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Al-Azizi K, Moubarak G, Dib C, Sayfo S, Szerlip M, Thomas S, Hale S, Zyl JV, Settele RM, Gonzalez OR, Ventura SJ, DiMaio JM, Mack MJ, Potluri S. Distal Versus Proximal Radial Artery Access for Cardiac Catheterization: 1-Year Outcomes. Am J Cardiol 2024; 220:102-110. [PMID: 38432334 DOI: 10.1016/j.amjcard.2024.02.036] [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: 12/24/2023] [Revised: 02/02/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
Proximal radial artery (PRA) access for cardiac catheterization is safe but can jeopardize subsequent use of the artery because of occlusion. Distal radial artery (DRA) access in the anatomical snuffbox preserves the RA but safety and potential detrimental effects on hand function are unknown. We aimed to assess hand function and complications after DRA and PRA. In this single-center trial, 300 patients were randomly allocated 1:1 to cardiac catheterization through DRA or PRA. The primary end point of change in hand function from baseline to 1 year was a composite of the Quick Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, hand grip test, and thumb-forefinger pinch test. The secondary end points included access feasibility and complications. Of 216 patients with 1-year completed follow-up, 112 were randomly allocated to DRA and 104 to PRA, with balanced demographics and procedural characteristics. Both groups had similar access site bleeding rates (DRA 0% vs PRA 1.4%, p = 0.25). Radial artery occlusion occurred in 1 PRA patient versus 2 in DRA. There was no significant difference in change of hand function, median (interquartile range) hand grip (DRA 0.7 [-3 to 4.5] vs PRA 1.3 [-2 to 4.3] kg, p = 0.57), pinch grip (DRA -0.1 [-1.1 to 1] vs PRA -0.3 [-1 to 0.7] kg, p = 0.66), and Quick DASH (DRA 0 [-6.6 to 2.3] vs PRA 0 [-4.6 to 2.9] points, p = 0.58). The composite of hand function was comparable between PRA and DRA. In conclusion, DRA is a safe strategy for cardiac catheterization, with a low complication rate. Compared with PRA, there is no increased risk of hand dysfunction or radial artery occlusion at 1 year.
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Affiliation(s)
- Karim Al-Azizi
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas.
| | | | - Chadi Dib
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Sameh Sayfo
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Molly Szerlip
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas; Baylor Scott and White Research Institute, Plano, Texas
| | - Sibi Thomas
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Sarah Hale
- Baylor Scott and White Research Institute, Plano, Texas
| | | | | | | | | | - J Michael DiMaio
- Baylor Scott and White Research Institute, Plano, Texas; Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Michael J Mack
- Baylor Scott and White Research Institute, Plano, Texas; Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Srinivasa Potluri
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas
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Schmolling ÁH, Pérez-García C, Trejo C, López-Frías A, Jaroenngarmsamer T, Rosati S, Arrazola J, Moreu M. Middle Meningeal Artery Embolization for Management of Chronic Subdural Hematoma. Radiographics 2024; 44:e230158. [PMID: 38451847 DOI: 10.1148/rg.230158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Chronic subdural hematoma (CSDH) is a prevalent medical condition with potentially severe consequences if left untreated. While surgical removal has traditionally been the standard approach for treatment, middle meningeal artery (MMA) embolization has emerged as a promising minimally invasive alternative to reduce recurrences. This comprehensive review provides the general radiology community with an overview of MMA embolization as a therapeutic option for managing CSDH. The authors base their insights on existing evidence and their institutional experience. This overview encompasses the pathophysiology of CSDH as well as the potential advantages and limitations, safety profile, and potential complications of MMA embolization as compared with surgical treatment. The imaging findings seen before and after MMA, as well as insights into the procedural techniques used at the authors' institution, are described. On the basis of reports in the current literature, MMA embolization appears to be a safe and effective therapeutic option for managing CSDH, especially in patients who are unsuitable for surgery or at risk for recurrence. Nonetheless, further research is needed to validate these findings. Results from ongoing clinical trials hold promise for future validation and the establishment of scientific evidence. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Chatterjee in this issue.
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Affiliation(s)
- Ángela H Schmolling
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Carlos Pérez-García
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Carmen Trejo
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Alfonso López-Frías
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Tanaporn Jaroenngarmsamer
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Santiago Rosati
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Juan Arrazola
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Manuel Moreu
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
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Toledano BRF, Garganera KB, Prado JPA, Sabas ML. Routine preprocedural ultrasound in palpation versus ultrasound guided radial access for cardiac catheterization. Catheter Cardiovasc Interv 2024; 103:722-730. [PMID: 38469945 DOI: 10.1002/ccd.31005] [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: 11/03/2023] [Revised: 01/19/2024] [Accepted: 02/26/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND The radial first approach in cardiac catheterization is preferred for its benefits in patient comfort and recovery time. Yet, challenges persist due to characteristics like small, deep, calcified, and mobile radial arteries. Utilizing ultrasound before and during procedures can improve success rates. However, the adoption of its use is still limited and subject to debate. AIM To utilize routine preprocedural ultrasound (US) and compare US guided with palpation guided radial access, focusing on operator efficiency and outcomes. METHODS AND RESULTS Consenting adult patients undergoing elective radial cardiac catheterization were divided into palpation and US groups. Routine preprocedural assessment of radial artery characteristics was performed using handheld US. Baseline data, US findings, procedural outcomes, and clinical outcomes were compared in 182 participants (91 in each group). US guided radial access had significantly higher first pass success rates (76.92% vs. 49.45%, p 0.0001), fewer number of attempts (1.46 ± 1 vs. 1.99 ± 1.46, p 0.004), and shorter amount of time (93.62 ± 44.04 vs. 120.44 ± 67.1, p 0.002) compared with palpation guidance. The palpation group had significantly higher incidence of spasm (15.38% vs. 3.3%, p 0.0052). Subgroup analysis indicated consistent benefits of US guidance, especially in calcified radial arteries. CONCLUSION This prospective, nonrandomized, single-center study demonstrated that real-time procedural US improved the operator's time and effort and enhanced patient comfort compared with palpation. US guidance use was particularly favorable in the presence of calcifications observed on baseline preoperative US.
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Affiliation(s)
- Bryan Rene F Toledano
- Cardiac Catheterization Department, Cardiovascular Institute, The Medical City Hospital, Pasig City, Philippines
| | - Kristy B Garganera
- Cardiac Catheterization Department, Cardiovascular Institute, The Medical City Hospital, Pasig City, Philippines
| | - Jose Paolo A Prado
- Cardiac Catheterization Department, Cardiovascular Institute, The Medical City Hospital, Pasig City, Philippines
| | - Michelangelo L Sabas
- Cardiac Catheterization Department, Cardiovascular Institute, The Medical City Hospital, Pasig City, Philippines
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Jiang X, Wang P, Liu F, Wu H, Jiang P, Yuan R, Zhang S, Shi Z. TRUST Technique for Neurointervention: A Promising Alternative for Complex Cases. Curr Neurovasc Res 2024; 21:47-53. [PMID: 38310556 DOI: 10.2174/0115672026291503240105093155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/01/1970] [Accepted: 12/27/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Neurointervention via Transradial Access (TRA) is becoming increasingly popular as experience with this technique increases. However, approximately 8.6-10.3% of complex TRA cases are converted to femoral access due to a lack of support or radial artery spasm. This study aimed to assess the efficacy and safety of the TRUST (trans-radial coaxial catheter technique using a short sheath, Simmons catheter, and Tethys intermediate catheter) technique in interventional procedures via TRA. METHODS This was a single-center retrospective analysis of 16 patients admitted to our institute between January 2023 to May 2023 to undergo endovascular interventions with the TRUST technique via the TRA. RESULTS The mean age of the study population was 63.8 years, and 62.5% were male (10/16). The most common procedure was intracranial atherosclerotic stenosis (93.75%, 15/16). All procedures were performed successfully, and the most common procedures in our cohort were ballooning (50.0%, 8/16), stenting (18.75%, 3/16), and both procedures combined (31.25%, 1/16). All procedures were performed using the TRA, and the distal and proximal radial arteries were used for access in 31.35% (5/16) and 68.75% (11/16) of the cases, respectively. Technical success was achieved in all patients and most cases demonstrated mTICI ≥2b recanalization (93.75%, 15/16). In this case, no major access-site complications occurred. CONCLUSION The TRUST technique is technically safe and feasible and had a high technical success rate and low complication rate in our study. These results demonstrate that the TRUST technique is a promising alternative for patients undergoing complex neurointerventions.
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Affiliation(s)
- Xinzhao Jiang
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China
| | - Peng Wang
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China
| | - Fang Liu
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China
| | - Huadong Wu
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China
| | - Peng Jiang
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China
| | - Ruozhen Yuan
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China
| | - Sheng Zhang
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China
| | - Zongjie Shi
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China
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Chyrchel M, Bartuś S, Piechocki M, Glądys K, Januszek R, Surdacki A, Rzeszutko Ł. Is single-catheter technique for coronary angiography an optimal tool for beginners in interventional cardiology?-randomized controlled study TRACT 2: Transradial Coronary Angiography Trial 2. Cardiovasc Diagn Ther 2023; 13:1019-1029. [PMID: 38162109 PMCID: PMC10753231 DOI: 10.21037/cdt-23-212] [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: 05/14/2023] [Accepted: 09/22/2023] [Indexed: 01/03/2024]
Abstract
Background Transradial coronary angiography can be performed using a dual-catheter technique (DCT) or single-catheter technique (SCT). The current study aimed to compare DxTerity SCT Ultra and the Trapease curve SCT catheters with DCT catheters in procedures performed by young, less experienced, interventional cardiologists. Methods For this prospective, single-blinded, randomized study 107 were enrolled and assigned to 1 of 3 groups. They underwent planned coronary angiography at the Second Department of Cardiology Jagiellonian University in Kraków. In groups 1 (n=37) and 2 (n=35), DxTerity SCT Ultra catheters and the Trapease curve were used, respectively. In control group 3 (n=35), standard DCT Judkins catheters were applied. One patient was excluded from group 2, bringing the total number of cases analysed to 106. The study endpoints comprised the percentage of optimal stability, proper ostial artery engagement, a good quality angiogram, the duration of each procedure stage, the amount of contrast and the radiation dose. Results The highest percentage of optimal stability was observed in group 1 for the right coronary artery (RCA): 94%, and in group 3, for the left coronary artery (LCA): 85%. The necessity to change the catheter was most common in group 2. Group 1 was characterised by a shorter total procedural time. The contrast volume was higher in group 2, while there were no differences in radiation dose. Conclusions SCT is at least as adequate as DCT for young cardiologists. SCT was associated with lower necessity of catheter exchange during RCA visualization. The DxTerity Ultra curve catheter allows shortening the total procedure time.
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Affiliation(s)
- Michał Chyrchel
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Second Department of Cardiology, Faculty of Medicine, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Second Department of Cardiology, Faculty of Medicine, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Piechocki
- Students’ Scientific Group, Second Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Kinga Glądys
- Students’ Scientific Group, Second Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Rafał Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Cracow University, Kraków, Poland
| | - Andrzej Surdacki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Second Department of Cardiology, Faculty of Medicine, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Łukasz Rzeszutko
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Second Department of Cardiology, Faculty of Medicine, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
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Koziński Ł, Orzałkiewicz Z, Dąbrowska-Kugacka A. Feasibility and Safety of the Routine Distal Transradial Approach in the Anatomical Snuffbox for Coronary Procedures: The ANTARES Randomized Trial. J Clin Med 2023; 12:7608. [PMID: 38137677 PMCID: PMC10743677 DOI: 10.3390/jcm12247608] [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: 08/27/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
The distal transradial approach (dTRA) through the anatomical snuffbox is hypothesized to offer greater benefits than the conventional transradial access (cTRA) for patients undergoing coronary procedures. Our goal was to assess the safety and efficacy of dTRA. Out of 465 consecutive Caucasian patients, 400 were randomized (1:1) to dTRA or cTRA in a prospective single-center trial. Clinical and ultrasound follow-ups were obtained at 24 h and 60 days post-procedure. The primary combined endpoint consisted of access crossover, access-related complications, and major adverse cardiovascular events (MACE). Secondary endpoints included clinical success endpoints (puncture success, crossover, and access time), access-site complications endpoints, and MACE at 60 days. The primary endpoint was significantly higher in the dTRA [odds ratio (OR): 2.31, 95% confidence interval (CI): 1.38-3.86, p = 0.001]. Clinical success endpoints, namely crossover (10% vs. 3.5%, p < 0.05) and access-time [median: 140s (85-322) vs. 80s (58-127), p < 0.001], did not favor the dTRA, despite a similar success rate in radial artery puncture between the dTRA and cTRA (99.5% vs. 99%). Radial artery spasm (19% vs. 4.5%, p < 0.0001), physical discomfort during access, and transient thumb numbness after the procedure occurred more frequently with the dTRA. However, early (2.5% vs. 4.5%, p = 0.41) and mid-term (2.5% vs. 3%, p = 0.98) forearm radial artery occlusion rates were comparable between the dTRA and cTRA. Randomization to the dTRA, lower forearm radial pulse volume, higher body mass index, and lower body surface area independently predicted the primary endpoint in multivariate analysis. In the interaction effect analysis, only diabetes increased the incidence of the primary endpoint with the dTRA (OR: 18.67, 95% CI: 3.96-88.07). The dTRA was a less favorable strategy than cTRA during routine coronary procedures due to a higher incidence of arterial spasm and the necessity for access crossover. The majority of local complications following the dTRA were clinically minor complications. Individuals with diabetes were particularly susceptible to complications associated with the dTRA.
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Affiliation(s)
- Łukasz Koziński
- Department of Cardiology, Chojnice Specialist Hospital, Lesna 10, 89-600 Chojnice, Poland
| | - Zbigniew Orzałkiewicz
- Department of Cardiology, Chojnice Specialist Hospital, Lesna 10, 89-600 Chojnice, Poland
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland
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Al‐Azizi K, Moubarak G, Dib C, Sayfo S, Szerlip M, Thomas S, McCracken J, Smith A, Kelavkar U, Hale S, Van Zyl J, McCoy SL, Lanfear AT, Banwait JK, Ravindranathan P, Chionh K, DiMaio JM, Mack MJ, Potluri S. Distal Versus Proximal Radial Artery Access for Cardiac Catheterization: 30-Day Outcomes of the DIPRA Study. J Am Heart Assoc 2023; 12:e030774. [PMID: 37889176 PMCID: PMC10727396 DOI: 10.1161/jaha.123.030774] [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: 05/05/2023] [Accepted: 08/31/2023] [Indexed: 10/28/2023]
Abstract
Background Proximal radial artery (pRA) access for cardiac catheterization is safe but can jeopardize subsequent use of the artery because of occlusion. Distal radial artery (dRA) access in the anatomical snuffbox preserves the radial artery, but safety and potential detrimental effects on hand function are unknown. Methods and Results In the DIPRA (Distal Versus Proximal Radial Artery Access for Cardiac Catheterization and Intervention) study, a single-center trial, 300 patients were randomized 1:1 to cardiac catheterization through dRA or pRA. The primary end point of change in hand function from baseline to 30 days was a composite of the QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand) questionnaire, hand-grip test, and thumb forefinger pinch test. Secondary end points included access feasibility and complications; 254 of 300 patients completed follow-up at 30 days; of these, 128 were randomized to dRA and 126 to pRA with balanced demographic and procedural characteristics. Both groups had similar rates of access site bleeding (dRA 0% versus pRA 1.4%; P=0.25). Six patients with dRA failed access compared with 2 patients with pRA. Radial artery occlusion occurred in 2 pRA versus none in dRA. There were no significant differences in change in hand function, median hand-grip (dRA 0 [-3.2, 3.3] versus pRA 0.7 [-2.3, 3.3] kg; P=0.21), pinch-grip (dRA -0.3 [-1.2, 0.5] versus pRA 0 [-0.9, 0.9] kg; P=0.09), and QuickDASH (dRA 0 [-4.6, 2.3] versus pRA 0 [-4.6, 2.3] points, P=0.96). There was no significant difference in the composite of hand function between pRA and dRA. Conclusions dRA is a safe strategy for cardiac catheterization with a low complication rate. Compared with pRA, there is no increased risk of hand dysfunction at 30 days. Registration URL: https://www.ClinicalTrials.gov. Unique identifier: NCT04318990.
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Affiliation(s)
- Karim Al‐Azizi
- Department of CardiologyBaylor Scott and White The Heart HospitalPlanoTX
| | | | - Chadi Dib
- Department of CardiologyBaylor Scott and White The Heart HospitalPlanoTX
| | - Sameh Sayfo
- Department of CardiologyBaylor Scott and White The Heart HospitalPlanoTX
| | - Molly Szerlip
- Department of CardiologyBaylor Scott and White The Heart HospitalPlanoTX
| | - Sibi Thomas
- Department of CardiologyBaylor Scott and White The Heart HospitalPlanoTX
| | | | - Adam Smith
- Baylor Scott and White Research InstitutePlanoTX
| | - Uma Kelavkar
- Baylor Scott and White Research InstitutePlanoTX
| | - Sarah Hale
- Baylor Scott and White Research InstitutePlanoTX
| | | | | | | | | | | | | | - J. Michael DiMaio
- Baylor Scott and White Research InstitutePlanoTX
- Department of Cardiothoracic SurgeryBaylor Scott and White The Heart HospitalPlanoTX
| | - Michael J. Mack
- Baylor Scott and White Research InstitutePlanoTX
- Department of Cardiothoracic SurgeryBaylor Scott and White The Heart HospitalPlanoTX
| | - Srinivasa Potluri
- Department of CardiologyBaylor Scott and White The Heart HospitalPlanoTX
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Yakupoğlu A, Buturak ÖSU. Transradial Access for Transarterial Radioembolization (TARE) in Patients with Hepatocellular Carcinoma: Comparison with Transfemoral Access. Cardiovasc Intervent Radiol 2023; 46:1359-1364. [PMID: 37723353 DOI: 10.1007/s00270-023-03542-7] [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: 03/31/2023] [Accepted: 08/16/2023] [Indexed: 09/20/2023]
Abstract
PURPOSE To compare safety, efficacy, radiation exposure and patients comfort in patients of transradial access (TRA) in patients undergoing TARE compared with transfemoral access (TFA) including patient radiation exposure and patient comfort. METHODS A total of 222 patients undergoing technetium-99 m macro-aggregated albumin and TARE were retrospectively reviewed from 2017 to 2022. We analyzed procedure-related pain, quality of life, recovery time, procedure time, fluoroscopy time (FT), air kerma product and air kerma (AK) to compare the two access for intervention for HCC. RESULTS A total of 222 [(TFA (n = 147) and TRA (n = 75)] patients who underwent TARE for hepatocellular carcinoma (HCC) were included. No significant difference was found regarding FT and DAP in comparison of TRA and TFA. (p = 0.385, p = 0.842). While the mean AK was 892.7 mGy in TFA patients, it was 545.2 mGy in TRA patients and there was statistically significant difference (p = 0.017). Patients who underwent TRA had significantly shorter hospital stays, and recovery times compared to those who underwent TFA (p = 0.001, p = 0.001). In terms of both mental health and physical function, TRA versus TFA has been observed to produce more favorable outcomes (p = 0.044, p = 0.032). CONCLUSION TRA access for TARE procedures significantly enhances patient comfort and satisfaction. The total radiation dose exposed to the patients who underwent TRA access was found to be significantly lower than the patients who underwent TFA access.
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Affiliation(s)
- Abdullah Yakupoğlu
- Department of Interventional Radiology, Memorial Şişli Hospital, Istanbul, Turkey.
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Fuga M, Tanaka T, Tachi R, Tomoto K, Wachi R, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. Predicting difficult transradial approach guiding into left internal carotid artery on unruptured intracranial aneurysms. Surg Neurol Int 2023; 14:233. [PMID: 37560592 PMCID: PMC10408647 DOI: 10.25259/sni_355_2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/21/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The transradial approach (TRA) is less invasive than the transfemoral approach (TFA), but the higher conversion rate represents a drawback. Among target vessels, the left internal carotid artery (ICA) is particularly difficult to deliver the guiding catheter to through TRA. The purpose of this study was thus to explore anatomical and clinical features objectively predictive of the difficulty of delivering a guiding catheter into the left ICA via TRA. METHODS Among 78 consecutive patients who underwent coil embolization for unruptured intracranial aneurysms through TRA in a single institution between March 1, 2021, and August 31, 2022, all 29 patients (37%) who underwent delivery of the guiding catheter into the left ICA were retrospectively analyzed. Clinical and anatomical features were analyzed to assess correlations with difficulty in guiding the catheter into the left ICA. RESULTS Of the 29 aneurysms requiring guidance of a catheter into the left ICA, 9 aneurysms (31%) required conversion from TRA to TFA. More acute innominate-left common carotid artery (CCA) angle (P < 0.001) and older age (P = 0.015) were associated with a higher conversion rate to TFA. Receiver operating characteristic analysis revealed that optimal cutoff values for the innominate-left CCA angle and age to distinguish between nonconversion and conversion to TFA were 16° (area under the curve [AUC], 0.93; 95% confidence interval [CI], 0.83-1.00) and 74 years (AUC, 0.79; 95% CI, 0.61-0.96), respectively. CONCLUSION A more acute innominate-left CCA angle and older age appear associated with difficulty delivering the guiding catheter into the left ICA for neurointervention through TRA.
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Affiliation(s)
- Michiyasu Fuga
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Toshihide Tanaka
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Rintaro Tachi
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Kyoichi Tomoto
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Ryoto Wachi
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Akihiko Teshigawara
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Yuzuru Hasegawa
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
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10
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Radial arterial access is a safe alternative to brachial artery and femoral artery access for endovascular lower extremity peripheral arterial disease. J Vasc Surg 2023; 77:870-876. [PMID: 36328139 DOI: 10.1016/j.jvs.2022.10.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 09/14/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Radial artery access is a well-described technique that has proven to be safe and efficacious in percutaneous cardiac intervention. This technique has been used with increased frequency in the treatment of lower extremity peripheral arterial disease (LE-PAD); however, the overall safety has not yet been well described in the vascular surgery literature. We sought to evaluate the safety of this technique compared with retrograde femoral artery access and brachial artery access (BA) in the treatment of PAD. METHODS The Vascular Quality Initiative database was used to identify all patients who underwent single site percutaneous access (retrograde femoral access [FA], BA, radial access [RA]) for treatment of LE-PAD from September 2016 through September 2019. Patients who underwent multiple access sites for intervention were excluded. Primary outcome was significant access site complications (ASCs), defined as those requiring treatment (blood transfusion, interventional treatment, or surgical treatment). Minor ASCs were also reported. RESULTS The cohort comprised 61,203 patients (270 RA, 1210 BA, and 59,723 FA) with an average age of 68 years and who were 59.6% male. The RA and BA groups had higher rates of prior endarterectomy or bypass compared with the FA group (66.7% RA; 86.0% BA; 50.2% FA; P < .001). RA was more often used for single-segment treatments (82% vs 74% [P < .020] and more aortoiliac arterial segments (59.6% vs 21.0% [P < .001]). ASC occurred in 1329 patients (2.7%), including minor ASC (996 [1.6%]) and significant ASC (333 [0.54%]). Significant ASC were less common after FA and RA compared with BA (RA, 1 [0.37%]; FA, 307 [0.51%]; BA, 25 [2.1%]; P < .001). On multivariate analysis, BA was the strongest predictor of significant ASC (odds ratio, 2.75; 95% confidence interval, 1.73-4.36; P < .001). Significant ASC was no different after RA compared with FA (odds ratio, 0.60; 95% confidence interval, 0.08-4.33; P = .616). Other factors independently associated with significant ASC were sex, age, diabetes, chronic obstructive pulmonary disease, dialysis, and closure device use. CONCLUSIONS RA as the primary access vessel for endovascular treatment of LE-PAD is safe when compared with other traditional access sites. When FA is not possible or desirable, the radial approach may provide suitable access to treatment with a better safety profile than BA.
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Zuin M, Turchetta S, Drudi A, Gasparetto M, Rubin L, Rigatelli G. Ultrasound-guided distal transradial access for cardiac catheterization: Technical notes for the interventionalist. Catheter Cardiovasc Interv 2023; 101:367-371. [PMID: 36626276 DOI: 10.1002/ccd.30539] [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: 11/20/2022] [Revised: 12/09/2022] [Accepted: 12/24/2022] [Indexed: 01/11/2023]
Abstract
Over the latest years, the use of distal radial access (dTRA), also called "snuffbox," has become more and more popular for cardiac catheterization. Indeed, dTRA has several advantages compared to the traditional proximal radial approach, such as a lower risk of hand ischemia, radial artery occlusion (RAO) and faster post-procedural hemostasis. However, due to the presence of different muscular-skeletal structures, as well as to the small diameter of the distal radial artery (dRA), an ultrasound-guided cannulation would be preferred since a blind puncture increases the risk of tendon damage and/or the irritation of the underlying periosteum. The present article is aimed to provide the key tips for performing US-guided access using the dRA in patients undergoing percutaneous cardiac procedures.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Stefano Turchetta
- Department of Radiology, Casa di Cura Madonna della Salute, Rovigo, Porto Viro, Italy
| | - Alessandro Drudi
- Department of Radiology, Casa di Cura Madonna della Salute, Rovigo, Porto Viro, Italy
| | - Marco Gasparetto
- Department of Radiology, Casa di Cura Madonna della Salute, Rovigo, Porto Viro, Italy
| | - Lorenzo Rubin
- Department of Radiology, Casa di Cura Madonna della Salute, Rovigo, Porto Viro, Italy
| | - Gianluca Rigatelli
- Department of Cardiology, Interventional Cardiology Unit, Ospedali Riuniti Padova Sud, Monselice, Italy
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Lorenzo Górriz A, Rodríguez Paz C, Aguilar Tejedor Y, Fandiño E, García MJ, López-Jurado ALF, Tomás Muñoz P, Paolillo R, Seguel Ravest V, Barranco-Pons R. Early exploration of the economic impact of transradial access (TRA) versus transfemoral access (TFA) for neurovascular procedures in Spain. J Med Econ 2023; 26:1445-1454. [PMID: 37814553 DOI: 10.1080/13696998.2023.2266956] [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: 08/29/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Transfemoral access (TFA) is the primary access approach for neurointerventional procedures. Transradial access (TRA) is established in cardiology due to its lower complications, yet, it is at its early stages in neuroprocedures. This study performs an early exploration of the economic impact associated with the introduction of TRA in diagnostic and therapeutic neuroprocedures from the Spanish NHS perspective. METHODS An economic model was developed to estimate the cost and clinical implications of using TRA compared to TFA. Costs considered access-related, complications and recovery time costs obtained from local databases and experts' inputs. Clinical inputs were sourced from the literature. A panel of eight experts from different Spanish hospitals, validated or adjusted the values based on local experience. Hypothetical cohorts of 10,000 and 1000 patients were considered for diagnostic and therapeutic neuroprocedures respectively. Deterministic sensitivity analysis was performed. RESULTS TRA in diagnostic procedures was associated with lower costs with savings ranging between €486 and €157 depending on the TFA recovery time considered. TRA is estimated to lead to 158 fewer access-site complications. In therapeutic procedures, TRA resulted in 76.4 fewer complications and was estimated to be cost-neutral with an incremental cost of €21.56 per patient despite recovery times were not included for this group. Variation of the parameters in the sensitivity analysis did not change the direction of the results. LIMITATIONS Clinical data was obtained from literature validated by experts therefore results generalizability is limited. In therapeutic neuroprocedures, there is an experience imbalance between approaches and recovery times were not included hence the total impact is not fully captured. CONCLUSIONS The early economic model suggests that implementing TRA is associated with reduced costs and complications in diagnostic procedures. In therapeutic procedures, TRA lead to fewer complications and it is estimated to be cost-neutral, however its full potential still needs to be quantified.
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Affiliation(s)
- Antonio Lorenzo Górriz
- Interventional Neuroradiology, Hospital General Universitari de Castelló, Castellon de la Plana, Spain
| | - Carlos Rodríguez Paz
- Neuroradiology Unit, Department of Radiology, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Yeray Aguilar Tejedor
- Radiology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Canarias, Spain
| | - Eduardo Fandiño
- Radiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - María Jesús García
- Neuroradiology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Pablo Tomás Muñoz
- Neuroradiology Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Rosa Paolillo
- Study & Scientific Solutions, Medtronic Italia SpA, Milano, Italy
| | | | - Roger Barranco-Pons
- Interventional Neuroradiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
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Dodd WS, Small CN, Goutnik M, Laurent D, Crossman J, Motwani K, Lucke-Wold B, Polifka AJ, Koch M, Brzezicki G, Hoh BL, Chalouhi N. Cost Comparison: Evaluating Transfemoral and Transradial Access for Diagnostic Cerebral Angiography. STROKE (HOBOKEN, N.J.) 2023; 3:e000428. [PMID: 36743257 PMCID: PMC9893797 DOI: 10.1161/svin.122.000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/01/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Modern medicine necessitates the delivery of increasingly complex health care while minimizing cost. Transradial access (TRA) for neuroendovascular procedures is becoming more common as accumulating data demonstrate fewer complications, improved patient satisfaction, and high rates of treatment success compared with the transfemoral access (TFA) approach; however, disparities in cost between these approaches remain unclear. We compared supply and equipment costs between TRA and TFA for diagnostic cerebral angiography and evaluate the specific items that account for these differences. METHODS We reviewed all adult patients who underwent diagnostic cerebral angiography from July 1, 2019 to December 31, 2019. Data related to patient demographics, vascular access site, catheters used, cost of catheters, arterial access sheath use, cost of sheaths, closure devices used, and cost of closure devices were collected. RESULTS The transradial approach resulted in higher price of radial access sheath; however, the overall cost of closure devices was much lower in TRA group than in the TFA cohort. There was no significant difference in the cost of catheters. Overall, the total supply costs for TRA cerebral angiography were significantly lower than those of TFA cerebral angiography. The relative materials cost difference of using TRA was 20.9%. CONCLUSION This study is the first itemized materials cost analysis of TRA versus TFA cerebral angiography. TRA necessitates the use of a more expensive access sheath device; however, this cost is offset by the increased cost of devices used for femoral arteriotomy closure. Overall, the supply and equipment costs were significantly lower for TRA than TFA.
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Affiliation(s)
- William S Dodd
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - Coulter N Small
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - Michael Goutnik
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - Dimitri Laurent
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - James Crossman
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - Kartik Motwani
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - Adam J Polifka
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - Matthew Koch
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - Grzegorz Brzezicki
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - Brian L Hoh
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
| | - Nohra Chalouhi
- Department of Neurosurgery, University of Florida, Gainesville, FL (W.S.D., C.N.S., M.G., D.L., J.C., K.M., B.L.-W., A.J.P., M.K., B.L.H., N.C.); Department of Neurosurgery, University of Florida Health, Jacksonville, FL (G.B.)
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14
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Transradial versus transfemoral arterial access in the uterine artery embolization of fibroids. Pol J Radiol 2022; 87:e672-e677. [PMID: 36643011 PMCID: PMC9834067 DOI: 10.5114/pjr.2022.123790] [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: 02/06/2022] [Accepted: 06/06/2022] [Indexed: 01/03/2023] Open
Abstract
Purpose Transradial arterial access has become more popular in body interventional procedures but has not been ubiquitously adapted. This retrospective study assesses the efficacy of this approach in uterine artery embolization. Aim of the study was to compare transradial to transfemoral arterial access in patients undergoing uterine artery embolization for the treatment of fibroids. Material and methods A total of 172 patients underwent uterine artery embolization procedures at our institute from October 2014 to June 2020. Of these, 76 patients had their operations performed via transfemoral access while 96 underwent transradial access. The peak radiation dose, fluoroscopy time, procedure time, total contrast volume, and equipment cost for each procedure were all reviewed to evaluate for statistical differences between the 2 groups. Results All cases were technically successful without major complications. The average peak skin dose was 2281 mGy,with no statistical difference between the transradial or transfemoral cohorts. Average fluoroscopy time was 25 minutes, also with no statistical difference between the subsets. Mean procedure time was 100 min, and mean contrast volume usage was 138 mL with no statistical differences. Similarly, the average equipment cost was $2204, with no significant differences found between transradial and transfemoral access. Conclusions With respect to many pertinent radiation parameters, transradial access was evaluated as being an equally efficacious alternative to transfemoral access in uterine artery embolization procedures. The results of this study suggest that transradial access should be considered more often, whenever viable, as an option in the uterine artery embolization treatment of fibroids.
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15
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Kuhn AL, Puri AS, Rodrigues KDM, Massari F, Singh J. Rate of periprocedural stroke in diagnostic cerebral angiograms comparing transradial versus transfemoral access. Interv Neuroradiol 2022:15910199221142653. [PMID: 36451543 DOI: 10.1177/15910199221142653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Transradial access for neurointerventional procedures has increased in popularity over the past few years due to data from extrapolated interventional cardiology studies, patient preference, and early reports of feasibility using this approach. Our aim was to evaluate the incidence of periprocedural stroke in patients undergoing transradial versus transfemoral access for diagnostic cerebral angiograms. METHODS We retrospectively reviewed our neurointerventional database and identified all patients who underwent a diagnostic angiogram between May 2019 and July 2021. Patients were further divided into transradial versus transfemoral access. In patients with postprocedural stroke, symptoms and National Institute of Health Stroke Scale score were recorded. Pertinent laboratory values and procedural data was reviewed, including COVID status, platelet count, International normalized ratio (INR), Glomerular filtration rate (GFR), vessels catheterized, amount of contrast used, and fluoroscopy time. Imaging work-up for stroke symptoms was reviewed, if available. RESULTS Thousand two-hundred thirty eight diagnostic cerebral angiograms with 656 patients (53%) undergoing transradial access. Stroke symptoms after angiogram were only observed in the transradial group (5 patients; 0.4% total and 0.8% among radial access cases, respectively). Symptoms included word finding difficulty, paresthesia, or weakness. Three patients underwent cross-sectional imaging, computed tomography was negative in all three patients. Magnetic resonance imaging showed small, scattered infarcts in two patients. All symptoms resolved without additional hospitalization. CONCLUSION In our experience, using transradial access for diagnostic cerebral angiograms was associated with a low but not negligible incidence of periprocedural strokes. Patient anatomy should be evaluated prior to selection of vascular access. Patients should be made aware of a slightly higher periprocedural stroke risk with transradial access.
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Affiliation(s)
- Anna Luisa Kuhn
- Department of Radiology, Division of Neurointerventional Radiology, 12262University of Massachusetts Medical Center, Worcester, MA, USA
| | - Ajit S Puri
- Department of Radiology, Division of Neurointerventional Radiology, 12262University of Massachusetts Medical Center, Worcester, MA, USA
| | | | - Francesco Massari
- Department of Radiology, Division of Neurointerventional Radiology, 12262University of Massachusetts Medical Center, Worcester, MA, USA
| | - Jasmeet Singh
- Department of Radiology, Division of Neurointerventional Radiology, 12262University of Massachusetts Medical Center, Worcester, MA, USA
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Fanaroff AC, Giri J. Fluoroscopic Guidance for Femoral Artery Access-Pushing Patients Out of the Plane Without a Parachute? JAMA Cardiol 2022; 7:1118-1120. [PMID: 36116072 DOI: 10.1001/jamacardio.2022.3413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Alexander C Fanaroff
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Leonard Davis Institute for Health Economics, and Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Leonard Davis Institute for Health Economics, and Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia
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Krothapalli N, Fayad M, Patel S, Elmashad A, Sussman E, Bruno C, Grande A, Jagadeesan B, Killory B, Alberts M, Kureshi I, Ollenschleger M, Tummala R, Mehta T. Use of reverse angle guide catheter with trans-radial approach in patients undergoing middle meningeal artery embolization. Front Neurol 2022; 13:990722. [DOI: 10.3389/fneur.2022.990722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTrans-radial access (TRA) for MMA embolization has grown due to lower access site complications and greater patient satisfaction. Here, we describe the feasibility of utilizing a 6F Envoy Simmons 2 (6F-SIM2) as a guide catheter with TRA and compare outcomes with trans-femoral approach (TFA) in a single center case series.MethodsWe performed a retrospective review of patients who underwent MMA embolization for management of chronic subdural hematoma (cSDH). TRA was performed by utilizing a combination of 6F 90cm Envoy (Codman & Shurtleff, Inc., Rayham, MA) Simmons 2 guide catheter and 5F 125cm Sofia (Microvention, Aliso Viejo, CA) intermediate catheter. Outcomes measured are Modified Rankin Score (mRS) at 90 days, inpatient mortality, post-embolization recurrence, fluoroscopy time and radiation exposure.ResultsA total of 71 patients underwent 97 MMA embolization overall with 65 (67%) in trans-femoral access group, 11 (11.3%) in trans-radial access without use of Simmons 2 Guide catheter group and 21 (21.6%) in trans-radial access with use of Simmons 2 Guide catheter group. There were no direct access-related complications in either group. One patient had thromboembolic stroke in trans-femoral group. There was no difference in average procedure-related total fluro time or radiation dose among all three groups.ConclusionTrans-radial approach using 6F-SIM2 guide catheter coupled with 5F Sofia intermediate catheter is safe and effective. It provides an alternative approach to access distal branches of bilateral anterior circulation in elderly patients with difficult anatomy undergoing MMA embolization.
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Ahsan MJ, Ahmad S, Latif A, Lateef N, Ahsan MZ, Abusnina W, Nathan S, Altin SE, Kolte DS, Messenger JC, Tannenbaum M, Goldsweig AM. Transradial versus transfemoral approach for percutaneous coronary intervention in patients with ST-elevation myocardial infarction complicated by cardiogenic shock: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:640-650. [PMID: 35460230 PMCID: PMC9442849 DOI: 10.1093/ehjqcco/qcac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND In ST-elevation myocardial infarction (STEMI), transradial access (TRA) for percutaneous coronary intervention (PCI) is associated with less bleeding and mortality than transfemoral access (TFA). However, patients in cardiogenic shock (CS) are more often treated via TFA. The aim of this meta-analysis is to compare the safety and efficacy of TRA vs. TFA in CS. METHODS Systematic review was performed querying PubMed, Google Scholar, Cochrane, and clinicaltrials.gov for studies comparing TRA to TFA in PCI for CS. Outcomes included in-hospital, 30-day and ≥1-year mortality, major and access site bleeding, TIMI3 (thrombolytics in myocardial infarction) flow, procedural success, fluoroscopy time, and contrast volume. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random effects models. RESULTS Six prospective and eight retrospective studies (TRA, n = 8032; TFA, n = 23 031) were identified. TRA was associated with lower in-hospital (RR 0.59, 95% CI 0.52-0.66, P < 0.0001), 30-day and ≥1-year mortality, as well as less in-hospital major (RR 0.41, 0.31-0.56, P < 0.001) and access site bleeding (RR 0.42, 0.23-0.77, P = 0.005). There were no statistically significant differences in post-PCI coronary flow grade, procedural success, fluoroscopy time, and contrast volume between TRA vs. TFA. CONCLUSIONS In PCI for STEMI with CS, TRA is associated with significantly lower mortality and bleeding complications than TFA while achieving similar TIMI3 flow and procedural success rates.
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Affiliation(s)
| | - Soban Ahmad
- Department of Internal Medicine, East Carolina University, Greenville, NC, USA
| | - Azka Latif
- Division of Cardiovascular Medicine, Creighton University, Omaha, NE, USA
| | - Noman Lateef
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Waiel Abusnina
- Division of Cardiovascular Medicine, Creighton University, Omaha, NE, USA
| | - Sandeep Nathan
- Division of Cardiovascular Medicine, University of Chicago, Chicago, IL, USA
| | - S Elissa Altin
- Division of Cardiovascular Medicine, Yale University, New Haven, CT, USA
| | - Dhaval S Kolte
- Division of Cardiovascular Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - John C Messenger
- Division of Cardiology Medicine, University of Colorado, Aurora, CO, USA
| | - Mark Tannenbaum
- Division of Cardiovascular Medicine, Iowa Heart Center, Des Moines, IA, USA
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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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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20
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Ghosh A, Gupta V, Al Khalifah A, Akhter NM. Transradial versus transfemoral arterial access in DEB-TACE for hepatocellular carcinoma. J Clin Imaging Sci 2022; 12:38. [PMID: 36128344 PMCID: PMC9479582 DOI: 10.25259/jcis_47_2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/24/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives
Transradial access has become increasingly popular in body interventional procedures but has not been ubiquitously adapted. This retrospective study compares the efficacy of this approach versus transfemoral access in hepatocellular carcinoma (HCC) patients who underwent drug-eluting bead transarterial chemoembolization (DEB-TACE).
Materials and Methods
A total of 130 HCC patients underwent 146 DEB-TACE procedures within our institution from June 2015 to May 2020. About 90 and 56 procedures were logged for the transradial and transfemoral cohorts, respectively. Peak skin dose, fluoroscopy time, administered contrast volume, total procedure time, and equipment cost data for each procedure were reviewed to evaluate for statistical differences between the two groups.
Results
All 146 cases were technically successful without major complications or access failures in either group. No statistical differences were present between the two access groups in regards to peak skin dose or fluoroscopy time. Transradial access recorded a significantly higher contrast volume (P < 0.05), and a significantly longer procedural time than transfemoral access (P < 0.01). However, transradial access also displayed a significantly lower procedural equipment cost (P < 0.01) between the two groups.
Conclusion
Transradial DEB-TACE has similar trends to transfemoral DEB-TACE in several pertinent radiation parameters and is also significantly more cost-efficacious. The results of this investigation suggest the consideration of transradial access whenever viable as an alternative to transfemoral access in the DEB-TACE treatment of HCC patients.
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Affiliation(s)
- Abheek Ghosh
- Department of Interventional Radiology, University of Maryland, Baltimore, Maryland, United States,
| | - Vikash Gupta
- Department of Interventional Radiology, University of Maryland, Baltimore, Maryland, United States,
| | - Abdullah Al Khalifah
- Department of Interventional Radiology, University of Maryland, Baltimore, Maryland, United States,
| | - Nabeel Mohsin Akhter
- Department of Interventional Radiology, University of Maryland, Baltimore, Maryland, United States,
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21
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Liu X, Luo W, Wang M, Huang C, Bao K. Feasibility and Safety of Flow Diversion in the Treatment of Intracranial Aneurysms via Transradial Approach: A Single-Arm Meta Analysis. Front Neurol 2022; 13:892938. [PMID: 35968279 PMCID: PMC9364832 DOI: 10.3389/fneur.2022.892938] [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] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background While studies have confirmed that flow diversion (FD) can treat intracranial aneurysms via transradial approach (TRA), it remains unclear whether their treatment ultimately impacts safety and feasibility. We aim to conduct a systematic review and meta-analysis assessing the safety and feasibility after FD treatment of intracranial aneurysms via TRA. Methods PubMed, EMBASE, and Web of Science were systematically reviewed. The primary outcomes were the success rate and the access-related complications of deploying FD via TRA. Meta-analysis was performed using a random or fixed effect model based on heterogeneity. And the publication bias was evaluated using a funnel plot. This study was registered with PROSPERO, number CRD42021244448. Results Data from 8 studies met inclusion criteria (250 non-duplicated patients). The success rate was 93% (95% confidence interval [CI] 0.86–0.98; I2 = 61.05%; p = 0.01). The access-related complications rate was 1% (95% CI 0–0.03; I2 = 0.00%; p < 0.01). The mainly access-related complications included radial artery spasm (85.7%) and radial artery occlusion (14.3%). The TRA convert to transfemoral approach (TFA) was 7% (95% CI 0.02–0.14; I2 = 61.05%; p = 0.01). Conclusions Although TFA is still the main access for FD in the treatment of intracranial aneurysms, the TRA also has a higher success rate and lower access-related complications rate. With the improvement of future experience and equipment, the TRA may become the main access for FD which has more advantages. Future studies should design prospective, multicenter randomized controlled studies for long-term follow-up.
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Affiliation(s)
- Xiang Liu
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Wenzhang Luo
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Mingyan Wang
- Department of Obstetrics and Gynecology, TCM Hospital Affiliated of Southwest Medical University, Luzhou, China
| | - Changren Huang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Neurosurgery Clinical Medical Research Center of Sichuan Province, Luzhou, China
- Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Laboratory of Neurological Diseases and Brain Functions, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- *Correspondence: Changren Huang
| | - Kunyang Bao
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Neurosurgery Clinical Medical Research Center of Sichuan Province, Luzhou, China
- Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Laboratory of Neurological Diseases and Brain Functions, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Kunyang Bao
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22
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Kulyassa P, Németh BT, Ehrenberger R, Ruzsa Z, Szük T, Fehérvári P, Engh MA, Becker D, Merkely B, Édes IF. The Design and Feasibility of the: Radial Artery Puncture Hemostasis Evaluation – RAPHE Study, a Prospective, Randomized, Multicenter Clinical Trial. Front Cardiovasc Med 2022; 9:881266. [PMID: 35694680 PMCID: PMC9184438 DOI: 10.3389/fcvm.2022.881266] [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: 02/23/2022] [Accepted: 04/27/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction and Aim Radial artery approach angiography is the current gold standard for coronary status diagnostics and eventual percutaneous revascularization (PCI). Currently, application of adequate, patent hemostasis based physical torniquets are used for puncture site control, to avoid bleeding, radial artery occlusion and damage (RAO and RAD). The Radial Artery Puncture Hemostasis Evaluation (RAPHE) is a prospective, randomized, multicenter clinical trial designed to investigate new, simplified techniques of radial artery hemostasis utilizing physical compression free methods. Methods and Results The RAPHE study has been designed to evaluate the efficacy and safety of two non-compression based radial artery hemostasis methods: a 100% chitosan bioactive hemostatic dressing and a purpose-built radial potassium-ferrate based topical hemostasis disc. These devices will be investigated in a standalone configuration. Control group is a standard pneumatic airbladder-based compression device. A total of 600 patients will be enrolled in a three-way randomization (1:1:1) with two study and one control groups. Safety and efficacy endpoints are RAO, puncture site hematoma formation and RAD respectively, consisting of dissection, (pseudo)aneurism and/or fistula formation, measured post-procedure and at sixty days. Conclusion The results from this trial will provide valuable information on new, simplified methods of radial artery hemostasis options and possibly simplify post-puncture management of patients. Clinical Trial Registration [www.ClinicalTrials.gov], identifier [NCT04857385].
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Affiliation(s)
- Péter Kulyassa
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Balázs T. Németh
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Réka Ehrenberger
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zoltán Ruzsa
- Invasive Cardiology Division, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Tibor Szük
- Department of Cardiology and Cardiac Surgery, University of Debrecen, Debrecen, Hungary
| | - Péter Fehérvári
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Biomathematics and Informatics, University of Veterinary Medicine, Budapest, Hungary
| | - Marie Anne Engh
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Dávid Becker
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - István F. Édes
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- *Correspondence: István F. Édes,
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23
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Ghaith AK, El Naamani K, Mualem W, Ghanem M, Rajjoub R, Sweid A, Yolcu YU, Onyedimma C, Tjoumakaris SI, Bydon M, Jabbour PM. Transradial versus Transfemoral Approaches in Diagnostic and Therapeutic Neuroendovascular Interventions: A Meta-Analysis of Current Literature. World Neurosurg 2022; 164:e694-e705. [PMID: 35580777 DOI: 10.1016/j.wneu.2022.05.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The adoption of the transradial approach (TRA) has been increasing in popularity as a primary method to conduct both diagnostic and therapeutic interventions. As this technique gains broader acceptance and use within the neuroendovascular community, comparing its complication profile with a better-established alternative technique, the transfemoral approach (TFA), becomes more important. This study aimed to evaluate the safety of TRA compared with TFA in patients undergoing diagnostic, therapeutic, and combined neuroendovascular procedures. METHODS A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search of PubMed and other databases was conducted for studies from all available dates. To compare TRA and TFA, we performed an indirect meta-analysis between studies that mentioned the complications of the procedures. RESULTS Our search yielded 532 studies, of which 108 met full inclusion criteria. A total of 54,083 patients (9137 undergoing TRA and 44,946 undergoing TFA) were included. Access site complication rate was lower in TRA (1.62%) compared with TFA (3.31%) (P < 0.01). Neurological complication rate was lower in TRA (1.64%) compared with TFA (3.82%) (P = 0.02 and P < 0.01, respectively). Vascular spasm rate was higher in TRA (3.65%) compared with TFA (0.88%) (P < 0.01). Wound infection complication rate was higher in TRA (0.32%) compared with TFA (0.2%) (P < 0.01). CONCLUSIONS Patients undergoing TFA are significantly more likely to experience access site complications and neurological complications compared with patients undergoing TRA. Patients undergoing TRA are more likely to experience complications such as wound infections and vascular spasm.
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Affiliation(s)
- Abdul Karim Ghaith
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - William Mualem
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Marc Ghanem
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Rami Rajjoub
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmad Sweid
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Yagiz U Yolcu
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Chiduziem Onyedimma
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Stavropoula I Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA.
| | - Pascal M Jabbour
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
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24
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Ghosh A, Zhang J, Akhter NM. Transradial versus transfemoral arterial access in Yttrium-90 microspheres radioembolization for hepatocellular carcinoma. J Clin Imaging Sci 2022; 12:27. [PMID: 35673590 PMCID: PMC9168346 DOI: 10.25259/jcis_213_2021] [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: 11/30/2021] [Accepted: 04/06/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE
Transradial access has become more popular in body intervention procedures but has not been ubiquitously adapted. This study assesses the efficacy of this approach in Yttrium-90 labeled microspheres radioembolization. To compare transradial to transfemoral access in hepatocellular carcinoma patients who underwent Yttrium-90 radioembolization.
MATERIALS AND METHODS
A total of 244 hepatocellular carcinoma patients underwent 337 radioembolization procedures at our institute from May 2014 to May 2020. The transradial access-group included 188 patients (252 procedures) while the transfemoral access group had 63 patients (85 procedures). The recovery time, fluoroscopy time, contrast volume, peak radiation dose, and equipment cost for each procedure were all reviewed to evaluate for statistical differences between the two groups.
RESULTS
The transradial cohort recorded a significantly shorter (P < 0.01) mean recovery time (from the end of the procedure to discharge) and had a significantly shorter (P < 0.05) use of contrast volume versus the transfemoral group. In addition, the radiation dose and fluoroscopy time were lower in the transradial subset, although not statistically different. Furthermore, the overall cost for procedural equipment was significantly less (P < 0.01) in the transradial cohort than in the transfemoral. No major complications were reported in the transradial group, while one pseudoaneurysm was noted in the transfemoral group.
CONCLUSION
With respect to many pertinent parameters, transradial access was evaluated as being more advantageous than transfemoral access. The results of this study suggest that transradial access should be considered more often, whenever feasible, as an option in the Yttrium-90 treatment of hepatocellular carcinoma patients.
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Affiliation(s)
- Abheek Ghosh
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Maryland, United States,
| | - Jian Zhang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Maryland, United States,
| | - Nabeel Mohsin Akhter
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Maryland, United States,
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25
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Weinberg JH, Sweid A, Asada A, Schaefer J, Ruiz R, Kang K, Gooch MR, Herial NA, Tjoumakaris S, Zarzour H, Rosenwasser RH, Jabbour P. Access Site Complications and Management of the Transradial Approach for Neurointerventions. Neurosurgery 2022; 91:339-346. [DOI: 10.1227/neu.0000000000002022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/07/2022] [Indexed: 11/19/2022] Open
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26
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Catheter ablation for atrial fibrillation can be safely performed without invasive hemodynamic monitoring: A multi-center study. J Interv Card Electrophysiol 2022; 64:743-749. [PMID: 35182273 DOI: 10.1007/s10840-022-01151-x] [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: 01/13/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Arterial invasive monitoring is the most common method in the USA for hemodynamic monitoring during atrial fibrillation (AF) ablation. Although studies have shown favorable comparison between non-invasive and invasive hemodynamic monitoring (IHM) in non-cardiac procedures under general anesthesia, limited data is available for complex cardiac procedures such as AF ablation in the USA. With progressive improvement in AF ablation procedural safety, particularly with routine use of intracardiac echocardiography (ICE) to monitor for pericardial effusion, it is unclear if invasive hemodynamic monitoring provides any advantage over non-invasive methods. Therefore, the purpose of this study is to determine whether noninvasive hemodynamic monitoring is non-inferior to invasive hemodynamic monitoring during AF ablation under general anesthesia in patients without major cardiac structural abnormality. METHODS A multi-center retrospective data of AF ablation from July 2019 to December 2020 was extracted. A total of three hundred and sixty-two patients (362) were included, which were divided into group A (non-invasive hemodynamic monitoring) and group B (invasive hemodynamic monitoring). The primary outcome was to compare procedural safety between the two groups. RESULTS Out of 362 patients, 184 (51%) received non-invasive and 178 (49%) received invasive hemodynamic monitoring with similar baseline characteristics. There was no significant difference between the two groups in complication rates (groin hematoma, pericardial effusion, cardiac tamponade). Mean procedure time was longer in group B with 3.35% arterial site discomfort. Urgent arterial access was required in only 1 patient in group A. CONCLUSION This retrospective multicenter study strongly suggests that catheter ablation for atrial fibrillation under general anesthesia can be safely performed with noninvasive hemodynamic monitoring without requiring arterial access, with potential benefit in procedural duration and cost.
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27
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Desta L, Jurga J, Völz S, Omerovic E, Ulvenstam A, Zwackman S, Pagonis C, Calle F, Olivecrona GK, Persson J, Venetsanos D. Transradial versus trans-femoral access site in high-speed rotational atherectomy in Sweden. Int J Cardiol 2022; 352:45-51. [PMID: 35074496 DOI: 10.1016/j.ijcard.2022.01.039] [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: 07/03/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Radial artery is the preferred access site in contemporary percutaneous coronary intervention (PCI). However, limited data exist regarding utilization pattern, safety, and long-term efficacy of transradial artery access (TRA) PCI in heavily calcified lesions using high-speed rotational atherectomy (HSRA). METHODS All patients who underwent HSRA-PCI in Sweden between 2005 and 2016 were included. Outcomes were major adverse cardiac events (MACE, including death, myocardial infarction (MI) or target vessel revascularisation (TVR)), in-hospital bleeding and restenosis. Inverse probability of treatment weighting was used to adjust for the non-randomized access site selection. RESULTS We included 1479 patients of whom 649 had TRA and 782 transfemoral artery access (TFA) HSRA-PCI. The rate of TRA increased significantly by 18% per year but remained lower in HSRA-PCI (60%) than in the overall PCI population (85%) in 2016. TRA was associated with comparable angiographic success but significantly lower risk for major (adjusted OR 0.16; 95% CI 0.05-0.47) or any in-hospital bleeding (adjusted OR 0.32; 95% CI 0.13-0.78). At one year, the adjusted risk for MACE (HR 0.87; 95% CI 0.67-1.13) and its individual components did not differ between TRA and TFA patients. The risk for restenosis did not significantly differ between TRA and TFA HSRA-PCI treated lesions (adjusted HR 0.92; 95% CI 0.46-1.81). CONCLUSION HSRA-PCI by TRA was associated with significantly lower risk for in-hospital bleeding and equivalent long-term efficacy when compared with TFA. Our data support the feasibility and superior safety profile of TRA in HSRA-PCI.
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Affiliation(s)
- Liyew Desta
- Division of Cardiology, Department of Medicine, Karolinska Institute Huddinge and Karolinska University Hospital, Stockholm, Sweden
| | - Juliane Jurga
- Division of Cardiology, Department of Medicine, Karolinska Institute Solna and Karolinska University Hospital, Stockholm, Sweden
| | - Sebastian Völz
- Department of Cardiology, Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Ulvenstam
- Department of Internal Medicine and Cardiology, Östersund Hospital, Östersund, Sweden
| | - Sammy Zwackman
- Department of Cardiology, and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University Linköping, Sweden
| | - Christos Pagonis
- Department of Cardiology, and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University Linköping, Sweden
| | - Fredrik Calle
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden
| | - Göran K Olivecrona
- Department of Cardiology, Lund University and HSkåne University Hospital, Lund, Sweden
| | - Jonas Persson
- Department of Clinical sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Dimitrios Venetsanos
- Division of Cardiology, Department of Medicine, Karolinska Institute Solna and Karolinska University Hospital, Stockholm, Sweden.
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28
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Tyler Z, Guttmann OP, Savvatis K, Jones D, O'Mahony C. Is This the Prime Time for Transradial Access Left Ventricular Endomyocardial Biopsy? Interv Cardiol 2021; 16:e29. [PMID: 34733353 PMCID: PMC8548872 DOI: 10.15420/icr.2021.20] [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: 06/11/2021] [Accepted: 08/24/2021] [Indexed: 11/23/2022] Open
Abstract
Left ventricular endomyocardial biopsy (EMB) is an essential tool in the management of myocarditis and is conventionally performed via transfemoral access (TFA). Transradial access EMB (TRA-EMB) is a novel alternative and the authors sought to determine its safety and feasibility by conducting a systematic review of the literature. Medline was searched in 2020, and cohort demographics, procedural details and complications were extracted from selected studies. Four observational studies with a combined total of 496 procedures were included. TRA-EMB was most frequently performed with a sheathless MP1 guide catheter via the right radial artery. The most common complication was pericardial effusion (up to 11% in one study), but pericardial drainage for tamponade was rare (one reported case). Death and mitral valve damage have not been reported. TRA-EMB was successful in obtaining samples in 99% of reported procedures. The authors concluded that TRA-EMB is a safe and feasible alternative to TFA-EMB and the most common complication is uncomplicated pericardial effusion.
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Affiliation(s)
| | - Oliver P Guttmann
- St Bartholomew's Hospital London, UK.,UCL Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London London, UK
| | - Konstantinos Savvatis
- St Bartholomew's Hospital London, UK.,UCL Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London London, UK
| | | | - Constantinos O'Mahony
- St Bartholomew's Hospital London, UK.,UCL Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London London, UK
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29
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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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Safety and Efficacy of Four Different Diagnostic Catheter Curves Dedicated to One-Catheter Technique of Transradial Coronaro-Angiography-Prospective, Randomized Pilot Study. TRACT 1: Trans RAdial CoronaryAngiography Trial 1. J Clin Med 2021; 10:jcm10204722. [PMID: 34682845 PMCID: PMC8541157 DOI: 10.3390/jcm10204722] [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: 09/28/2021] [Accepted: 10/12/2021] [Indexed: 12/13/2022] Open
Abstract
Transradial coronaro-angiography (TRA) can be performed with one catheter. We investigate the efficacy of four different DxTerity catheter curves dedicated to the single-catheter technique and compare this method to the standard two-catheter approach. For this prospective, single-blinded, randomized pilot study, we enrolled 100 patients. In groups 1, 2, 3, and 4, the DxTerity catheters Trapease, Ultra, Transformer and Tracker Curve, respectively, were used. In group 5 (control), standard Judkins catheters were used. The study endpoints were the percentage of optimal stability, proper ostial artery engagement and a good quality angiogram, the duration of each procedure stage, the amount of contrast, and the radiation dose. The highest rate of optimal stability was observed in groups 2 (90%) and 5 (95%). Suboptimal results with at least one episode of catheter fallout from the ostium were most frequent in group 1 (45%). The necessity of using another catheter was observed most frequently in group 4. The analysis of time frames directly depending on the catheter type revealed that the shortest time for catheter introduction and for searching coronary ostia was achieved in group 2 (Ultra). There were no differences in contrast volume and radiation dose between groups. DxTerity catheters are suitable tools to perform TRA coronary angiography. The Ultra Curve catheter demonstrated an advantage over other catheters in terms of its ostial stability rate and procedural time.
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Jurga J, Szummer KE, Lewinter C, Mellbin L, Götberg M, Zwackman S, Nilsson J, Völz S, Erlinge D, Persson J, Omerovic E, Jernberg T, Venetsanos D. Pretreatment With P2Y12 Inhibitors in Patients With Chronic Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Report From the Swedish Coronary Angiography and Angioplasty Registry. Circ Cardiovasc Interv 2021; 14:e010849. [PMID: 34592825 DOI: 10.1161/circinterventions.121.010849] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with chronic coronary syndrome undergoing percutaneous coronary intervention, the optimal timing of P2Y12 inhibitors' administration is uncertain. We compared pretreatment versus treatment in the catheterization laboratory (In-Cathlab) in a real-world population. METHODS In Swedish Coronary Angiography and Angioplasty Registry, all patients with chronic coronary syndrome undergoing coronary angiography and ad hoc percutaneous coronary intervention, between 2006 and 2017 were identified. Pretreatment was defined as P2Y12 inhibitor administration before coronary angiography, outside the catheterization laboratory. Outcomes were net adverse clinical events including death, myocardial infarction, stroke, or bleeding within 30 days of the index procedure and in-hospital bleeding. RESULTS We included 26 814 patients, 8237 in the In-Cathlab, and 18 577 in the pretreatment group. In-Cathlab treatment compared with pretreatment was associated with lower risk for net adverse clinical event (4.2 versus 5.1%, adjusted hazard ratio 0.79 [0.63-0.99]), bleeding (2.3 versus 2.6%, adjusted hazard ratio, 0.76 [0.57-1.01]). and in-hospital bleeding (1.9 versus 2.1%, adjusted odds ratio, 0.70 [0.51-0.96]). The risk for death, myocardial infarction, or stroke did not significantly differ between the groups. Among the In-Cathlab treated patients, 41% received ticagrelor or prasugrel and 59% clopidogrel. Treatment with ticagrelor or prasugrel was associated with higher risk for net adverse clinical events (5.4% versus 3.4%, adjusted hazard ratio, 1.66 [1.12-2.48]), bleeding (3.4 versus 1.6%, adjusted hazard ratio, 2.14 [1.34-3.42]), and in-hospital bleeding (2.9 versus 1.2%, adjusted odds ratio, 2.24 [1.29-3.90]) but similar risk for death, myocardial infarction, or stroke, compared with clopidogrel. CONCLUSIONS In patients with chronic coronary syndrome undergoing coronary angiography and ad hoc percutaneous coronary intervention, pretreatment with P2Y12 inhibitors, before arrival to the catheterization laboratory, was not associated with improved clinical outcomes but was associated with increased risk for bleeding. Our data support clopidogrel administration in the catheterization laboratory as the standard of care. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
- Juliane Jurga
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Solna, Stockholm, Sweden (J.J., C.L., L.M., D.V.)
| | - Karolina Elizabeth Szummer
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Huddinge, Stockholm, Sweden (K.E.S.)
| | - Christian Lewinter
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Solna, Stockholm, Sweden (J.J., C.L., L.M., D.V.)
| | - Linda Mellbin
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Solna, Stockholm, Sweden (J.J., C.L., L.M., D.V.)
| | - Matthias Götberg
- Department of Cardiology, Lund University Hospital, Skåne, Sweden (M.G., D.E.)
| | - Sammy Zwackman
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University, Sweden (S.Z.)
| | - Johan Nilsson
- Department of Cardiology, Umeå University and Umeå University Hospital, Sweden (J.N.)
| | - Sebastian Völz
- Department of Cardiology, Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden (S.V., E.O.)
| | - David Erlinge
- Department of Cardiology, Lund University Hospital, Skåne, Sweden (M.G., D.E.)
| | - Jonas Persson
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden (J.P., T.J.)
| | - Elmir Omerovic
- Department of Cardiology, Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden (S.V., E.O.)
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden (J.P., T.J.)
| | - Dimitrios Venetsanos
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Solna, Stockholm, Sweden (J.J., C.L., L.M., D.V.)
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Couldwell M, Elzamly K, Hextrum S, Aysenne A, Olewink Ł, Iwanaga J, Nerva J, Dumont AS, Tubbs RS. Wrist Extension Does Not Change the Position of the Radial Artery: Cadaveric Study With Application to Arterial Line Placement, and Transradial Neurointerventional Procedures. World Neurosurg 2021; 155:e588-e591. [PMID: 34474160 DOI: 10.1016/j.wneu.2021.08.105] [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: 07/26/2021] [Revised: 08/21/2021] [Accepted: 08/23/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND The radial artery is gaining popularity as a vascular access site for neurointerventional procedures. However, recent analyses of wrist position and radial artery anatomy has suggested that the extended position of the wrist is not always necessary. Therefore, the following cadaveric study was performed to verify these findings. METHODS Twenty adult cadaveric upper limbs underwent dissection of the radial artery. The radial artery was exposed but left in its anatomical position. With the hand supinated, the wrist was extended to 45 degrees and 90 degrees. Observations were then made of any movement of the artery during these ranges of motion. Next, a tension gauge was attached to the radial artery and any tension on the artery measured during the above noted ranges of motion. RESULTS During extension of the wrist, none of the radial artery specimens was found to move in any direction. Moreover, an average of only 0.28 N of tension on the artery was found with wrist extension up to 90 degrees. Our cadaveric study found that, contrary to popular belief, extension of the wrist during cannulation of the radial artery does not change the position of the artery nor does it significantly alter the tension on the artery. CONCLUSIONS These data support several recent clinical studies.
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Affiliation(s)
- Mitchell Couldwell
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Kareem Elzamly
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Shannon Hextrum
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aimee Aysenne
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Łukasz Olewink
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.
| | - John Nerva
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Surgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies; University of Queensland, Australia
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Magee GA. Assessing the utility of transradial access in the trauma patient. J Vasc Surg 2021; 73:740-741. [PMID: 33485503 DOI: 10.1016/j.jvs.2020.08.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 08/17/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Gregory A Magee
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
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Sweid A, Weinberg JH, Khanna O, Das S, Kim J, Curtis D, Hammoud B, El Naamani K, Abbas R, Majmundar S, Sajja KC, Chalouhi N, Saiegh FA, Mouchtouris N, Atallah E, Gooch MR, Herial NA, Tjoumakaris S, Romo V, Rosenwasser RH, Jabbour P. Lessons Learned After 760 Neurointerventions via the Upper Extremity Vasculature: Pearls and Pitfalls. Neurosurgery 2021; 88:E510-E522. [PMID: 33862629 DOI: 10.1093/neuros/nyab084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/24/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The radial approach has been gaining more widespread use by neurointerventionalists fueled by data from the cardiology literature showing better safety and overall reduced morbidity. OBJECTIVE To present our institution's experience with the radial approach for neuroendovascular interventions in 614 consecutive patients who underwent a cumulative of 760 procedures. METHODS A retrospective analysis was performed and identified neuroendovascular procedures performed via the upper extremity vasculature access site. RESULTS Amongst 760 procedures, 34.2% (260) were therapeutic, and 65.7% (500) were nontherapeutic angiograms. Access sites were 71.5% (544) via a conventional radial artery, 27.8% (211) via a distal radial artery, 0.5% (4) via an ulnar artery, and 0.1% (1) via the brachial artery. Most of the procedures (96.9%) were performed via the right-sided (737), 2.9% (22) via the left-sided, and 0.1% (1) via a bilateral approach. Major access site complications occurred at a rate of 0.9% (7). The rate of transfemoral conversion was 4.7% (36). There was a statistically higher incidence of transfemoral conversion when repeat procedures were performed using the same access site. Also, there was no significant difference between nontherapeutic procedures performed using the right and left radial access, and conventional versus distal radial access. Procedural metrics improved after completion of 14 procedures, indicating a learning curve that should be surpassed by operators to reach optimal outcomes. CONCLUSION Radial artery catheterization is a safe and effective means of carrying out a wide range of neuroendovascular procedures associated with excellent clinical outcomes and an overall low rate of periprocedural complications.
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Affiliation(s)
- Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Joshua H Weinberg
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Omaditya Khanna
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Somnath Das
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Julie Kim
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Darcy Curtis
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Batoul Hammoud
- Department of Pediatric Endocrinology, Children Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Rawad Abbas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.,American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Shyam Majmundar
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Kalyan C Sajja
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nohra Chalouhi
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.,Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Fadi Al Saiegh
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nikolaos Mouchtouris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Elias Atallah
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - M Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nabeel A Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Victor Romo
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Catapano JS, Ducruet AF, Nguyen CL, Majmundar N, Wilkinson DA, Cole TS, Baranoski JF, Cavalcanti DD, Fredrickson VL, Srinivasan VM, Rutledge C, Lawton MT, Albuquerque FC. Propensity-Adjusted Comparative Analysis of Radial Versus Femoral Access for Neurointerventional Treatments. Neurosurgery 2021; 88:E505-E509. [PMID: 33582816 DOI: 10.1093/neuros/nyab036] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/20/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Transradial artery (TRA) catheterization for neuroendovascular procedures is associated with a lower risk of complications than transfemoral artery (TFA) procedures. However, the majority of literature on TRA access pertains to diagnostic procedures rather than interventional treatments. OBJECTIVE To compare TRA and TFA approaches for cerebrovascular interventions. METHODS All patients with an endovascular intervention performed at a single center from October 1, 2018 to December 31, 2019 were retrospectively analyzed. Patients were grouped into 2 cohorts on the basis of whether TRA or TFA access was used. Outcomes included complications, fluoroscopy times, and total contrast administered. RESULTS A total 579 interventional treatments were performed during the 15-mo study period. TFA procedures (n = 417) were associated with a significantly higher complication rate than TRA (n = 162) procedures (43 cases [10%] vs 5 cases [3%]; P = .008). After excluding patients who underwent thrombectomy and performing a propensity adjustment (including age, sex, pathology, procedure, sheath size, and catheter size), TRA catheterization was associated with decreased odds of a complication (odds ratio, 0.25; 95% CI 0.085-0.72; P = .01), but no significant difference in the amount of contrast administered (6.7-mL increase; 95% CI, -7.2 to 20.6; P = .34) or duration of fluoroscopy (2.1-min increase; 95% CI, -2.5 to 6.7; P = .37) compared with TFA catheterization. CONCLUSION Neurointerventional procedures and treatments for a variety of pathologies can be performed successfully using the TRA approach, which is associated with a lower risk of complications and no difference in fluoroscopy duration compared with the TFA approach.
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Affiliation(s)
- Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Candice L Nguyen
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Neil Majmundar
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - D Andrew Wilkinson
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Tyler S Cole
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jacob F Baranoski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Daniel D Cavalcanti
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Vance L Fredrickson
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Caleb Rutledge
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Roczniak J, Koziołek W, Piechocki M, Tokarek T, Surdacki A, Bartuś S, Chyrchel M. Comparison of Access Site-Related Complications and Quality of Life in Patients after Invasive Cardiology Procedures According to the Use of Radial, Femoral, or Brachial Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116151. [PMID: 34200250 PMCID: PMC8201254 DOI: 10.3390/ijerph18116151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/26/2021] [Accepted: 06/05/2021] [Indexed: 11/16/2022]
Abstract
The radial approach (RA) is the most common in invasive cardiology, but depending on the clinical situation, the femoral approach (FA) and brachial approach (BA) are also used. The BA is associated with the highest odds of complications so it is used mainly if a first-choice approach fails. The aim of the study was to assess clinical outcomes after invasive cardiology procedures stratified by the use of the RA, FA, and BA, with a focus on access site-related complications, quality of life (QoL), and patients' perspective. A total of 250 procedures (RA: 98; FA: 99; BA: 53) performed between 2013 and 2020 were retrospectively analyzed. Puncture site-related complications, vascular events, patient preferences, and QoL were assessed by the analysis of medical records and telephone follow-up using a proprietary questionnaire and the modified EQ-5D-3L questionnaire. Patients from the RA group received the smallest volume of contrast during a percutaneous coronary interventions (PCI) procedure (RA vs. FA vs. BA: 180 (150-240) mL vs. 200 (180-270) mL vs. 190 (100-200) mL, p = 0.045). The access site was changed most frequently in the procedures initiated from the RA (p < 0.04). Overall puncture site-related complications, especially local hematomas, occurred most commonly in the BA group (7.1, 14.1, and 24.5% for RA, FA, and BA, respectively, p = 0.01). During the index procedure, the access site was changed most frequently in procedures initiated from the RA (19.7, 8.5 and 0%, p = 0.04). The RA was indicated as an approach preferred by the patient for a hypothetical next procedure (87.9, 55.4, and 70.0% for subjects preferring the same approach out of patients who underwent a procedure by the RA, FA, and BA, respectively, p < 0.001). For the RA and FA, the prevalence of moderate or extreme access site-related problems in self-care decreased significantly (RA: p < 0.01, FA: p < 0.05) within 1 month after the index procedure (RA: 18.1, 4.2, and 1.4%; FA: 20.7, 11.1, and 9.6% periprocedurally, after 1 and 6 months, respectively). In contrast, for the BA these percentages were higher and a significant improvement (p < 0.05) was delayed until 6 months (54.6, 36.4, and 18.2% periprocedurally, after 1 and 6 months, respectively). In conclusion, compared to the BA and FA, the RA appears to be not only the safest, mainly due to the lowest risk of puncture site-related complications after coronary procedures but also represents a preferable approach from the patient's perspective. Although overall post-procedural QoL outcomes did not differ significantly according to the access site, nevertheless, the BA was associated with more frequent self-care problems whose improvement was delayed until more than one month after the index procedure.
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Affiliation(s)
- Jan Roczniak
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, Poland; (J.R.); (W.K.); (M.P.)
| | - Wojciech Koziołek
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, Poland; (J.R.); (W.K.); (M.P.)
| | - Marcin Piechocki
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, Poland; (J.R.); (W.K.); (M.P.)
| | - Tomasz Tokarek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (T.T.); (A.S.); (S.B.)
- Center for Intensive Care and Perioperative Medicine, Faculty of Medicine, Jagiellonian University Medical College, 30-901 Cracow, Poland
| | - Andrzej Surdacki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (T.T.); (A.S.); (S.B.)
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Cracow, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (T.T.); (A.S.); (S.B.)
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Cracow, Poland
| | - Michał Chyrchel
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (T.T.); (A.S.); (S.B.)
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Cracow, Poland
- Correspondence: ; Tel.: +48-12-400-2250
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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] [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 theUnited 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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Son C, Tavakoli S, Mahadev V. Systematic Review of Transradial Access for Flow Diversion of Intracranial Aneurysms. World Neurosurg 2021; 151:6-11. [PMID: 33862294 DOI: 10.1016/j.wneu.2021.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transradial access is an increasingly popular route for cerebral angiography and neurointerventions. However, obstacles to wider adoption remain, especially for complex interventions typically performed with larger, multiaxial systems such as flow diversion. We sought to analyze the published evidence for transradial flow diversion of intracranial aneurysms. METHODS Using Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, a literature review was performed to identify all published reports and studies of transradial flow diversion for intracranial aneurysm. The search was limited from April 2011 to February 2021. Primary outcome was successful completion of the procedure via a transradial approach. Heterogeneity was analyzed with Q and I2 statistics. Secondary outcomes were transradial access-site complications and other complications. RESULTS In total, 11 studies involving 290 treated aneurysms were identified; 90.7% of the procedures were completed via the transradial approach. The heterogeneity between studies was high, with an I2 of 56.9%. There were no transradial access-site complications. The procedural complication rate was 2.41%. CONCLUSIONS Transradial access has a high success rate for both anterior and posterior circulation flow-diversion embolizations. The success rate may be particularly high for posterior circulation and right anterior circulation aneurysms. It has a negligible access-site complication rate. Transradial access is a viable alternative to transfemoral access for flow diversion and should be considered as a first-line approach.
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Affiliation(s)
- Colin Son
- Neurosurgical Associates of San Antonio, University of Texas Health Science Center, San Antonio, Texas, USA.
| | - Samon Tavakoli
- Department of Neurosurgery, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Vaidehi Mahadev
- Department of Neurosurgery, University of Texas Health Science Center, San Antonio, Texas, USA
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Al-Azizi KM, Idris A, Christensen J, Hamandi M, Hale S, Martits-Chalangari K, Van Zyl JS, Ravindranathan P, Banwait JK, Mcckracken J, Smith A, Apakama G, Swim J, Dolton P, Chionh K, Dimaio M, Thomas S, Szerlip M, Sayfo S, Dib C, Mack M, Potluri S. Distal versus proximal radial artery access for cardiac catheterization and intervention: Design and rationale of the DIPRA trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:104-109. [PMID: 33926835 DOI: 10.1016/j.carrev.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Radial artery (RA) catheterization is the access of choice over femoral artery access for most interventional vascular procedures given its safety and faster patient recovery. There has been growing interest in distal radial artery (dRA) access as an alternative to the conventional proximal radial artery (pRA) access. Preserving the RA is important which serves as a potential conduit for future coronary artery bypass surgery, dialysis conduit or preserve the artery for future cardiovascular procedures. The dRA runs in close proximity to the radial nerve, which raises the concern of potential detrimental effects on hand function. STUDY DESIGN The Distal versus Proximal Radial Artery Access for cardiac catheterization and intervention (DIPRA) trial is a prospective, randomized, parallel-controlled, open-label, single center study evaluating the outcomes of hand function and effectiveness of dRA compared to pRA access in patients undergoing cardiac catheterization. The eligible subjects will be randomized to dRA and pRA access in a (1:1) fashion. The primary end point is an evaluation of hand function at one and twelve months follow-up. Secondary end points include rates of access site hematoma, access site bleeding, other vascular access complications, arterial access success rate, and RA occlusion at one and twelve months follow up. CONCLUSION Effects of dRA on hand function remains unknown and it's use questionable in the presence of a widely accepted pRA. DIPRA trial is designed to determine the safety and effectiveness of dRA for diagnostic and interventional cardiovascular procedures compared to the standard of care pRA.
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Affiliation(s)
- Karim M Al-Azizi
- Interventional Cardiology and Structural Heart Disease, Texas A&M University College of Medicine, The Heart Hospital - Plano, Baylor Scott & White Health, 1100 Allied Dr, Plano, TX 75093, United States of America.
| | - Amr Idris
- The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Jared Christensen
- The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Mohanad Hamandi
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Sarah Hale
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | | | - Johanna S Van Zyl
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Preethi Ravindranathan
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Jasjit K Banwait
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Julie Mcckracken
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Adam Smith
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Ginika Apakama
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Jennifer Swim
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Penni Dolton
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Kristen Chionh
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Michael Dimaio
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Sibi Thomas
- Interventional Cardiology and Structural Heart Disease, The Heart Hospital - Plano, Baylor Scott & White Health, United States of America
| | - Molly Szerlip
- Interventional Cardiology and Structural Heart Disease, The Heart Hospital - Plano, Baylor Scott & White Health, United States of America
| | - Sameh Sayfo
- Interventional Cardiology and Structural Heart Disease, The Heart Hospital - Plano, Baylor Scott & White Health, United States of America
| | - Chadi Dib
- Interventional Cardiology, The Heart Hospital - Plano, Baylor Scott & White Health, United States of America
| | - Michael Mack
- Baylor Research Institute, The Heart Hospital Plano - Baylor Scott & White, United States of America
| | - Srinivasa Potluri
- Interventional Cardiology and Structural Heart Disease, The Heart Hospital - Plano, Baylor Scott & White Health, United States of America
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Besli F, Gungoren F, Tanriverdi Z, Tascanov MB, Fedai H, Akcali H, Demirbag R. The high dose unfractionated heparin is related to less radial artery occlusion rates after diagnostic cardiac catheterisation: a single centre experience. Acta Cardiol 2021; 76:168-174. [PMID: 31869279 DOI: 10.1080/00015385.2019.1705584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Transradial approach (TRA) has increasingly become the default strategy for cardiac catheterisation. However, TRA can result in several complications; radial artery occlusion (RAO) is the most unwilling complication. Unfractionated heparin (UFH) is an effective therapy in preventing RAO. The goal of this study was to evaluate whether weight-adjusted high dose UFH reduces the rate of RAO after diagnostic cardiac catheterisation compared to weight-adjusted standard dose UFH. METHODS A total of 1215 patients screened and after exclusion criteria, 686 consecutive patients were enrolled. 100 IU/kg UFH (high dose UFH group) and 50 IU/kg UFH (standard dose UFH group) were given the patients undergoing diagnostic cardiac catheterisation. RAO was evaluated with vascular Doppler ultrasonography at 10 days after cardiac catheterisation. RESULTS Among 686 patients undergoing diagnostic cardiac catheterisation, RAO was detected in 36 (5.2%) patients. There was no significant difference with respect to baseline characteristics and co-morbid diseases between high dose UFH group and standard dose UFH group. RAO was significantly higher in standard dose UFH group than high dose UFH group (7.9% vs. 3.0%, p = .004). Multivariate logistic regression analysis was demonstrated that age (OR: 0.958, 95% CI: 0.924-0.993, p = .019) and standard dose heparin (OR: 2.811, 95% CI: 1.347-5.866, p = .006) were independent factor for RAO. CONCLUSIONS High dose UFH was independently associated with a lower rate of RAO. Given that RAO nearly affects about 10% patient underwent TRA, prefer to high dose UFH may be a reasonable choice for RAO prevention.
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Affiliation(s)
- Feyzullah Besli
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Fatih Gungoren
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Zulkif Tanriverdi
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | | | - Halil Fedai
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Huseyin Akcali
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Recep Demirbag
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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Angiographic evaluation of radial artery injury after transradial approach for percutaneous coronary intervention. Cardiovasc Interv Ther 2021; 37:128-135. [PMID: 33638093 PMCID: PMC8789693 DOI: 10.1007/s12928-020-00750-7] [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: 07/17/2020] [Accepted: 12/20/2020] [Indexed: 10/28/2022]
Abstract
The transradial approach for percutaneous coronary intervention (TRA-PCI) has been increasingly gaining popularity in clinical practice. However, its association with risk for long-term radial artery injury has not been yet thoroughly defined. We retrospectively examined the patients undergoing radial artery angiography (RAG) after TRA-PCI to determine the incidence and risk factors of radial artery injury. The study included 558 patients undergoing follow-up radial artery angiography at 12 month after TRA-PCI. Radial artery injury occurred in 140 patients (25%) with 3 distinct morphological patterns: focal radial artery stenosis (RAS) P.7,7: in 7 patients (1%), diffuse radial artery stenosis (RAS) in 78 patients (14%), and radial artery occlusion (RAO) in 55 patients (10%). Patients with RAS/RAO were more likely to be female, had smaller height and body weight, smaller body mass index and smaller body surface area (BSA) as compared with those without RAS/RAO. Multivariable logistic regression analysis identified BSA (odds ratio, 1.34 per 0.1 m2 increase; 95% confidence interval, 1.07-1.71; p = 0.01) and a history of TRA-PCI (odds ratio, 2.35; 95% confidence interval, 1.16-5.08; p = 0.017) as independent predisposing factors of radial artery injury. In a sub-analysis of 323 patients undergoing both pre-PCI RAG and follow-up RAG, pre-PCI radial diameter as well as BSA and a history of TRA-PCI were independently associated with radial artery injury. Long-term injury after TRA-PCI is considerably common and care should be paid for RAS/RAO, especially for those patients with lower BSA, history of TRA-PCI and small radial artery diameter.
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42
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Jung Y, Frisvold D, Dogan T, Dogan M, Philibert R. Cost-utility analysis of an integrated genetic/epigenetic test for assessing risk for coronary heart disease. Epigenomics 2021; 13:531-547. [PMID: 33625255 DOI: 10.2217/epi-2021-0021] [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: 01/04/2023] Open
Abstract
Aim: New epigenetically based methods for assessing risk for coronary heart disease may be more sensitive but are generally more costly than current methods. To understand their potential impact on healthcare spending, we conducted a cost-utility analysis. Methods: We compared costs using the new Epi + Gen CHD™ test with those of existing tests using a cohort Markov simulation model. Results: We found that use of the new test was associated with both better survival and highly competitive negative incremental cost-effectiveness ratios ranging from -$42,000 to -$8000 per quality-adjusted life year for models with and without a secondary test. Conclusion: The new integrated genetic/epigenetic test will save money and lives under most real-world scenarios. Similar advantages may be seen for other epigenetic tests.
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Affiliation(s)
- Younsoo Jung
- Cardio Diagnostics Inc., Coralville, IA 52241, USA
| | - David Frisvold
- Department of Economics, University of Iowa, Iowa City, IA 52242, USA
| | - Timur Dogan
- Cardio Diagnostics Inc., Coralville, IA 52241, USA
| | | | - Rob Philibert
- Cardio Diagnostics Inc., Coralville, IA 52241, USA.,Department of Psychiatry, University of Iowa, Iowa City, IA 52242, USA
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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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Weinberg JH, Sweid A, Hammoud B, Asada A, Greco-Hiranaka C, Piper K, Gooch MR, Tjoumakaris S, Herial N, Hasan D, Zarzour H, Rosenwasser RH, Jabbour P. A comparative study of transradial versus transfemoral approach for flow diversion. Neuroradiology 2021; 63:1335-1343. [PMID: 33560470 DOI: 10.1007/s00234-021-02672-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Data in neurointerventional literature is extremely limited regarding the safety and efficacy of flow diversion using transradial access (TRA). We aim to demonstrate the safety and efficacy of intracranial aneurysm treatment with the Pipeline Embolization Device (PED) using TRA compared to transfemoral access (TFA). METHODS We conducted a retrospective analysis of a prospectively maintained database and identified 79 consecutive patients who underwent neuroendovascular embolization for cerebral aneurysms using the PED from April 2018 through October 2019. Patients were divided into 2 groups: TRA (32 patients) and TFA (47 patients). A comparative analysis was performed between the two groups. RESULTS There was no significant difference in postoperative intracranial hemorrhage (p>.99), symptomatic ischemic stroke (p=.512), access site complications (p=.268), or other complications (p=.512). However, there was a significant increase in overall complications (14.9% vs. 0.0%, p=.038) and procedure duration (71.4 min ± 31.2 vs. 58.5 ± 20.3, p=.018) in the TFA group. There was no significant difference in complete occlusion at latest follow-up (19/25, 76.0% vs. 35/40, 87.5%; p=.311), 6-month follow-up (17/23, 73.9% vs. 33/38, 86.8%; p=.303), or 12-month follow-up (8/8, 100.0% vs. 5/6, 83.3%; p=.429). There was also no significant difference in rate of retreatment (p>.99), morbidity (p=.512), mortality (p>.99), latest follow-up (p=.985), or loss of follow-up (p=.298). CONCLUSIONS The feasibility and efficacy of flow diversion with the PED via TRA for the treatment of intracranial aneurysms is comparable to TFA. Widespread adoption of this approach may be facilitated by improvements in device navigation and manipulation via radial-specific engineering.
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Affiliation(s)
- Joshua H Weinberg
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Batoul Hammoud
- Department of Pediatric Endocrinology, Children Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ashlee Asada
- Drexel University College of Medicine, Drexel University, Philadelphia, PA, USA
| | | | - Keenan Piper
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nabeel Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - David Hasan
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Hekmat Zarzour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
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Li Y, Xue Z, Ma H, Zhang W, Nie S, Ma C. Pseudoaneurysm with Median Nerve Injury Caused by Right Radial Artery Puncture: A Case Report. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2021. [DOI: 10.15212/cvia.2019.1265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Pseudoaneurysm with median nerve injury is a serious complication of radial artery puncture. It is very important to summarize the prevention and treatment experience of this complication through case discussion.Case report: A 66-year-old woman was admitted
to the hospital because of “paroxysmal chest tightness and suffocation for 5 days.” Coronary angiography was performed. During insertion of the arterial sheath, the patient experienced severe pain in the right forearm, which radiated to the palm. The puncture sheath did not return
blood after the sheath core was withdrawn. The sheath was removed and local compression was used to stop bleeding. There was no obvious bleeding at the puncture point, and the compression was removed 6 hours after the procedure. Local swelling and increased tension were seen in the right forearm.
At the 1-week follow-up she exhibited swelling, high local tension, small blisters, and bluish-purple skin of the right forearm, with an acceptable right radial artery pulsation. She had severe pain in the affected limb, which radiated to the thumb, index finger, and middle finger.Case
discussion: We discuss the causes of and treatment measures for pseudoaneurysm with median nerve injury caused by radial artery puncture.
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Affiliation(s)
- Yachao Li
- Department of Cardiology, People’s Hospital of Langfang City, Langfang, 065000 Hebei, People’s Republic of China
| | - Zengming Xue
- Department of Cardiology, People’s Hospital of Langfang City, Langfang, 065000 Hebei, People’s Republic of China
| | - He Ma
- Department of Ultrasound, People’s Hospital of Langfang City, Langfang, 065000 Hebei, People’s Republic of China
| | - Wei Zhang
- Department of Orthopedics, People’s Hospital of Langfang City, Langfang, 065000 Hebei, People’s Republic of China
| | - Shaoping Nie
- Emergency Department, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, People’s Republic of China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, People’s Republic of China
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Kühn AL, Satti SR, Eden T, de Macedo Rodrigues K, Singh J, Massari F, Gounis MJ, Puri AS. Anatomic Snuffbox (Distal Radial Artery) and Radial Artery Access for Treatment of Intracranial Aneurysms with FDA-Approved Flow Diverters. AJNR Am J Neuroradiol 2021; 42:487-492. [PMID: 33446501 DOI: 10.3174/ajnr.a6953] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/08/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Transradial access for neurointerventional procedures has been proved a safer and more comfortable alternative to femoral artery access. We present our experience with transradial (distal radial/anatomic snuffbox and radial artery) access for treatment of intracranial aneurysms using all 3 FDA-approved flow diverters. MATERIALS AND METHODS This was a high-volume, dual-center, retrospective analysis of each institution's data base between June 2018 and June 2020 and a collection of all patients treated with flow diversion via transradial access. Patient demographic information and procedural and radiographic data were obtained. RESULTS Seventy-four patients were identified (64 female patients) with a mean age of 57.5 years with a total of 86 aneurysms. Most aneurysms were located in the anterior circulation (93%) and within the intracranial ICA (67.4%). The mean aneurysm size was 5.5 mm. Flow diverters placed included the Pipeline Embolization Device (Flex) (PED, n = 65), the Surpass Streamline Flow Diverter (n = 8), and the Flow-Redirection Endoluminal Device (FRED, n = 1). Transradial access was successful in all cases, but femoral crossover was required in 3 cases (4.1%) due to tortuous anatomy and inadequate support of the catheters in 2 cases and an inability to navigate to the target vessel in a patient with an aberrant right subclavian artery. All 71 other interventions were successfully performed via the transradial approach (95.9%). No access site complications were encountered. Asymptomatic radial artery occlusion was encountered in 1 case (3.7%). CONCLUSIONS Flow diverters can be successfully placed via the transradial approach with high technical success, low access site complications, and a low femoral crossover rate.
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Affiliation(s)
- A L Kühn
- From the Division of Neurointerventional Radiology (A.L.K., K.d.M.R., J.S., F.M., M.J.G., A.S.P.), Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - S R Satti
- Department of Neurointerventional Surgery (S.R.S., T.E.), Christiana Health System, Newark, Delaware
| | - T Eden
- Department of Neurointerventional Surgery (S.R.S., T.E.), Christiana Health System, Newark, Delaware
| | - K de Macedo Rodrigues
- From the Division of Neurointerventional Radiology (A.L.K., K.d.M.R., J.S., F.M., M.J.G., A.S.P.), Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - J Singh
- From the Division of Neurointerventional Radiology (A.L.K., K.d.M.R., J.S., F.M., M.J.G., A.S.P.), Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - F Massari
- From the Division of Neurointerventional Radiology (A.L.K., K.d.M.R., J.S., F.M., M.J.G., A.S.P.), Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - M J Gounis
- From the Division of Neurointerventional Radiology (A.L.K., K.d.M.R., J.S., F.M., M.J.G., A.S.P.), Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - A S Puri
- From the Division of Neurointerventional Radiology (A.L.K., K.d.M.R., J.S., F.M., M.J.G., A.S.P.), Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
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Li Y, Chen SH, Spiotta AM, Jabbour P, Levitt MR, Kan P, Griessenauer CJ, Arthur AS, Osbun JW, Park MS, Chalouhi N, Sweid A, Wolfe SQ, Fargen KM, Dumont AS, Dumont TM, Brunet MC, Sur S, Luther E, Strickland A, Yavagal DR, Peterson EC, Schirmer CM, Goren O, Dalal S, Weiner G, Rosengart A, Raper D, Chen CJ, Amenta P, Scullen T, Kelly CM, Young C, Nahhas M, Almallouhi E, Gunasekaran A, Pai S, Lanzino G, Brinjikji W, Abbasi M, Dornbos Iii D, Goyal N, Peterson J, El-Ghanem MH, Starke RM. Lower complication rates associated with transradial versus transfemoral flow diverting stent placement. J Neurointerv Surg 2021; 13:91-95. [PMID: 32487766 PMCID: PMC7708402 DOI: 10.1136/neurintsurg-2020-015992] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Currently, there are no large-scale studies in the neurointerventional literature comparing safety between transradial (TRA) and transfemoral (TFA) approaches for flow diversion procedures. This study aims to assess complication rates in a large multicenter registry for TRA versus TFA flow diversion. METHODS We retrospectively analyzed flow diversion cases for cerebral aneurysms from 14 institutions from 2010 to 2019. Pooled analysis of proportions was calculated using weighted analysis with 95% CI to account for results from multiple centers. Access site complication rate and overall complication rate were compared between the two approaches. RESULTS A total of 2,285 patients who underwent flow diversion were analyzed, with 134 (5.86%) treated with TRA and 2151 (94.14%) via TFA. The two groups shared similar patient and aneurysm characteristics. Crossover from TRA to TFA was documented in 12 (8.63%) patients. There were no access site complications in the TRA group. There was a significantly higher access site complication rate in the TFA cohort as compared with TRA (2.48%, 95% CI 2.40% to 2.57%, vs 0%; p=0.039). One death resulted from a femoral access site complication. The overall complications rate was also higher in the TFA group (9.02%, 95% CI 8.15% to 9.89%) compared with the TRA group (3.73%, 95% CI 3.13% to 4.28%; p=0.035). CONCLUSION TRA may be a safer approach for flow diversion to treat cerebral aneurysms at a wide range of locations. Both access site complication rate and overall complication rate were lower for TRA flow diversion compared with TFA in this large series.
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Affiliation(s)
- Yangchun Li
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stephanie H Chen
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Alejandro M Spiotta
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Pascal Jabbour
- Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Michael R Levitt
- Neurological Surgery, Radiology and Mechanical Engineering and Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Christoph J Griessenauer
- Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
- Research Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Salzburg, Austria
| | - Adam S Arthur
- Department of Neurological Surgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
- Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Joshua W Osbun
- Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Min S Park
- Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Nohra Chalouhi
- Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ahmad Sweid
- Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Stacey Q Wolfe
- Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Kyle M Fargen
- Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Aaron S Dumont
- Department of Neurological Surgery, Tulane University, New Orleans, Louisiana, USA
| | - Travis M Dumont
- Neurosurgery, Neurology and Medical Imaging, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA
| | - Marie-Christine Brunet
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Samir Sur
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Evan Luther
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Allison Strickland
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Dileep R Yavagal
- Neurology and Neurosurgery, University of Miami, Miami, Florida, USA
| | - Eric C Peterson
- Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Clemens M Schirmer
- Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
- Research Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Oded Goren
- Neurosurgery, Geisinger, Danville, Pennsylvania, USA
| | - Shamsher Dalal
- Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Gregory Weiner
- Neurosurgery, Geisinger Health System, Wilkes-Barre, Pennsylvania, USA
| | - Axel Rosengart
- Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Daniel Raper
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Ching-Jen Chen
- Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Peter Amenta
- Neurological Surgery, Tulane Medical Center Downtown, New Orleans, Louisiana, USA
| | - Tyler Scullen
- Neurosurggery, Tulane University, New Orleans, Louisiana, USA
| | - Cory Michael Kelly
- Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Christopher Young
- Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Michael Nahhas
- Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Eyad Almallouhi
- Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Suhas Pai
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | | | - Mehdi Abbasi
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David Dornbos Iii
- Neurosurgery, Semmes-Murphey Clinic, Memphis, Tennessee, USA
- Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Nitin Goyal
- Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jeremy Peterson
- Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
| | - Mohammad H El-Ghanem
- Neurosurgery, Neurology and Medical Imaging, University of Arizona Health Sciences Center, Tucson, Arizona, USA
| | - Robert M Starke
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
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48
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Goldman DT, Bageac D, Mills A, Yim B, Yaeger K, Majidi S, Kellner CP, De Leacy RA. Transradial Approach for Neuroendovascular Procedures: A Single-Center Review of Safety and Feasibility. AJNR Am J Neuroradiol 2021; 42:313-318. [PMID: 33446499 DOI: 10.3174/ajnr.a6971] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In recent years, the transradial approach has become more widely adopted for neuroendovascular procedures. The purpose of this study was to evaluate the safety and feasibility of a transradial approach and distal transradial access for neuroendovascular procedures in a single center. MATERIALS AND METHODS Retrospective analysis was performed for all patients who underwent transradial approach or distal transradial access neuroendovascular procedures from January 2016 to August 2019 at a single center. Exclusion criteria included a Barbeau D waveform, a radial artery of <2 mm on sonographic evaluation, and known radial artery occlusion. Procedures were evaluated for technical success (defined as successful radial artery access and completion of the intended procedure without crossover to an auxiliary access site), complications, and adverse events during follow-up at 30 days. RESULTS The transradial approach or distal transradial access was attempted in 279 consecutive patients (58.1% women; median age, 57.7 years) who underwent 328 standard or distal transradial approach procedures. Two-hundred seventy-nine transradial approach and 49 distal transradial approach procedures were performed (cerebral angiography [n = 213], intracranial intervention [n = 64], head and neck intervention [n = 30], and stroke intervention [n = 21]). Technical success was 92.1%. Immediate adverse events (2.1%) included radial access site hematoma (n = 5), radial artery occlusion (n = 1), and acute severe radial artery spasm (n = 1). Thirty-day adverse events (0.3%) included a radial artery pseudoaneurysm (n = 1). Twenty-six cases (7.9%) required crossover to transfemoral access. CONCLUSIONS The transradial approach for neuroendovascular procedures is safe and feasible across a wide range of neuroendovascular interventions.
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Affiliation(s)
- D T Goldman
- From the Departments of Radiology (D.T.G., R.A.D.L.)
| | - D Bageac
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - A Mills
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - B Yim
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - K Yaeger
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - S Majidi
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - C P Kellner
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - R A De Leacy
- From the Departments of Radiology (D.T.G., R.A.D.L.)
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
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49
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Barranco Pons R, Rodriguez Caamaño I, de Dios Lascuevas M. Radial Access for Neurointerventions. VASCULAR AND ENDOVASCULAR REVIEW 2020. [DOI: 10.15420/ver.2020.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Transradial access (TRA) has become the standard approach for cardiac intervention, with a large body of evidence demonstrating a lower incidence of vascular complications, better patient experience and cost reduction. There has been increasing interest in using TRA both for diagnostic neuroangiography and for interventional neurovascular procedures. This aim of this article is to discuss the advantages and limitations of TRA for neurointerventions. General technical details, such as pre-procedure recommendations, prevention of spasm and occlusion, haemostasis protocols and distal TRA puncture, are also described, along with the specific technical details of TRA for aneurysm embolisation, stroke thrombectomy and other neurovascular interventions. TRA provides additional tools to the neurointerventionist and – with appropriate training – the whole spectrum of intervention procedures can be achieved using this approach.
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Affiliation(s)
- Roger Barranco Pons
- Department of Interventional Neuroradiology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Isabel Rodriguez Caamaño
- Department of Interventional Neuroradiology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Marta de Dios Lascuevas
- Department of Interventional Neuroradiology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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50
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Riyami HA, Riyami AA, Nadar SK. Comparison between two protocols for deflation of the TR band following coronary procedures via the radial route. J Saudi Heart Assoc 2020; 32:52-56. [PMID: 33154892 PMCID: PMC7640594 DOI: 10.37616/2212-5043.1009] [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: 08/31/2019] [Revised: 10/16/2019] [Accepted: 11/10/2019] [Indexed: 11/26/2022] Open
Abstract
Aim Coronary interventions are increasingly being performed via the radial rather than femoral route because of the lower complication rate. Compression devices such as the TR band are used to achieve hemostasis after the procedure. At present, there are no clear protocols for the deflation of the band. In this study we compared two protocols (early deflation with increased intervals vs. late deflation with smaller intervals) in terms of total time to band removal and complications, and patient and staff satisfaction. Methods All patients who underwent a transradial coronary procedure and had a TR band fitted were enrolled into the study. The TR band was applied using the patent hemostasis method (2 ml air pushed in after the radial pulse appears on pulse oximetry after full occlusion with 16 ml air). Patients were randomly assigned to either protocol. Protocol 1 involved removal of 2 ml of air starting 1 hour after the sheath removal and then removal of 2 ml every 30 minutes until the band came off. Protocol 2 involved removal of 4 ml of air 2 hours after the sheath removal and then further 4 ml of air every 15 minutes until the band came off. Patient and staff satisfaction was measured with a visual analogue scale. Results A total of 174 patients were recruited (mean age, 60 ± 11 years; 127 male, 47 female). The baseline characteristics including total heparin dose and type of procedure, in the two arms were the same. Protocol 2 (n = 84) was associated with a significantly lower time to TR band removal as compared to protocol 1 (n = 90; 201 ± 43 min vs. 274 ± 54 min; p < 0.001). There was no difference in complications such as bleeding or hematoma formation between the two groups. Patient satisfaction was the same between the two groups. However, the staff preferred protocol 1 (p = 0.01). Conclusion A protocol of delayed initiation of TR band deflation followed by quick deflations is associated with a lower time to band removal with no increase in bleeding complications or patient satisfaction. However, the staff preferred longer intervals between deflations.
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Affiliation(s)
- Hassan Al Riyami
- Department of Cardiology, Sultan Qaboos University Hospital, Alkhod, Muscat, Oman
| | - Adil Al Riyami
- Department of Cardiology, Sultan Qaboos University Hospital, Alkhod, Muscat, Oman
| | - Sunil K Nadar
- Department of Cardiology, Sultan Qaboos University Hospital, Alkhod, Muscat, Oman
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