P=.02). Primary transfemoral access use was higher in women older than 75 years. Use of the transradial approach in this subgroup did not affect reperfusion time or the success of angioplasty, although there was a greater need for crossover (10.9% vs 2.6%; P=.006). Among patients in cardiogenic shock, the transradial approach was used in 51.5%; reperfusion times and angioplasty success rates were similar to those obtained with transfemoral access, but there was a greater need for crossover. CONCLUSIONS Transradial access can be used safely and effectively in most primary angioplasty procedures. In older women and in patients in cardiogenic shock, there is a higher crossover requirement, with no detriment to reperfusion time.
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Affiliation(s)
- Francisco J Hernández-Pérez
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Ana Blasco-Lobo
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Leire Goicolea
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Ana Muñiz-Lozano
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - José A Fernandez-Díaz
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - José R Domínguez
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Javier Goicolea-Ruigómez
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Hernández-Pérez FJ, Blasco-Lobo A, Goicolea L, Muñiz-Lozano A, Fernandez-Díaz JA, Domínguez JR, Goicolea-Ruigómez J. El uso del acceso radial en la angioplastia primaria: resultados en 1.029 pacientes consecutivos y análisis en subgrupos desfavorables. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rao SV, Tremmel JA, Gilchrist IC, Shah PB, Gulati R, Shroff AR, Crisco V, Woody W, Zoghbi G, Duffy PL, Sanghvi K, Krucoff MW, Pyne CT, Skelding KA, Patel T, Pancholy SB. Best practices for transradial angiography and intervention: a consensus statement from the society for cardiovascular angiography and intervention's transradial working group. Catheter Cardiovasc Interv 2013; 83:228-36. [PMID: 24123781 DOI: 10.1002/ccd.25209] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 09/12/2013] [Indexed: 01/22/2023]
Affiliation(s)
- Sunil V Rao
- Duke University Medical Center, Durham, North Carolina
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Romagnoli E, Mann T, Sciahbasi A, Pendenza G, Biondi-Zoccai GGL, Sangiorgi GM. Transradial approach in the catheterization laboratory: Pros/cons and suggestions for successful implementation. Int J Cardiol 2013; 163:116-24. [PMID: 22137451 DOI: 10.1016/j.ijcard.2011.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 09/07/2011] [Accepted: 11/01/2011] [Indexed: 02/05/2023]
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Tuncez A, Kaya Z, Aras D, Yıldız A, Gül EE, Tekinalp M, Karakaş MF, Kısacık HL. Incidence and predictors of radial artery occlusion associated transradial catheterization. Int J Med Sci 2013; 10:1715-9. [PMID: 24151442 PMCID: PMC3804796 DOI: 10.7150/ijms.7087] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 08/21/2013] [Indexed: 11/16/2022] Open
Abstract
In this study, we sought to assess the incidence and predictors of radial artery occlusion (RAO), which is a significant complication of transradial cardiac catheterization. We prospectively evaluated the results of 106 patients who underwent coronary angiography and percutaneous coronary intervention (PCI) via the transradial approach (TRA). At the 3(rd) h of intervention, the radial artery was checked by palpation; color doppler ultrasonography was performed at the 24(th) h. Fluoroscopy duration, procedure success, and complications of the radial artery were recorded. The procedure was successfully completed in all patients. RAO was detected in eight female and two male patients. In terms of RAO, there was a statistically significant difference between males and females (p=0.019). Other parameters did not show a significant correlation with RAO. Altough did not have any effect on procedural success, eight patients developed transient radial artery spasm. Gender was not associated with radial arterial spasms (p=0.19). TRA in the diagnosis and treatment of coronary artery disease has shown high procedural success and low complication rates; it addition, it presents a low economic burden. It should be used widely and be involved in the routine cardiology residency program.
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Affiliation(s)
- Abdullah Tuncez
- 1. Division of Cardiology, Konya Numune State Hospital, Konya
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Jang JS, Jin HY, Seo JS, Yang TH, Kim DK, Kim DK, Kim DI, Cho KI, Kim BH, Park YH, Je HG, Kim DS. The transradial versus the transfemoral approach for primary percutaneous coronary intervention in patients with acute myocardial infarction: a systematic review and meta-analysis. EUROINTERVENTION 2012; 8:501-10. [PMID: 22581470 DOI: 10.4244/eijv8i4a78] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jae-Sik Jang
- Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea.
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Bertrand OF, Bélisle P, Joyal D, Costerousse O, Rao SV, Jolly SS, Meerkin D, Joseph L. Comparison of transradial and femoral approaches for percutaneous coronary interventions: a systematic review and hierarchical Bayesian meta-analysis. Am Heart J 2012; 163:632-48. [PMID: 22520530 DOI: 10.1016/j.ahj.2012.01.015] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 01/18/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite lower risks of access site-related complications with transradial approach (TRA), its clinical benefit for percutaneous coronary intervention (PCI) is uncertain. We conducted a systematic review and meta-analysis of clinical studies comparing TRA and transfemoral approach (TFA) for PCI. METHODS Randomized trials and observational studies (1993-2011) comparing TRA with TFA for PCI with reports of ischemic and bleeding outcomes were included. Crude and adjusted (for age and sex) odds ratios (OR) were estimated by a hierarchical Bayesian random-effects model with prespecified stratification for observational and randomized designs. The primary outcomes were rates of death, combined incidence of death or myocardial infarction, bleeding, and transfusions, early (≤ 30 days) and late after PCI. RESULTS We collected data from 76 studies (15 randomized, 61 observational) involving a total of 761,919 patients. Compared with TFA, TRA was associated with a 78% reduction in bleeding (OR 0.22, 95% credible interval [CrI] 0.16-0.29) and 80% in transfusions (OR 0.20, 95% CrI 0.11-0.32). These findings were consistent in both randomized and observational studies. Early after PCI, there was a 44% reduction of mortality with TRA (OR 0.56, 95% CrI 0.45-0.67), although the effect was mainly due to observational studies (OR 0.52, 95% CrI 0.40-0.63, adjusted OR 0.49 [95% CrI 0.37-0.60]), with an OR of 0.80 (95% CrI 0.49-1.23) in randomized trials. CONCLUSION Our results combining observational and randomized studies show that PCI performed by TRA is associated with substantially less risks of bleeding and transfusions compared with TFA. Benefit on the incidence of death or combined death or myocardial infarction is found in observational studies but remains inconclusive in randomized trials.
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Cohen A, Bertrand OF, Meerkin D. Transradial angioplasty for ST-elevation myocardial infarction. Interv Cardiol 2011. [DOI: 10.2217/ica.11.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Pujara K, Wood A, Roberts EB. Management of radial artery perforation during coronary angiography and angioplasty-A report of two cases. Catheter Cardiovasc Interv 2011; 78:54-7. [DOI: 10.1002/ccd.22866] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Revised: 10/02/2010] [Accepted: 10/05/2010] [Indexed: 11/08/2022]
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Cooper L, Banerjee S, Brilakis ES. Crossover from radial to femoral access during a challenging percutaneous coronary intervention can make the difference between success and failure. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2010; 11:266.e5-8. [DOI: 10.1016/j.carrev.2010.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 04/16/2010] [Accepted: 04/22/2010] [Indexed: 10/19/2022]
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Franchi E, Marino P, Biondi-Zoccai GG, De Luca G, Vassanelli C, Agostoni P. Transradial versus transfemoral approach for percutaneous coronary procedures. Curr Cardiol Rep 2010; 11:391-7. [PMID: 19709500 DOI: 10.1007/s11886-009-0054-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Selective coronary angiography was originally performed through open brachial arteriotomy. Thereafter, the percutaneous Seldinger technique and the use of preformed Judkins-type catheters popularized the femoral approach. More recently, after the first report of successful coronary angiography by the transradial approach in 1989, the radial artery has been increasingly used as an alternative access site. The main advantage offered by the transradial approach is represented by the very low (< 1%) incidence of relevant vascular access site complications, which on the contrary occur in about 3% to 7% of patients undergoing procedures through the femoral route. The main disadvantage is a higher incidence of procedural failure that leads to a crossover to the femoral route. In this review, we examine the available evidence on transradial and transfemoral approach advantages, disadvantages, and complications in coronary angiography and intervention. Their use in the acute myocardial infarction setting and other situations is described. Vascular closure device usefulness is also considered.
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Affiliation(s)
- Elena Franchi
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Arzamendi D, Ly HQ, Tanguay JF, Chan MYY, Chevallereau P, Gallo R, Ibrahim R, L'Allier P, Levesque S, Gosselin G, DeGuise P, Joyal M, Gregoire J, Bonan R, Crepeau J, Doucet S. Effect on bleeding, time to revascularization, and one-year clinical outcomes of the radial approach during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. Am J Cardiol 2010; 106:148-54. [PMID: 20598995 DOI: 10.1016/j.amjcard.2010.02.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 02/21/2010] [Accepted: 02/21/2010] [Indexed: 11/26/2022]
Abstract
The radial approach during percutaneous coronary intervention (PCI) has been reported to reduce the incidence of bleeding complications. However, the radial approach still accounts for <10% of procedures worldwide and only 1% in the United States. Our objective was to compare the effect of radial versus femoral vascular access on the time to reperfusion, incidence of bleeding complications, and overall clinical outcomes in the setting of primary PCI. We prospectively collected data on all patients undergoing primary PCI at the Montreal Heart Institute from April 1, 2007 to March 30, 2008. The time to revascularization and major bleeding were prespecified as a co-primary end point, and major adverse cardiac events, including death, myocardial infarction, and target vessel revascularization within 12 months, were considered a secondary end point. A total of 489 patients were included in the present longitudinal cohort study, 234 in the femoral group and 254 in the radial group. In the propensity-adjusted model, the use of the femoral approach was a strong independent predictor of bleeding (odds ratio 4.22, 95% confidence interval 3.17 to 10.60). No significant difference between the radial and femoral groups was observed relative to the time to revascularization (21.4 +/- 11.8 minutes vs 22.8 +/- 10.3 minutes, respectively; p = 0.68). Moreover, the radial approach was associated with a decreased risk of major adverse cardiac events (odds ratio 0.31, 95% confidence interval 0.10 to 0.94). In conclusion, primary PCI using the radial approach was associated with a fourfold reduction in major bleeding, without compromising the time to revascularization. Moreover, the radial approach was associated with a significant reduction in major adverse cardiac events at 12 months.
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Koutouzis M, Matejka G, Olivecrona G, Grip L, Albertsson P. Radial vs. femoral approach for primary percutaneous coronary intervention in octogenarians. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2010; 11:79-83. [DOI: 10.1016/j.carrev.2009.04.107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 04/10/2009] [Accepted: 04/13/2009] [Indexed: 10/19/2022]
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Gan L, Lib Q, Liuc R, Zhaoc Y, Qiuc J, Liao Y. Effectiveness and feasibility of transradial approaches for primary percutaneous coronary intervention in patients with acute myocardial infarction. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1007-4376(09)60068-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Filippatos G, Heras M. Acute Cardiac Care: subspecialty accreditation ante Portas. ACUTE CARDIAC CARE 2007; 9:67-8. [PMID: 17573578 DOI: 10.1080/17482940701474254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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