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Kular S, Maiter A, Martin A, Dyde R, Waterworth A, Radatz MWR, Cahill J, Tse GH. Trans-radial cerebral angiography for stereotactic radiosurgery treatment of arteriovenous malformations. Clin Radiol 2024; 79:e941-e948. [PMID: 38710602 DOI: 10.1016/j.crad.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 03/21/2024] [Accepted: 04/06/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVES The popularity of trans-radial access (TRA) for cerebral angiography is growing. Potential benefits of TRA over traditional trans-femoral access (TFA) are multitude. This study aimed to evaluate discharge outcomes and patient opinion of TRA compared to TFA in patients undergoing cerebral angiography prior to stereotactic radiosurgery (SRS) treatment for cerebral arteriovenous malformations. METHODS Consecutive patients treated at the National Centre for Stereotactic Radiosurgery (Sheffield, United Kingdom) over a 22-month period were included. All patients underwent cerebral angiography with either TRA or TFA as part of treatment planning prior to SRS. TRA patients who had previously undergone TFA in other centres were surveyed for their experience of cerebral angiography using a questionnaire. SRS staff at our centre was approached for their opinion. RESULTS 492 patients were included (median age = 43 years, 57.5% male, median lesions treated = 1). More patients underwent angiography with TFA (75.2%) than TRA (24.8%). No difference was found in accumulated dose for angiography between the groups (p>0.05). There was 17.6% reduction in overnight stay between TRA and TRF, the proportion of patients requiring overnight admission was higher for the TFA (35.2%) than TRA (17.6%, p<0.05). 101 patients were surveyed, with a response rate of 47%. Most respondents (79%) indicated preference for TRA over TFA. CONCLUSIONS Use of TRA in pre-SRS cerebral angiography is feasible and improves both patient and staff experience. The adoption of TRA could have important implications for department resources and costs by reducing the proportion of overnight admissions.
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Affiliation(s)
- S Kular
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - A Maiter
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, UK; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, UK
| | - A Martin
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - R Dyde
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - A Waterworth
- Scientific Computing, Department of Medical Physics, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - M W R Radatz
- National Centre for Stereotactic Radiosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - J Cahill
- National Centre for Stereotactic Radiosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - G H Tse
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, UK.
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2
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Marangoni M, Macdonald IR, Pickett GE, Weeks A, Kim CN, Rohr A, Guest W, Heran MKS, Volders D. Practical uses of the BENCHMARK™ BMX®81 in the road less travelled: Guide catheter comparison for radial access in neurovascular intervention. Interv Neuroradiol 2024:15910199241261756. [PMID: 38874547 DOI: 10.1177/15910199241261756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Radial arterial access has gained interest for neurovascular procedures in recent years. Although there are no randomized control trials for neurointervention procedures using radial access, there is growing literature demonstrating its feasibility and favorable outcomes. Equipment technical improvements, like the recently introduced BENCHMARK™ BMX®81 System, have made radial navigation safer, with improved maneuverability and support for a variety of procedures. We present a multicenter case series highlighting our institutional radial access experience comparing the BMX®81 with alternative catheters. METHODS Multicenter retrospective cohort study of 80 patients who underwent neurovascular procedures through a radial approach. In half of the cases a BENCHMARK™ BMX®81 System was used. The comparison group consisted of the BENCHMARK™071 and 96, Neuron MAX®088 and BALLAST™ systems. Procedures included endovascular thrombectomy, carotid and brachiocephalic artery stenting, middle meningeal artery embolization, flow diverter stenting, vertebral artery sacrifice, aneurysm coiling, and WEB™ device deployment. RESULTS In our series, the BMX®81 was successful in the navigation of the anatomy to the target location in 95% of cases. No radial access or BMX®81 related complications were identified. There was no significant difference in fluoroscopy time between the BMX81 and the comparison group. Four patients in the comparison group had catheter-related complications due to vasospasm. Eighty-six percent of BMX®81 cases had satisfactory outcomes and no technical difficulties. The remainder presented technical difficulties, but none of these were considered secondary to the puncture site or support structure. CONCLUSIONS The BENCHMARK™ BMX®81 System is a recently developed guiding catheter which has design and size features supporting radial access for a variety of neurovascular interventions. Early multicenter experience highlights the ease of use and versatility of this new catheter as an alternative to transfemoral access as well as other catheters used for radial access.
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Affiliation(s)
- Marco Marangoni
- Division of Interventional Neuroradiology, Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Ian R Macdonald
- Division of Neuroradiology, Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Gwynedd E Pickett
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Adrienne Weeks
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Cha-Ney Kim
- Division of Interventional Neuroradiology, Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Axel Rohr
- Division of Interventional Neuroradiology, Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - William Guest
- Division of Interventional Neuroradiology, Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Manraj K S Heran
- Division of Interventional Neuroradiology, Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - David Volders
- Division of Neuroradiology, Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
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Hamilton GW, Sharma V, Yeoh J, Yudi MB, Raman J, Clark DJ, Farouque O. Ultrasound Guidance for Transradial Access in the Cardiac Catheterisation Laboratory: A Systematic Review of the Literature and Meta-Analysis. Heart Lung Circ 2024:S1443-9506(24)00617-6. [PMID: 38871531 DOI: 10.1016/j.hlc.2024.04.308] [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: 10/16/2023] [Revised: 04/25/2024] [Accepted: 04/30/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Although ultrasound (US) guidance for vascular access has been widely adopted, its use for transradial access (TRA) in the cardiac catheterisation laboratory is rare. There is a perception that US guidance does not offer a clinically relevant benefit over traditional palpation-guided TRA, amplified by inconsistent findings of individual studies. METHOD A systematic review of MEDLINE, EMBASE and the Cochrane Library identified studies comparing US to palpation-guided TRA for cardiac catheterisation. Studies evaluating radial artery (RA) cannulation for any other reason were excluded. Event rates and risk ratios (RRs) were pooled for meta-analysis. Access failure was the primary outcome. A random-effects model was used for analysis. RESULTS Of the 977 records screened, four studies with a total of 1,718 patients (861 US-guided and 864 palpation-guided procedures) were included in the meta-analysis. Most procedures were elective. The pooled analysis showed US guidance significantly lowered the risk of access failure (RR 0.45; 95% confidence interval [CI] 0.21-0.97; p=0.04). Heterogeneity was moderate (I2=51.2%; p=0.105). There was a strong trend to improved first-pass success with US (RR 1.29; 95% CI 1.00-1.66; p=0.05; I2=83.8%), although no differences were found in rates of difficult access (RR 0.29; 95% CI 0.07-1.18; p=0.09; I2=88.3%). Salvage US guidance was successful in 30/41 (73.2%) patients following failed palpation-guided TRA. No differences were found in already low complication rates including RA spasm (RR 1.18; 95% CI 0.70-1.99; p=0.53; I2=0.0%) and bleeding (RR 1.32; 95% CI 0.46-3.80; p=0.60; I2=0.0%). CONCLUSIONS US guidance was found to improve TRA success in the cardiac catheterisation laboratory. Further investigation is necessary to determine whether routine, selective, or salvage use of US confers the most RA protection, patient satisfaction, and overall clinical benefit. (PROSPERO registration: CRD42022332238).
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Affiliation(s)
- Garry W Hamilton
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia.
| | - Varun Sharma
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia; Brian F. Buxton Cardiac Surgical Unit, Austin Health, Melbourne, Vic, Australia
| | - Julian Yeoh
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia
| | - Jaishankar Raman
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia; Brian F. Buxton Cardiac Surgical Unit, Austin Health, Melbourne, Vic, Australia; Department of Cardiac Surgery, St Vincent's Hospital, Melbourne, Vic, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia
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Khirul Ashar NA, Ismail II, Lingam R, Mazlan NF, Azmi NS. A case series of forearm compartment syndrome complicating transradial cardiac catheterization. Egypt Heart J 2024; 76:68. [PMID: 38819489 PMCID: PMC11143145 DOI: 10.1186/s43044-024-00498-y] [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] [Accepted: 05/24/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Acute compartment syndrome following a transradial coronary approach is rare. However, as the incidence of coronary arterial disease increases due to lifestyle factors and multiple comorbidities, transradial coronary angiography has become more common for diagnostic and therapeutic purposes in cardiovascular centers. Despite its rarity, we encountered two cases of acute compartment syndrome within a 1-week interval in the cardiology unit of a tertiary hospital. CASE PRESENTATION The first case involved a 75-year-old woman diagnosed with non-ST elevation myocardial infarction (NSTEMI). A coronary angiogram was performed via an uncomplicated right radial artery puncture. Following the procedure, the patient experienced significant swelling in the right forearm. An emergency fasciotomy release of the right forearm was conducted, revealing a gushing hematoma upon entering the flexor compartment. Fortunately, the wound healed well two months postoperatively with no functional deficits. In the second case, an 80-year-old man presented with severe angina pectoris upon exertion and was diagnosed with NSTEMI. The following day, he developed compartment syndrome in the left forearm, necessitating an emergency fasciotomy. Intraoperative examination revealed muscle bulging within the forearm compartments accompanied by extensive hematoma. Postoperatively, a deranged coagulation profile caused oozing from the wound. However, since there was no arterial bleeding, a compression dressing was applied. This led to a gradual drop in hemoglobin levels and worsened his heart condition. Despite resuscitative efforts and attempts to correct the coagulopathy, the patient experienced cardiorespiratory arrest and succumbed to ischemic heart disease in failure. CONCLUSION Clinicians must remain vigilant in identifying this potentially limb-threatening condition. Patients with pre-existing anticoagulant therapy and underlying atherosclerotic disease are at a higher risk of bleeding complications. Implementing effective hemostasis techniques and promptly managing swelling can help prevent the occurrence of compartment syndrome. Timely assessment and maintaining a high level of clinical suspicion are paramount. If necessary, early consideration of decompressive fasciotomy is essential to avert catastrophic outcomes.
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Affiliation(s)
- Nur Ayuni Khirul Ashar
- Orthopaedic Surgery & Traumatology Department, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia.
| | - Imma Isniza Ismail
- Orthopaedic Department, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Rahul Lingam
- Orthopaedic Department, Hospital Serdang, Serdang, Selangor, Malaysia
| | | | - Nur Syahirah Azmi
- Orthopaedic Department, Hospital Serdang, Serdang, Selangor, Malaysia
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5
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Gatt V. Cath Lab nurses and technicians: key contributors to safe, effective, and quality care. Eur J Cardiovasc Nurs 2024; 23:e43-e44. [PMID: 38537626 DOI: 10.1093/eurjcn/zvae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Vincent Gatt
- Department of Cardiology, Ministry for Health and Active Aging, Malta
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6
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Toprak K, Inanır M, Memioğlu T, Palice A, Kaplangoray M, Yesilay AB, Tascanov MB, Altıparmak İH, Demirbağ R. Effect of Hand Dominance on Radial Artery Spasm and Occlusion: A Prospective Observational Study. Angiology 2024; 75:340-348. [PMID: 36745059 DOI: 10.1177/00033197231155599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Transradial access has become the most commonly used method for cardiac catheterization. Many medical and technical applications have been proposed to reduce TRA complications. The aim of this study is to examine the effect of hand dominance on radial artery spasm and radial artery occlusionin subjects undergoing CC via TRA. Between April 2020 and August 2022, 1713 subjects who underwent CC via TRA were included in the study. Patient data were obtained in terms of hand dominance of the catheterized side and RAS and RAO during a 1-month follow-up period. RAS was seen in 9.6% of the subjects. The RAS in patients catheterized by the dominant hand was significantly higher than that performed by the non-dominant hand (12 vs 7.8%; P = .004). RAO was seen in 1% of the subjects. RAO was significantly higher in the spasm side than in the no-spasm side (3 vs .8%; P = .009). Hand dominance was determined as an independent predictor of radial artery spasm (P = .006). In our study, RAS and RAO were more common on the dominant hand side than on the non-dominant side. Choosing the non-dominant hand for TRA for CC may reduce the incidence of RAS and RAO.
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Affiliation(s)
- Kenan Toprak
- Department of Cardiology, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Mehmet Inanır
- Cardiology Department, Bolu Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Tolga Memioğlu
- Cardiology Department, Bolu Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Ali Palice
- Sanliurfa Mehmet Akif İnan Training and Research Hospital, Sanlıurfa, Turkey
| | - Mustafa Kaplangoray
- Sanliurfa Mehmet Akif İnan Training and Research Hospital, Sanlıurfa, Turkey
| | - Asuman Biçer Yesilay
- Department of Cardiology, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | | | | | - Recep Demirbağ
- Department of Cardiology, Harran University Faculty of Medicine, Sanliurfa, Turkey
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7
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Hernandez D, Requena M, Olivé-Gadea M, de Dios M, Gramegna LL, Muchada M, García-Tornel Á, Diana F, Rizzo F, Rivera E, Rubiera M, Piñana C, Rodrigo-Gisbert M, Rodríguez-Luna D, Pagola J, Carmona T, Juega J, Rodríguez-Villatoro N, Molina C, Ribo M, Tomasello A. Radial Versus Femoral Access for Mechanical Thrombectomy in Patients With Stroke: A Noninferiority Randomized Clinical Trial. Stroke 2024; 55:840-848. [PMID: 38527149 DOI: 10.1161/strokeaha.124.046360] [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: 01/02/2024] [Accepted: 01/25/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Transfemoral access is predominantly used for mechanical thrombectomy in patients with stroke with a large vessel occlusion. Following the interventional cardiology guidelines, routine transradial access has been proposed as an alternative, although its safety and efficacy remain controversial. We aim to explore the noninferiority of radial access in terms of final recanalization. METHODS The study was an investigator-initiated, single-center, evaluator-blinded, noninferiority randomized clinical trial. Patients with stroke undergoing mechanical thrombectomy, with a patent femoral artery and a radial artery diameter ≥2.5 mm, were randomly assigned (1:1) to either transradial (60 patients) or transfemoral access (60 patients). The primary binary outcome was the successful recanalization (expanded Treatment in Cerebral Ischemia score, 2b-3) assigned by blinded evaluators. We established a noninferiority margin of -13.2%, considering an acceptable reduction of 15% in the expected recanalization rates. RESULTS From September 2021 to July 2023, 120 patients were randomly assigned and 116 (58 transradial access and 58 transfemoral access) with confirmed intracranial occlusion on the initial angiogram were included in the intention-to-treat analysis. Successful recanalization was achieved in 51 (87.9%) patients assigned to transfemoral access and in 56/58 (96.6%) patients assigned to transradial (adjusted 1 side risk difference [RD], -5.0% [95% CI, -6.61% to +13.1%]) showing noninferiority of transradial access. Median time from angiosuite arrival to first pass (femoral, 30 [interquartile range, 25-37] minutes versus radial: 41 [interquartile range, 33-62] minutes; P<0.001) and from angiosuite arrival to recanalization (femoral: 42 (IQR, 28-74) versus radial: 59.5 (IQR, 44-81) minutes; P<0.050) were longer in the transradial access group. Both groups presented 1 severe access complication and there was no difference in the rate of access conversion: transradial 7 (12.1%) versus transfemoral 5 (8.6%) (P=0.751). CONCLUSIONS Among patients who underwent mechanical thrombectomy, transradial access was noninferior to transfemoral access in terms of final recanalization. Procedural delays may favor transfemoral access as the default first-line approach. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05225636.
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Affiliation(s)
- David Hernandez
- Neuroradiologia Intervencionista (D.H., M. Requena, M.d.D., F.D., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Manuel Requena
- Neuroradiologia Intervencionista (D.H., M. Requena, M.d.D., F.D., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Marta Olivé-Gadea
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Marta de Dios
- Neuroradiologia Intervencionista (D.H., M. Requena, M.d.D., F.D., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Laura Ludovica Gramegna
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Marian Muchada
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Álvaro García-Tornel
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Francesco Diana
- Neuroradiologia Intervencionista (D.H., M. Requena, M.d.D., F.D., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Federica Rizzo
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Eila Rivera
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Marta Rubiera
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Carlos Piñana
- Interventional Radiology Unit, Hospital Clínico Universitario de Valencia, Spain (C.P.)
| | - Marc Rodrigo-Gisbert
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - David Rodríguez-Luna
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Jorge Pagola
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Tomás Carmona
- Neurosurgery Department, Hospital San Pablo, Coquimbo, Chile (T.C.)
| | - Jesús Juega
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Noelia Rodríguez-Villatoro
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Carlos Molina
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Marc Ribo
- Unitat d'Ictus (M. Requena, M.O.-G., M.M., A.G.-T., F.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
| | - Alejandro Tomasello
- Neuroradiologia Intervencionista (D.H., M. Requena, M.d.D., F.D., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Grup de Recerca en Ictus, Vall d'Hebron Insitut de Recerca, Barcelona, Spain (D.H., M. Requena, M.O.-G., M.d.D., L.L.G., M.M., A.G.-T., F.D., F.R., E.R., M. Rubiera, M.R.-G., D.R.-L., J.P., J.J., N.R.-V., C.M., M.R., A.T.)
- Departament de Medicina, Universitat Autonoma de Barcelona, Spain (A.T.)
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8
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Durães Campos I, Galvão Braga C, Costa J, Quina Rodrigues C, Vieira C, Marques J. A simple and easy technique to overcome anatomic challenges of transradial access in STEMI patients. Curr Probl Cardiol 2024; 49:102436. [PMID: 38309545 DOI: 10.1016/j.cpcardiol.2024.102436] [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: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Transradial access (TRA) is associated with fewer access-related complications, earlier discharge and lower mortality than transfemoral access (TFA), being the preferred route to perform primary percutaneous coronary interventions (PPCIs) in STEMI patients. However, the radial artery is smaller, more superficial and thinner than the femoral artery, which may make PPCIs difficult. PURPOSE This study describes a practical solution to overcome several of the anatomical difficulties during the TRA, demonstrating its outcomes during clinical practice. METHODS The authors reviewed the clinical records of 1510 STEMI patients who underwent PPCIs over seven years. Of these, 95 (6.3%) patients experienced problems in advancing a 6F guiding catheter and underwent to STR technique. This technique consists in the use of a longer 5Fr STR flush catheter, which can be used as a "child" type rapid exchange catheter inside the 6Fr guiding catheter, adopting a 5-in-6 Fr technique and creating a smooth distal tip transition of the 6Fr guiding catheter. RESULTS In 89/95 patients (93.7%), this new technique was successful. The majority of these patients were female (51; 53.7%) and the mean age was 67 ± 14.3 years. The mean reperfusion time since arrival at the catheterization laboratory with STR technique was 24.5 ± 9.9 min, being statistically shorter than when a crossover to TFA was used (29.3 ± 9.5 min; p < 0.017). PPCIs were successfully completed in all different coronary arteries, without complications related to the procedure. CONCLUSIONS The STR technique is a simple and useful approach that allowed more successful passage of guiding catheters through difficult TRA, allowing a reduction of crossover to TFA in this study to 2.4 %, which translates into a shorter reperfusion time.
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Affiliation(s)
- Isabel Durães Campos
- Department of Intensive Care Medicine of Centro Hospitalar Universitário São João, Porto, Portugal.
| | | | - João Costa
- Department of Cardiology of Hospital de Braga, Braga, Portugal
| | | | - Catarina Vieira
- Department of Cardiology of Hospital de Braga, Braga, Portugal
| | - Jorge Marques
- Department of Cardiology of Hospital de Braga, Braga, Portugal
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9
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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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10
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Ghanem I, Mesbah M, Refaat H. Safety and efficacy of brachial approach for coronary angiography and percutaneous coronary intervention. Egypt Heart J 2024; 76:36. [PMID: 38530485 DOI: 10.1186/s43044-024-00466-6] [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: 06/06/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND There are many percutaneous coronary approaches. The most commonly used one is the radial artery because of its lowest risk of adverse vascular events. However, it could not be an option in some situations as congenital radial artery hypoplasia and spasm. In these cases, the second most common access is the femoral artery. The current literature over the brachial artery access is controversial. Thus, the aim of this study was to verify the brachial artery approach's effectiveness and safety. RESULTS We studied 300 patients who underwent elective coronary angiography and angioplasty in our institution with failed radial access between August 2022 and February 2023. They were classified into two groups; 150 patients with brachial access and 150 with femoral access. Access, procedural and fluoroscopy times were recorded. All patients were examined carefully immediately after the procedure and before discharge to assess any complications. Left brachial access was used more frequently than left femoral access (32.7% vs. 22.7%, P = 0.05), but no significant difference noted regarding right sided or bilateral access. Procedure time, fluoroscopy time, and contrast volume did not significantly differ (P = 0.19, 0.06 and 0.1 respectively). However, brachial group had shorter access time (2.6 ± 1.1 vs. 3.4 ± 0.7 min, P = 0.05) and hospital stay (3.5 ± 1.1 vs. 5.9 ± 1.3 days, P < 0.001). Regarding major and minor complications (especially hematomas), they were significantly less in the brachial arm (P = 0.04 and P = 0.05, respectively). CONCLUSIONS Brachial access is a safe, efficient and non-inferior to the femoral route for coronary intervention whenever radial access is not an option.
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Affiliation(s)
- Islam Ghanem
- Cardiology Department, Zagazig University, Zagazig, Egypt
| | - Mohamed Mesbah
- Cardiology Department, Zagazig University, Zagazig, Egypt
| | - Hesham Refaat
- Cardiology Department, Zagazig University, Zagazig, Egypt.
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11
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Xu L, Lu W, Shi G, Li W, Xiao J, Yang A, Li F, Cai G. Comparison of Long-Term Prognoses of Percutaneous Coronary Intervention via Distal Transradial and Conventional Transradial Access for Acute Coronary Syndrome. Hellenic J Cardiol 2024:S1109-9666(24)00056-3. [PMID: 38453013 DOI: 10.1016/j.hjc.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/28/2024] [Accepted: 03/01/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Distal transradial access (dTRA) has recently emerged as a new vascular access alternative for coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). However, published data on long-term mortality and major adverse cardiac events after PCI via dTRA are inconclusive. The aim of this study was to compare the long-term prognoses of PCI via dTRA and conventional transradial access (cTRA) for acute coronary syndrome (ACS) after 1-3 years of follow-up. METHODS Patients who were diagnosed with ACS and underwent PCI between January 1, 2020, and December 31, 2021, were retrospectively enrolled. The patients were divided into two groups at a 1:1 ratio, subjected to propensity score matching (PSM) and then followed for 1-3 years after PCI. Cox proportional hazards regression was used to evaluate the relationship between the two access sites and clinical outcomes. RESULTS Among the 550 patients in the dTRA and cTRA groups, 11 (4.0%) and 19 (6.9%) died during the observation period, respectively. dTRA and cTRA had similar risks of all-cause mortality [hazard ratio (HR) =0.688; 95% CI=0.323-1.463; P=0.331] and major adverse cardiac events (MACEs, HR=0.806, 95% CI= 0.515-1.263; P=0.347) after PCI. The risk of cardiovascular mortality (HR=0.330, 95% CI= 0.107-1.105; P=0.053), TLR-MACEs (HR= 0.587, 95% CI=0.339-1.109; P=0.058), and unplanned revascularization (HR= 0.860, 95% CI=0.483-1.529; P=0.606) were not significantly different between the two groups. CONCLUSIONS PCI via dTRA has the same long-term prognoses as PCI via cTRA in ACS patients, and the compression time and bleeding rate are lower than those in patients undergoing PCI via cTRA.
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Affiliation(s)
- Lingxia Xu
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2nd North Yong ning Road, Tian ning District, Changzhou 213017, Jiangsu Province, China.
| | - Wei Lu
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2(nd) North Yong ning Road, Tian ning District, Changzhou 213017, Jiangsu Province, China.
| | - Ganwei Shi
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2(nd) North Yong ning Road, Tian ning District, Changzhou 213017, Jiangsu Province, China.
| | - Wenhua Li
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2(nd) North Yong ning Road, Tian ning District, Changzhou 213017, Jiangsu Province, China.
| | - Jianqiang Xiao
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2(nd) North Yong ning Road, Tian ning District, Changzhou 213017, Jiangsu Province, China.
| | - Anni Yang
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2(nd) North Yong ning Road, Tian ning District, Changzhou 213017, Jiangsu Province, China.
| | - Feng Li
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2(nd) North Yong ning Road, Tian ning District, Changzhou 213017, Jiangsu Province, China.
| | - Gaojun Cai
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2(nd) North Yong ning Road, Tian ning District, Changzhou 213017, Jiangsu Province, China
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12
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Perng PS, Chang Y, Wang HK, Huang YT, Wong CE, Chi KY, Lee JS, Wang LC, Huang CY. Systematic Review and Meta-analysis of Radial or Femoral Access for Carotid Stenting. Clin Neuroradiol 2024; 34:3-12. [PMID: 37401948 DOI: 10.1007/s00062-023-01315-w] [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: 02/25/2023] [Accepted: 05/23/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE There is a growing interest in performing coronary artery and neurovascular interventions via the radial artery; however, few studies have examined the outcomes of transradial carotid stenting. Therefore, our study aimed to compare cerebrovascular outcomes and crossover rates in carotid stenting between transradial and traditional transfemoral approaches. METHODS A systematic review was performed by searching three electronic databases from inception to June 2022 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In addition, random effect meta-analysis was used to pool the odds ratios (ORs) for stroke, transient ischemic attack, major adverse cardiac events, death, major vascular access site complications, and procedure crossover rates between the transradial and transfemoral approaches. RESULTS A total of 6 studies were included involving a total of n = 567 transradial and n = 6176 transfemoral procedures. The ORs for stroke, transient ischemic attack, and major adverse cardiac events were 1.43 (95% confidence interval, CI 0.72-2.86, I2 = 0), 0.51 (95% CI 0.17-1.54, I2 = 0), and 1.08 (95% CI 0.62-1.86, I2 = 0), respectively. Neither the major vascular access site complication rate (OR 1.11, 95% CI 0.32-3.87, I2 = 0) nor crossover rate (OR 3.94, 95% CI 0.62-25.11, I2 = 57%) showed statistically significant differences between the two approaches. CONCLUSION The modest quality of the data suggested comparable procedural outcomes between the transradial and transfemoral approaches when performing carotid stenting; however, high level evidence regarding postoperative brain images and risk of stroke in transradial carotid stenting are lacking. Therefore, it is reasonable for interventionists to weigh up the risks of neurological events and potential benefits, including fewer access site complications, before choosing the radial or femoral arteries as access sites. Future large-scale randomized controlled trials are imperative.
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Affiliation(s)
- Pang-Shuo Perng
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, 70428, Tainan, Taiwan
| | - Yu Chang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, 70428, Tainan, Taiwan
| | - Hao-Kuang Wang
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-En Wong
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, 70428, Tainan, Taiwan
| | - Kuan-Yu Chi
- Department of internal medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jung-Shun Lee
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, 70428, Tainan, Taiwan
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Liang-Chao Wang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, 70428, Tainan, Taiwan
| | - Chih-Yuan Huang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, 70428, Tainan, Taiwan.
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13
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Achim A, Ruzsa Z. The distal radial artery: Versatile vascular access for transcatheter interventions. J Vasc Access 2024; 25:415-422. [PMID: 38477132 DOI: 10.1177/11297298221118235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Conventional transradial access has been established as the gold standard for invasive coronary angiography and percutaneous interventions by the current European and American guidelines. The distal or snuffbox radial artery access represents an alternative transradial access site that allows radial sheath insertion with the patient's hand pronated. Firstly described 40 years ago, it exploded in popularity only recently. Promising additional benefits, the distal radial access is increasingly being adopted in various types of percutaneous interventions, being preferred by many interventional cardiologists and radiologists for its reduced vascular complications and time to hemostasis, and improvement of patient and operator comfort. Other centers consider it a fad, waiting for solid clear evidence and benefits. The evidence is dynamic and discrepant, depending on the center, the operator, and how it was collected (randomized controlled vs observational studies). Another essential aspect raised by "skeptics" was whether distal radial access, by its smaller diameter and more angled course, can support all types of interventions. The aim of this review is to gather all the scenarios where distal radial access has been utilized and to conclude whether this vascular access is feasible across all transcatheter interventions.
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Affiliation(s)
- Alexandru Achim
- Department of Interventional Cardiology, Medicala 1 Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Klinik für Kardiologie, Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal, Switzerland
- Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Zoltan Ruzsa
- Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
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14
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Morsi RZ, Kothari SA, Thind S, Desai H, Polster SP, Goldenberg F, Coleman E, Brorson JR, Mendelson S, Mansour A, Prabhakaran S, Kass-Hout T. The Zoom RDL radial access system for neurointervention: An early single-center experience. J Neurointerv Surg 2024; 16:266-271. [PMID: 37236781 DOI: 10.1136/jnis-2023-020153] [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: 02/01/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The transradial approach (TRA) for neurointerventional procedures is increasingly being used given its technical feasibility and safety. However, catheter trackability and device deliverability are reported barriers to TRA adoption. METHODS This is the first report describing the technical feasibility and performance of using the Zoom RDL Radial Access System (Imperative Care, Inc., Campbell, CA) in 29 patients who underwent neurointerventional procedures from October 2022 to January 2023 in a single-center institution. RESULTS Mean age of the study population was 61.9±17.2 years, 79.3% were male (23/29), and 62.1% were black (18/29). The most common procedures were stroke thrombectomy (31.0%, 9/29) and aneurysm embolization (27.6%, 8/29). All the stroke thrombectomy procedures were successfully performed; first-pass effect rate (mTICI≥2 c in one pass) was achieved in 66.7% (6/9) of cases. We used TRA in 86.2% of cases (25/29), including distal radial/snuffbox access in 31.0% (9/29) of cases. The radial diameter was >2 mm for all cases. An intermediate/aspiration catheter was used in 89.7% (26/29) of cases. Access success was achieved in 89.7% of cases (26/29); two cases required conversion from TRA to transfemoral approach (6.9%) and one case required conversion to a different guide catheter (3.4%). There were no access site complications or other Zoom RDL-related complications. One intracerebral hemorrhage, and one procedure-related thrombus were observed. CONCLUSIONS The use of Zoom RDL Radial Access System is technically feasible and effective for complex neurointerventional procedures with low complication rates.
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Affiliation(s)
- Rami Z Morsi
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Sachin A Kothari
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Sonam Thind
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Harsh Desai
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Sean P Polster
- Neurovascular Surgery Program, Department of Neurosurgery, University of Chicago, Chicago, Illinois, USA
| | | | - Elisheva Coleman
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - James R Brorson
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Scott Mendelson
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Ali Mansour
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Tareq Kass-Hout
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
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Ortega-Paz L, Mehran R, Angiolillo DJ. North American perspective on the 2023 European Society of Cardiology guidelines for the management of acute coronary syndromes. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:165-172. [PMID: 38092517 DOI: 10.1093/ehjacc/zuad153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 02/10/2024]
Affiliation(s)
- Luis Ortega-Paz
- Division of Cardiology, University of Florida College of Medicine, 655 West 8th Street, Jacksonville, FL 32209, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NewYork, NY, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, 655 West 8th Street, Jacksonville, FL 32209, USA
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Seecheran NA, Leyva Quert AY, Seecheran VK, Seecheran RV, Katwaroo A, Jagdeo CL, Rafeeq S, Ramcharan P, Peram L, Ramlal R, Ramlackhansingh A, Giddings S, Sandy S. Effectiveness and Safety of Left Distal Transradial Access in Coronary Procedures in the Caribbean. Cureus 2024; 16:e54601. [PMID: 38384868 PMCID: PMC10880138 DOI: 10.7759/cureus.54601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION This retrospective study investigated the effectiveness and safety of left distal transradial access (LDTRA) in patients with cardiovascular disease in Trinidad undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). METHOD Procedural parameters, including technical success and safety outcomes such as vascular complications and radial artery occlusion (RAO), were assessed in 111 consecutive patients undergoing CAG or PCI from January 2023 to June 2023 at the Eric Williams Medical Sciences Complex, Trinidad and Tobago. Eighty-eight patients underwent LDTRA, while 23 received left transradial access (LTRA). RESULTS There was no difference in procedural success with LDTRA compared to LTRA, 90.9% vs. 100%, p-value 0.202, non-significant (ns). LDTRA was associated with shorter fluoroscopy times (8.4 ± 6.8 minutes vs. 12.4 ± 7.7 minutes, p-value = 0.02), procedural duration (26.7 ± 18 minutes vs. 35.8 ± 20 minutes, p-value = 0.04), and hemostasis time (142 ± 41 minutes vs. 186 ± 44 minutes, p-value < 0.05). There were no significant differences in procedural-related complications (8% for LDTRA vs. 4.3% for LTRA, p-value = 0.476, ns). There were no reported cases of RAO. In the subgroup of patients with prior coronary artery bypass grafting (CABG), the fluoroscopy and procedure times were similar for both access sites; however, LDTRA was associated with a shorter hemostasis time (128 ± 30 minutes vs. 194 ± 39 minutes, p-value = 0.01). CONCLUSIONS LDTRA is effective and safe for coronary procedures and is associated with a shorter hemostasis time. This study may prove clinically pertinent in a limited-resource Caribbean setting.
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Affiliation(s)
- Naveen A Seecheran
- Clinical Medical Sciences, The University of the West Indies, St. Augustine, TTO
| | | | | | | | - Arun Katwaroo
- Internal Medicine, Trinidad Institute of Medical Technology, St. Augustine, TTO
| | - Cathy-Lee Jagdeo
- Cardiology, Eric Williams Medical Sciences Complex, Mt. Hope, TTO
| | - Salma Rafeeq
- Cardiology, Eric Williams Medical Sciences Complex, Mt. Hope, TTO
| | - Priya Ramcharan
- Cardiology, Eric Williams Medical Sciences Complex, Mt. Hope, TTO
| | | | - Ravi Ramlal
- Cardiology, Eric Williams Medical Sciences Complex, Mt. Hope, TTO
| | - Anil Ramlackhansingh
- Clinical Medical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Stanley Giddings
- Clinical Medical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Sherry Sandy
- Clinical Medical Sciences, The University of the West Indies, St. Augustine, TTO
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Bianchini F, Lombardi M, Ricchiuto A, Paraggio L, Aurigemma C, Romagnoli E, Trani C, Burzotta F. Combined ultrasound and angiographic guidance to facilitate transradial access procedures. Catheter Cardiovasc Interv 2024; 103:443-454. [PMID: 38173287 DOI: 10.1002/ccd.30947] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
The introduction of transradial access for percutaneous coronary diagnostic and interventional procedures has led to a decrease in access site complications. The aim of this paper is to propose a combined stepwise technical approach where real time ultrasound ("echo-first" approach) can be used to select the best vascular access and, together with angiography, to manage the potential obstacles that may occur during transradial procedures. In each section, we summarize some tips and tricks based on both our experience and current literature that can be easily implemented in daily practice to increase the success of transradial procedures.
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Affiliation(s)
- Francesco Bianchini
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Lombardi
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alfredo Ricchiuto
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lazzaro Paraggio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Barbosa RR, De Barros L, Sylvestre RC, Belloti VL, de Oliveira GF, Ferraz RD, de Aragão BP, Calil OA, Serpa R, Barbosa LFM. Distal Transradial Access in the Anatomical Snuffbox for Interventional Coronary Procedures: Analysis of Access Site Pain and Complications. Cureus 2024; 16:e54878. [PMID: 38533145 PMCID: PMC10965110 DOI: 10.7759/cureus.54878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION A novel arterial access distally on the radial artery through the anatomical snuffbox has been recently described for coronary interventional procedures. However, there is insufficient data comparing the advantages and limitations of distal transradial access (dTRA), conventional transradial access (TRA), and transfemoral access (TFA). The aim of this study was to compare the three access sites regarding local pain and complications during or after coronary interventional procedures. METHODS This prospective observational single-center study included 211 patients undergoing cardiac catheterization or percutaneous coronary intervention, divided into three groups: dTRA (n=69), TRA (n=71), and TFA (n=71). The access site was chosen at the discretion of three operators. We administered a questionnaire to all patients, addressing local pain or discomfort during or after the procedure and the occurrence of possible complications such as distal pallor, local bleeding, and purple color on the access site. RESULTS Pain on the access site during the procedure was reported more frequently in the TRA group (dTRA 15.9% vs. TRA 32.4% vs. TFA 15.5%). There were no differences in the occurrence of local pain after the procedure in all three groups (29.6% in the dTRA group, 28.2% in the TRA group, and 26.8% in the TFA group). Pain intensity, when it occurred, was higher in the dTRA group (dTRA 5.8 vs. TRA 4.8 vs. TFA 4.6 on a 1-10 scale), as was its duration (dTRA 13.7 vs. TRA 7.6 vs. TFA 8.2 days). Only two local bleeding events were reported, both in the TFA group. No major complications were recorded. CONCLUSION The occurrence of local pain on the puncture site after coronary interventional procedures did not differ among the three groups. The dTRA group presented a lower incidence of pain during the procedure when compared to TRA and a lower incidence of purple color when compared to TFA. However, pain intensity and duration were higher in the dTRA group when pain was reported. Using dTRA for coronary procedures is a feasible and safe strategy in selected cases.
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Affiliation(s)
- Roberto R Barbosa
- Cardiology, Hospital Santa Casa de Misericórdia de Vitória, Vitória, BRA
| | - Lucas De Barros
- Cardiology, Hospital Santa Casa de Misericórdia de Vitória, Vitória, BRA
| | | | - Vítor L Belloti
- Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, BRA
| | | | - Rodrigo D Ferraz
- Internal Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, BRA
| | - Bruno P de Aragão
- Internal Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, BRA
| | - Osmar A Calil
- Cardiology, Hospital Santa Casa de Misericórdia de Vitória, Vitória, BRA
| | - Renato Serpa
- Cardiology, Hospital Santa Casa de Misericórdia de Vitória, Vitória, BRA
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19
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Guimaraes M, Fischman A, Yu H, Tasse J, Stewart J, Pereira K. The RAVI registry: prospective, multicenter study of radial access in embolization procedures - 30 days follow up. CVIR Endovasc 2024; 7:15. [PMID: 38289433 PMCID: PMC10828405 DOI: 10.1186/s42155-023-00415-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/05/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND There is a lack of registry studies about transradial access (TRA) outcomes. This prospective registry evaluated the TRA and procedure outcomes of visceral embolizations performed via TRA with 30-day follow-up. MATERIAL & METHODS Prospective, multicenter registry included uterine fibroids (UFE), prostate artery (PAE), liver tumors (LT), and other hypervascular tumors (OHT) embolization performed in six US hospitals. Between February 2020 and January 2022, 99 patients underwent one radial artery visceral intervention (RAVI); 70 had UFE (70.7%), 16 PAE (16.2%), 7 LT (7.1%), and 6 OHT (6.1%). The mean age was 50.1 (±11.1) years, and 74/99 (74.7%) were females. The primary safety endpoints included hand ischemia, stroke, and death. Procedural success was defined as completing the intended procedure via radial artery (RA) access. Technical success was defined as the successful delivery of HydroPearl™ microspheres and complete embolization of the target vessel. RESULTS Procedural and technical successes were 100% and 97%, respectively. There was no stroke, hand ischemia, radial-to-femoral conversion, access-related serious adverse events, or clinically evident radial artery occlusion at 30 days. There were two deaths: one respiratory failure and one progression of liver disease. Minor RA-related adverse event included arterial spasm, hematoma, and post-procedure discomfort. CONCLUSION This prospective, multicenter, open-label registry confirmed the high safety profile and effectiveness of radial access in UFE, PAE, LT, and OHT embolization procedures without stroke, hand ischemia, or access-related serious adverse events at 30-day follow-up.
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Affiliation(s)
- Marcelo Guimaraes
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive MSC 226, Room 3304, Charleston, SC, 29425, USA.
| | - Aaron Fischman
- Department of Diagnostic, Molecular and Interventional Radiology, Urology and Surgery, Icahn School of Medicine, Mt. Sinai Hospital, New York City, NY, USA
| | - Hyeon Yu
- Department of Radiology, Division of Interventional Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Jordan Tasse
- Department of Diagnostic Radiology and Nuclear Medicine, Division of Interventional Radiology, Rush University Medical College, Chicago, IL, USA
| | - Jessica Stewart
- Department of Radiology, Division of Interventional Radiology, University of North Carolina, Chapel Hill, NC, USA
- Department of Radiology, Division of Interventional Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Keith Pereira
- Division of Interventional Radiology, St. Louis University School of Medicine, St. Louis, MO, USA
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20
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Ye Y, Hao Y, Zhao X, Liu J, Yang N, Smith SC, Huo Y, Fonarow GC, Ge J, Morgan L, Sun Z, Hu D, Yang Y, Ma CS, Zhao D, Han Y, Liu J, Zeng Y. Percutaneous Coronary Intervention in Acute Coronary Syndrome with Mild-to-Moderate Thrombocytopenia. Thromb Haemost 2024. [PMID: 38081311 DOI: 10.1055/a-2225-5263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND Baseline thrombocytopenia is commonly observed in patients with acute coronary syndrome (ACS) requiring percutaneous coronary intervention (PCI). AIM The purpose of this analysis was to investigate safety and effectiveness of PCI in ACS patients with baseline mild-to-moderate thrombocytopenia. METHODS The data were collected from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome project. A total of 50,009 ACS patients were recruited between July 2017 and December 2019. Among them, there were 6,413 patients with mild-to-moderate thrombocytopenia, defined as a platelet count of ≥50 × 109/L and <150 × 109/L on admission. The primary outcome was in-hospital net adverse clinical events (NACE), consisting of major adverse cardiac events (MACE) and major bleeding events. The associations between PCI and in-hospital outcomes were analyzed by inverse probability treatment weighting (IPTW) method. RESULTS PCI was performed in 4,023 of 6,413 patients (62.7%). The IPTW analysis showed that PCI was significantly associated with a reduced risk of in-hospital MACE (odd ratio [OR]: 0.45; 95% confidence interval [CI]: 0.31-0.67; p < 0.01) and NACE (OR: 0.59; 95% CI: 0.42-0.83; p < 0.01). PCI was also associated with an increased risk of any bleeding (OR: 1.56; 95% CI: 1.09-2.22; p = 0.01) and minor bleeding (OR: 1.52; 95% CI: 1.00-2.30; p = 0.05), but not major bleeding (OR: 1.51; 95% CI: 0.76-2.98; p = 0.24). CONCLUSION Compared with medical therapy alone, PCI is associated with better in-hospital outcomes in ACS patients with mild-to-moderate thrombocytopenia. Further studies with long-term prognosis are needed.
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Affiliation(s)
- Yicong Ye
- Department of Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
| | - Yongchen Hao
- Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
| | - Xiliang Zhao
- Department of Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
| | - Jun Liu
- Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
| | - Na Yang
- Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
| | - Sidney C Smith
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Gregg C Fonarow
- Division of Cardiology, Geffen School of Medicine at University of California, Los Angeles, California, United States
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Fudan University, Zhongshan Hospital, Shanghai, China
| | - Louise Morgan
- International Quality Improvement Department, American Heart Association, Dallas, Texas, United States
| | - Zhaoqing Sun
- Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
| | - Danqing Hu
- Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
| | - Yiqian Yang
- Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
| | - Dong Zhao
- Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
| | - Yaling Han
- Department of Cardiology, Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Jing Liu
- Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
| | - Yong Zeng
- Department of Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
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21
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Rehan R, Beltrame J, Yong A. Insights into the invasive diagnostic challenges of coronary artery vasospasm - A systematic review. J Cardiol 2024; 83:8-16. [PMID: 37541429 DOI: 10.1016/j.jjcc.2023.07.020] [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: 05/11/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/06/2023]
Abstract
Coronary provocation testing is an essential diagnostic procedure when evaluating vasospastic angina. Invasive methods using acetylcholine or ergonovine are considered the current gold standard. Despite efforts from global cardiovascular institutions, current protocols vary in dosage, administration time, and procedural approach. In addition, concerns over the specificity of findings and potential complications have limited routine uptake of this procedure in clinical practice. This systematic review evaluates current diagnostic protocols, focusing on invasive provocation testing. We included studies using intracoronary provocation testing with acetylcholine or ergonovine for the assessment of coronary artery vasospasm that detailed specific elements of the procedure (dosage, administration time, etc.) and included ≥50 patients. A total of 28 articles met strict inclusion criteria. Our review highlights the heterogeneity between current diagnostic protocols for invasive provocation testing. We believe standardization of a diagnostic protocol will encourage both current and future cardiologists to incorporate such procedures in the evaluation of variant angina.
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Affiliation(s)
- Rajan Rehan
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Department of Cardiology, Concord Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - John Beltrame
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Central Adelaide Local Health Network, Adelaide, South Australia, Australia; Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
| | - Andy Yong
- Department of Cardiology, Concord Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.
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22
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Katsaros O, Apostolos A, Ktenopoulos N, Koliastasis L, Kachrimanidis I, Drakopoulou M, Korovesis T, Karanasos A, Tsalamandris S, Latsios G, Synetos A, Tsioufis K, Toutouzas K. Transcatheter Aortic Valve Implantation Access Sites: Same Goals, Distinct Aspects, Various Merits and Demerits. J Cardiovasc Dev Dis 2023; 11:4. [PMID: 38248874 PMCID: PMC10817029 DOI: 10.3390/jcdd11010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/03/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has been established as a safe and efficacious treatment for patients with severe symptomatic aortic stenosis (AS). Despite being initially developed and indicated for high-surgical-risk patients, it is now offered to low-risk populations based on the results of large randomized controlled trials. The most common access sites in the vast majority of patients undergoing TAVI are the common femoral arteries; however, 10-20% of the patients treated with TAVI require an alternative access route, mainly due to peripheral atherosclerotic disease or complex anatomy. Hence, to achieve successful delivery and implantation of the valve, several arterial approaches have been studied, including transcarotid (TCr), axillary/subclavian (A/Sc), transapical (TAp), transaortic (TAo), suprasternal-brachiocephalic (S-B), and transcaval (TCv). This review aims to concisely summarize the most recent literature data and current guidelines as well as evaluate the various access routes for TAVI, focusing on the indications, the various special patient groups, and the advantages and disadvantages of each technique, as well as their adverse events.
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Affiliation(s)
- Odysseas Katsaros
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Anastasios Apostolos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Nikolaos Ktenopoulos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Leonidas Koliastasis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
- Department of Cardiology, University of Brussels, CHU Saint-Pierre, 1000 Brussels, Belgium
| | - Ioannis Kachrimanidis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Maria Drakopoulou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Theofanis Korovesis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Antonios Karanasos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Sotirios Tsalamandris
- Department of Cardiology, Hippokration General Hospital of Athens, 11527 Athens, Greece;
| | - George Latsios
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Andreas Synetos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
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23
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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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24
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Leesar MA, Waheed S, Al Solaiman F, Chatterjee A, Daya HA, Hage FG, Brott BC. Randomized trial of an oblique versus standard fluoroscopic-guided micropuncture technique for femoral arterial access: The Micropuncture-CFA trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 57:43-50. [PMID: 37414613 DOI: 10.1016/j.carrev.2023.06.029] [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: 04/01/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND The anterior-posterior fluoroscopic guidance (the AP technique) is a standard method for common femoral artery (CFA) access, but the rate of CFA access with ultrasound vs. the AP technique was not significantly different. We have shown an oblique fluoroscopic guidance (the oblique technique) with a micropuncture needle (MPN) resulted in CFA access in 100 % of patients. The outcome of the oblique vs. AP technique is unknown. We compared the utilities of the oblique vs. AP technique for CFA access with a MPN in patients undergoing coronary procedures. METHODS A total of 200 patients were randomized to the oblique vs. AP technique. Using the oblique technique, a MPN was advanced to the mid pubis in the 20° ipsilateral right-or left anterior oblique view with fluoroscopic guidance and the CFA was punctured. In the AP technique, a MPN was advanced to the mid femoral head in the AP view with fluoroscopic guidance and the CFA was punctured. The primary endpoint was the rate of successful access to the CFA. RESULTS The rates of first pass and CFA access were higher with the oblique vs. AP technique (82 % vs. 61 %, and 94 % vs. 81 %, respectively; P < 0.01). The number of needle punctures was lower with the oblique vs. AP technique (1.1 ± 0.39 vs. 1.4 ± 0.78, respectively; P < 0.01). In high CFA bifurcations, the rate of CFA access was higher with the oblique vs. AP technique (76 % vs. 52 %, respectively; P < 0.01). Vascular complications were lower with the oblique vs. AP technique (1 % vs. 7 %, respectively; P < 0.05). CONCLUSIONS Our data suggest that the oblique technique, compared with the AP technique, significantly increased the rates of first pass and access to the CFA, and decreased the number of punctures and vascular complication. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03955653.
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Affiliation(s)
- Massoud A Leesar
- Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America.
| | - Salman Waheed
- Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America; Division of Cardiology, University of Illinois, Chicago, IL, United States of America
| | - Firas Al Solaiman
- Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America
| | - Arka Chatterjee
- Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America; Division of Cardiology, Banner-University Medical Center in Tucson, AZ, United States of America
| | - Hussein Abu Daya
- Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America
| | - Fadi G Hage
- Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America
| | - Brigitta C Brott
- Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America
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Tsigkas GG, Moulias AΙ, Spyropoulou PN, Almpanis GC, Stavrou K, Trigka-Vasilakopoulou AA, Chamakioti MD, Chlorogiannis DDI, Vythoulkas-Biotis NI, Kartas NA, Davlouros P. Randomized comparison of Glidesheath Slender with conventional 5Fr arterial sheaths for coronary angiography through the distal radial artery. Minerva Cardiol Angiol 2023; 71:692-701. [PMID: 37458692 DOI: 10.23736/s2724-5683.23.06337-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND The potential benefits of the thin-walled 5F Glidesheath Slender sheath in the distal transradial access (dTRA) have not been investigated. This study aimed to compare the Glidesheath Slender versus conventional 5Fr arterial sheaths in patients undergoing diagnostic coronary angiography (CAG) through the dTRA. METHODS A total of 352 consecutive patients with an indication for CAG were randomized (1:1) to Glidesheath Slender 5Fr versus a conventional 5Fr arterial sheath for dTRA. The primary endpoint was the rate of successful hemostasis at 30 minutes after sheath removal. Follow-up ultrasound of the right radial and distal radial artery was performed 7-10 days after the procedure. RESULTS After exclusion of patients where a 6Fr sheath or crossover of access site was required, 108 patients in the Glidesheath Slender and 105 patients in the conventional 5Fr arterial sheath group were included in the analysis. The crossover rate to conventional radial access and the rate of successful hemostasis at 30 minutes after sheath removal were similar between the two groups (18.9% in the Glidesheath slender vs. 22% in the control group; P=0.460, and 62% vs. 51.4%; P=0.118, respectively). The level of pain associated with the procedure was significantly lower in the Glidesheath Slender group (2.69 vs. 3.29 in the control group; P=0.02). No significant difference was recorded between the two groups in the rate of access-related complications. CONCLUSIONS Use of Glidesheath Slender for dTRA did not increase the rate of early hemostasis compared with conventional arterial sheath.
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Affiliation(s)
| | | | | | | | - Katerina Stavrou
- Department of Cardiology, Patras University Hospital, Patras, Greece
| | | | | | | | | | - Nikolaos A Kartas
- Department of Cardiology, Patras University Hospital, Patras, Greece
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Shi M, He S. Transradial and transfemoral accesses for cerebral angiography: a retrospective comparative study. Neurol Res 2023; 45:1063-1068. [PMID: 37751776 DOI: 10.1080/01616412.2023.2257410] [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: 07/20/2022] [Accepted: 06/10/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE Many large randomized trials in interventional cardiology have shown a significant advantage of transradial access (TRA) over transfemoral access (TFA). However, TRA has yet been widely used in Neurovascular interventional surgery. The purpose of this retrospective comparative study is to compare the effectiveness and safety of transradial and transfemoral accesses for cerebral angiography. METHODS A total of 380 patients underwent cerebral angiography in our center between January 2019 and January 2021. Among them, 192 patients underwent TRA, and 188 patients via TFA. The success rate of cerebral angiography, X-ray time, total absorbed dose, dose-area product (DAP), complications, and other clinical data were extracted. RESULTS The operative success (94.27% vs 97.87%; P = 0.071) and the puncture failure (1.56% vs 1.60%) were not significantly different between the TRA and TFA groups. Only arterial spasm, which is more common in the TRA group, was substantially different between the two groups in terms of surgical consequences (P = 0.015). In addition, there were no significant differences between the groups in total absorbed dose (P = 0.604) and DAP(P = 0.097). However, the X-ray time of the TRA group [281.50(216.30,342.00)] was shorter than the TFA group [296.50(230.80,363.50)] (P = 0.019). CONCLUSIONS TRA is effective and safe in cerebral angiography, and its use may be expanded.
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Affiliation(s)
- Miaomiao Shi
- Department of Neurology, Nantong Third People's Hospital, Nantong, China
| | - Shuang He
- Department of Stroke Center, Affiliated Hospital of Nantong University, Nantong, China
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Theofilis P, Vlachakis PK, Mantzouranis E, Sakalidis A, Chrysohoou C, Leontsinis I, Lazaros G, Dimitriadis K, Drakopoulou M, Vordoni A, Oikonomou E, Tsioufis K, Tousoulis D. Acute Coronary Syndromes in Women: A Narrative Review of Sex-Specific Characteristics. Angiology 2023:33197231218331. [PMID: 37995282 DOI: 10.1177/00033197231218331] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Acute coronary syndromes (ACSs) encompass a spectrum of life-threatening cardiovascular conditions, including unstable angina (UA) and myocardial infarction. While significant progress has been made in the understanding and management of ACS over the years, it has become increasingly evident that sex-based differences play a pivotal role in the pathophysiology, presentation, and outcomes of these conditions. Despite this recognition, the majority of clinical research in the field has historically focused on male populations, leading to a significant knowledge gap in understanding the unique aspects of ACS in women. This review article aims to comprehensively explore and synthesize the current body of literature concerning the sex-specific characteristics of ACS, shedding light on the epidemiology, risk factors, clinical presentation, diagnostic challenges, treatment strategies, and prognosis in women. By elucidating the distinct aspects of ACS in women, this review intends to foster greater awareness and improved clinical management, ultimately contributing to enhanced cardiovascular care for female patients.
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Affiliation(s)
- Panagiotis Theofilis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayotis K Vlachakis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil Mantzouranis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Sakalidis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Chrysohoou
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Leontsinis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Lazaros
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyriakos Dimitriadis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Drakopoulou
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Vordoni
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, "Sotiria" Chest Disease Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Bikdeli B, Erlinge D, Valgimigli M, Kastrati A, Han Y, Steg PG, Stables RH, Mehran R, James SK, Frigoli E, Goldstein P, Li Y, Shahzad A, Schüpke S, Mehdipoor G, Chen S, Redfors B, Crowley A, Zhou Z, Stone GW. Bivalirudin Versus Heparin During PCI in NSTEMI: Individual Patient Data Meta-Analysis of Large Randomized Trials. Circulation 2023; 148:1207-1219. [PMID: 37746717 DOI: 10.1161/circulationaha.123.063946] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND The benefit:risk profile of bivalirudin versus heparin anticoagulation in patients with non-ST-segment-elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) is uncertain. Study-level meta-analyses lack granularity to provide conclusive answers. We sought to compare the outcomes of bivalirudin and heparin in patients with non-ST-segment-elevation myocardial infarction undergoing PCI. METHODS We performed an individual patient data meta-analysis of patients with non-ST-segment-elevation myocardial infarction in all 5 trials that randomized ≥1000 patients with any myocardial infarction undergoing PCI to bivalirudin versus heparin (MATRIX [Minimizing Adverse Hemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox], VALIDATE-SWEDEHEART [Bivalirudin Versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies Registry Trial], ISAR-REACT 4 [Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment 4], ACUITY [Acute Catheterization and Urgent Intervention Triage Strategy], and BRIGHT [Bivalirudin in Acute Myocardial Infarction vs Heparin and GPI Plus Heparin Trial]). The primary effectiveness and safety end points were 30-day all-cause mortality and serious bleeding. RESULTS A total of 12 155 patients were randomized: 6040 to bivalirudin (52.3% with a post-PCI bivalirudin infusion), and 6115 to heparin (53.2% with planned glycoprotein IIb/IIIa inhibitor use). Thirty-day mortality was not significantly different between bivalirudin and heparin (1.2% versus 1.1%; adjusted odds ratio, 1.24 [95% CI, 0.86-1.79]; P=0.25). Cardiac mortality, reinfarction, and stent thrombosis rates were also not significantly different. Bivalirudin reduced serious bleeding (both access site-related and non-access site-related) compared with heparin (3.3% versus 5.5%; adjusted odds ratio, 0.59; 95% CI, 0.48-0.72; P<0.0001). Outcomes were consistent regardless of use of a post-PCI bivalirudin infusion or routine lycoprotein IIb/IIIa inhibitor use with heparin and during 1-year follow-up. CONCLUSIONS In patients with non-ST-segment-elevation myocardial infarction undergoing PCI, procedural anticoagulation with bivalirudin and heparin did not result in significantly different rates of mortality or ischemic events, including stent thrombosis and reinfarction. Bivalirudin reduced serious bleeding compared with heparin arising both from the access site and nonaccess sites.
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Affiliation(s)
- Behnood Bikdeli
- Cardiovascular Medicine Division (B.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Thrombosis Research Group (B.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Yale-New Haven Hospital/Yale Center for Outcomes Research and Evaluation, New Haven, CT (B.B.)
| | | | - Marco Valgimigli
- Bern University Hospital, University of Bern, Switzerland (M.V., E.F.)
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität, Munich, Germany (A.K., S.S.)
- German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Germany (A.K., S.S.)
| | - Yaling Han
- General Hospital of Northern Theater Command, Shenyang, China (Y.H., Y.L.)
| | - Philippe Gabriel Steg
- Université Paris-Cité, French Alliance for Cardiovascular Trials, L'Institut national de la santé et de la recherche médicale U-1148, Assistance Publique - Hôpitaux de Paris, Hôpital Bichat, Paris, France (P.G.S.)
- Imperial College, Royal Brompton Hospital, London, United Kingdom (P.G.S.)
| | - Rod H Stables
- Liverpool Heart and Chest Hospital, United Kingdom (R.H.S., A.S.)
- University of Liverpool, United Kingdom (R.H.S., A.S.)
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M., G.W.S.)
- Cardiovascular Research Foundation, New York, NY (R.M., Z.Z.)
| | | | - Enrico Frigoli
- Bern University Hospital, University of Bern, Switzerland (M.V., E.F.)
| | | | - Yi Li
- General Hospital of Northern Theater Command, Shenyang, China (Y.H., Y.L.)
| | - Adeel Shahzad
- Liverpool Heart and Chest Hospital, United Kingdom (R.H.S., A.S.)
- University of Liverpool, United Kingdom (R.H.S., A.S.)
| | - Stefanie Schüpke
- Deutsches Herzzentrum München, Technische Universität, Munich, Germany (A.K., S.S.)
- German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Germany (A.K., S.S.)
| | - Ghazaleh Mehdipoor
- Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Bronx, NY (G.M.)
| | - Shmuel Chen
- Weill-Cornell Cornell Medical Center/ New York-Presbyterian Hospital, New York, NY (S.C.)
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.)
| | | | - Zhipeng Zhou
- Cardiovascular Research Foundation, New York, NY (R.M., Z.Z.)
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M., G.W.S.)
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Eesa M, Mitha AP, Lewkonia P. Distal transradial access for targeted spinal angiography and embolization. Interv Neuroradiol 2023; 29:498-503. [PMID: 35484816 PMCID: PMC10549704 DOI: 10.1177/15910199221097489] [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: 03/11/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Spinal catheter angiography is commonly performed in the evaluation and treatment of spinal vascular lesions. The typical approach to spinal angiography consists of access through the femoral artery with the use of suitably shaped catheters for selective catheterization of the spinal segmental vasculature. The purpose of our study was to evaluate the safety and feasibility of distal transradial access through the "anatomical snuffbox" for targeted spinal angiography, for the investigation and treatment of selected spinal lesions. METHODS A retrospective review of patients who underwent transradial spinal angiography and embolization was performed from August 2019 to January 2022. A total of eight patients were identified, who underwent targeted spinal angiography through distal transradial access. Outcome measures were documented in a tabular manner. RESULTS Radial access was successful in all patients. Seven patients had vascular tumors of the spinal column and underwent tumor embolization followed by segmental artery occlusion prior to surgery. One patient had a spinal dural AV fistula that could not be embolized due to feeding vessel tortuosity and eventually went on to have a laminectomy. Mean fluoroscopy time was 31.4 min. There were no access site hemorrhagic complications. One patient experienced transient mild hand numbness during the period of hemostasis with the vascular compression device that resolved completely within 24 h. CONCLUSIONS Distal transradial access is a feasible and safe option for targeted spinal angiography and treatment in selected patients.
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Affiliation(s)
- Muneer Eesa
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Alim P Mitha
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Peter Lewkonia
- Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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Cervantes-Nieto JA, Pimentel-Esparza JA, Gomez-Monterrosas O, Casillas-Gastelum HJ, Fuentes Mendoza JA. A Single Transradial Guiding Catheter in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: A Door-to-Balloon Optimized Strategy. Cureus 2023; 15:e46802. [PMID: 37954753 PMCID: PMC10635583 DOI: 10.7759/cureus.46802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/14/2023] Open
Abstract
Background Acute coronary syndrome (ACS) is the leading cause of morbidity and mortality worldwide. The different reperfusion strategies have evolved over the years, and efforts have been directed to reduce its complications. Among these strategies, the one that has shown the best results is percutaneous coronary intervention, which has significantly improved the survival and prognosis of these patients; however, this procedure is not free of complications since multiple factors are involved. Among them is the time of patient care from the time of diagnosis until the coronary reperfusion therapy is performed. Methodology In this study, we describe the experience in our center with the 6-French Ikari Left guide catheter as a strategy of radial angiography-angioplasty with a single catheter to reduce the care times of patients with acute ST-elevation myocardial infarction (STEMI) in our center and compare it with the series reported by other international centers since. To establish an alternative to the usual approach that consists of the use of Judkins catheters, diagnosis, and guiding. Results Our study showed a success rate for diagnostic angiography and percutaneous coronary intervention (PCI) with the 6- French Ikari Left catheter comparable to those obtained in other centers, even with lower complication rates than the usual approach with Judkins' Catheters. Conclusions The use of the 6-French Ikari Left catheter demonstrated shorter needle-device time and compared to other international series, it was shown to be shorter and related to shorter fluoroscopy time. Our study has a small sample and only included a highly selected population, which represents a limitation. This study is vulnerable to the different practices of the operators, with involvement in procedure time and use of contrast volume.
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31
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Rao SM, Jayaram AA, Vb M, Uk AR, Rangaswamy D, Samath J. Trans-radial percutaneous intervention for thrombosed hemodialysis access: A single-center experience. J Vasc Access 2023; 24:957-964. [PMID: 34844464 DOI: 10.1177/11297298211058984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Traditionally, percutaneous transluminal angioplasty (PTA) is a first-line approach for stenosed dialysis accesses and has been performed through the non-thrombosed vein segment. For thrombosed accesses, thrombectomy (whether open or percutaneous) is a standard approach. The primary objective of our study is to determine the clinical and technical outcomes of the trans-radial approach of PTA among thrombosed dialysis accesses, in terms of safety and feasibility, technical and clinical aspects and factors influencing them, as well as assisted primary patency, secondary patency at 6 and 12 months. METHODS This is a single-center retrospective study that included 150 patients over 3 years. About 123 patients underwent successful percutaneous balloon angioplasty through the radial access. RESULTS We report an overall technical and clinical success rate of 82%, assisted primary patency rate of about 90.25% at 3 months, 82.93% at 6 months, 73.18% at 1 year, and secondary patency rate of 94% at 1 year. Twenty-seven patients were referred for surgical revisions/creation of a new fistula for reasons like inability to pass wire (6 patients), unfavorable anatomical variations like aneurysms at the proximal segments (5 patients), inability to cross the fistula (5 patients), and persistent fistula dysfunction with no flow after initial balloon dilatation (11 patients). Three patients had hematoma at the radial access site (2.5%) while two patients had the AV fistula segment rupture and were successfully treated conservatively. CONCLUSION We conclude that PTA through the trans-radial approach to completely thrombosed hemodialysis accesses is a good alternative to transvenous access and has a very good assisted primary patency and secondary patency at 1 year without major complications.
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Affiliation(s)
- Sudhakar M Rao
- Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Ashwal Adamane Jayaram
- Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Mohan Vb
- Department of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Abdul Razak Uk
- Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Dharshan Rangaswamy
- Department of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Jyothi Samath
- Department of Cardiovascular Technology, School of Allied Health Science, Manipal Academy of Higher Education, Manipal, India
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Dang D, Dowling C, Zaman S, Cameron J, Kuhn L. Predictors of radial to femoral artery crossover during primary percutaneous coronary intervention in ST-elevation myocardial infarction: A systematic review and meta-analysis. Aust Crit Care 2023; 36:915-923. [PMID: 36496332 DOI: 10.1016/j.aucc.2022.10.018] [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: 01/24/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In contrast to traditional femoral artery access, radial artery access for primary percutaneous coronary intervention (PPCI) in ST-elevation myocardial infarction (STEMI) is associated with reduced mortality and bleeding but has higher crossover rates. Therefore, factors associated with crossover warrant exploration as crossover due to technical challenges associated with the radial route may be mitigated. OBJECTIVE The objective of this study was to identify predictors of radial access failure or crossover to femoral access in PPCI. METHODS A systematic review and meta-analysis was undertaken according to the Joanna Briggs Institute Systematic Reviews Checklist with searches conducted in Medline, EMBASE, CINAHL, and SCOPUS databases. Inclusion criteria for this study included patients with STEMI; PPCI; and primary research identifying predictors of radial access failures and/or crossovers, published in English, and after 2010. This study was registered with PROSPERO (CRD42020167122). Statistical analysis was performed using IBM SPSS Statistics for Windows version 26.0 (IBM Corp, Armonk, NY) and RevMan version 5.4 (Cochrane Collaboration, London, United Kingdom) with meta-analysis conducted by using the DerSimonian and Laird random-effects method. The National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was utilised for quality and risk of bias assessment, with EndNote software used for citations. RESULTS Eight observational studies met inclusion criteria, comprising 12,621 patients. Risk of bias of these studies was assessed using the National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The mean age was 61.2 ± 12.0 years, and 75.3% were male. Crossover from transradial to transfemoral artery occurred in 529 (4.2%) patients. Reasons for radial access failure included failed puncture (35.3%), peripheral occlusion or tortuosity (24.5%), and radial artery spasm (20.1%). Predictors of crossover included older age (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.44-2.65; p < 0.001), female sex (OR, 2.10; 95% Cl, 1.58-2.80; p < 0.001), weight ≤65 kg (OR, 2.95; 95% CI, 1.95-4.46; p < 0.001), and previous percutaneous coronary intervention (OR, 2.80; 95% Cl, 1.74-4.52; p < 0.001). CONCLUSION Older age, female sex, weight ≤65 kg, and previous percutaneous coronary intervention were predictors of crossover or failure from the radial to femoral artery. As these predictors are known to be associated with high bleeding and mortality, they should not preclude attempting a radial-first approach in all patients with STEMI. However, as these results were unadjusted, this study warrants further research to thoroughly investigate predictors of radial artery crossover.
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Affiliation(s)
- Denee Dang
- School of Nursing and Midwifery, Monash University, Melbourne, Australia; MonashHeart, Monash Health, Melbourne, Australia; Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
| | - Cameron Dowling
- MonashHeart, Monash Health, Melbourne, Australia; Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Sarah Zaman
- Westmead Applied Research Centre, University of Sydney, Sydney, Australia; Cardiology Department, Westmead Hospital, Sydney, Australia; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Jan Cameron
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Lisa Kuhn
- School of Nursing and Midwifery, Monash University, Melbourne, Australia; Monash Emergency Research Collaborative, Monash Health, Melbourne, Australia
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Catapano JS, Winkler EA, Srinivasan VM, Dishion EL, Rutledge C, Baranoski JF, Cole TS, Rudy RF, Rumalla K, Zomaya MP, Jadhav AP, Ducruet AF, Albuquerque FC. Retained radial catheters associated with variant radial anatomy in neurointerventional procedures. J Neurointerv Surg 2023; 15:858-863. [PMID: 36190952 DOI: 10.1136/jnis-2022-019004] [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: 04/01/2022] [Accepted: 08/15/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Transradial artery access (TRA) for neurointerventional procedures is gaining widespread acceptance. However, complications that were previously rare may arise as TRA procedures increase. Here we report a series of retained catheter cases with a literature review. METHODS All patients who underwent a neurointerventional procedure during a 23-month period at a single institution were retrospectively reviewed for a retained catheter in TRA cases. In cases of retained catheters, imaging was reviewed for anatomical variances in the radial artery, and clinical and demographic case details were analyzed. RESULTS A total of 1386 nondiagnostic neurointerventional procedures were performed during the study period, 631 (46%) initially via TRA. The 631 TRA cases were performed for aneurysm embolization (n=221, 35%), mechanical thrombectomy (n=116, 18%), carotid stent/angioplasty (n=40, 6%), arteriovenous malformation embolization (n=38, 6%), and other reasons (n=216, 34%). Thirty-nine (6%) TRA procedures crossed over to femoral access, most commonly because the artery of interest could not be catheterized (26/39, 67%). A retained catheter was identified in five cases (1%), and one (0.2%) patient had an entrapped catheter that was recovered. All six patients with a retained or entrapped catheter had aberrant radial anatomy. CONCLUSION Retained catheters for neurointerventional procedures performed via TRA are rare. However, this complication may be associated with variant radial anatomy. With the increased use of TRA for neurointerventional procedures, awareness of anatomical abnormalities that may lead to a retained catheter is necessary. We propose a simple protocol to avoid catheter entrapment, including in emergent situations such as TRA for stroke thrombectomy.
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Affiliation(s)
- Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Ethan A Winkler
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Evan L Dishion
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Caleb Rutledge
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Jacob F Baranoski
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Tyler S Cole
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Robert F Rudy
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Kavelin Rumalla
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Martin P Zomaya
- The University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA
| | - Ashutosh P Jadhav
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
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Liang KW, Wang B, Huang HH, Tsao TF, Tyan YS, Wang PH. Effectiveness and Safety of Intra-arterial Imipenem/Cilastatin Sodium Infusion for Patients with Hand Osteoarthritis-Related Interphalangeal Joint Pain. J Vasc Interv Radiol 2023; 34:1485-1492.e1. [PMID: 37295555 DOI: 10.1016/j.jvir.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/10/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of intra-arterial imipenem/cilastatin sodium (IPM/CS) infusion for painful interphalangeal joint osteoarthritis (OA). MATERIALS AND METHODS Fifty-eight patients with interphalangeal joint OA who underwent intra-arterial IPM/CS infusion were retrospectively evaluated. Intra-arterial infusions were performed via percutaneous wrist arterial access. The Numerical Rating Scale (NRS), Functional Index for Hand Osteoarthritis (FIHOA), and Patient Global Impression of Change (PGIC) scale scores were assessed at intervals of 1, 3, 6, 12, and 18 months. Clinical success was evaluated based on PGIC. RESULTS All patients were followed up for at least 6 months after treatment. Of them, 30 and 6 patients were followed up for 12 and 18 months, respectively. No severe or life-threatening adverse events were encountered. The mean NRS score was 6.0 ± 1.4 at baseline, which significantly decreased to 2.8 ± 1.4, 2.2 ± 1.9, and 2.4 ± 1.9 at 1, 3, and 6 months after treatment, respectively (all P < .001). The mean NRS scores were 2.8 ± 1.7 and 2.9 ± 1.9 at 12 and 18 months, respectively, in the remaining patients. The mean FIHOA score significantly decreased from 9.8 ± 5.0 at the baseline to 4.1 ± 3.5 at 3 months (P < .001). The mean FIHOA score was 4.5 ± 3.3 at 12 months in the remaining 30 patients. The clinical success rates based on PGIC at 1, 3, 6, 12, and 18 months were 62.1%, 77.6%, 70.7%, 63.4%, and 50.0%, respectively. CONCLUSIONS Intra-arterial IPM/CS infusion is a potential treatment option for interphalangeal joint OA refractory to medical management.
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Affiliation(s)
- Keng-Wei Liang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Bow Wang
- Department of Medical Imaging, National Cheng Kung University, Tainan, Taiwan; College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Hui Huang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Teng-Fu Tsao
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yeu-Sheng Tyan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Po-Hui Wang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan.
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Alonso AG, Kobzeva-Herzog A, Siracuse JJ. Alternative access for peripheral vascular interventions. J Vasc Surg Cases Innov Tech 2023; 9:101232. [PMID: 37408940 PMCID: PMC10319322 DOI: 10.1016/j.jvscit.2023.101232] [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: 03/03/2023] [Accepted: 05/11/2023] [Indexed: 07/07/2023] Open
Abstract
Percutaneous endovascular interventions for advanced lower extremity peripheral arterial disease are becoming increasingly used, often as first-line treatment of chronic limb threatening ischemia. Advancements in endovascular techniques have provided safe and effective alternative revascularization options, especially for high-risk surgical patients. Although the classic transfemoral approach results in high technical success and patency rates, an estimated 20% of lesions remain challenging to access via an antegrade approach. As such, alternative access sites are important in the endovascular armamentarium for the management of chronic limb threatening ischemia. The goal of this review is to discuss alternative access sites, specifically the transradial, transpopliteal, and transpedal approaches, in addition to transbrachial and transaxillary access, and their outcomes in peripheral arterial disease and limb salvage.
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Affiliation(s)
| | | | - Jeffrey J. Siracuse
- Correspondence: Jeffrey J. Siracuse, MD, MBA, Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, 85 E Concord St, Boston, MA 02118
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Oliveira GMMD, Almeida MCCD, Rassi DDC, Bragança ÉOV, Moura LZ, Arrais M, Campos MDSB, Lemke VG, Avila WS, Lucena AJGD, Almeida ALCD, Brandão AA, Ferreira ADDA, Biolo A, Macedo AVS, Falcão BDAA, Polanczyk CA, Lantieri CJB, Marques-Santos C, Freire CMV, Pellegrini D, Alexandre ERG, Braga FGM, Oliveira FMFD, Cintra FD, Costa IBSDS, Silva JSN, Carreira LTF, Magalhães LBNC, Matos LDNJD, Assad MHV, Barbosa MM, Silva MGD, Rivera MAM, Izar MCDO, Costa MENC, Paiva MSMDO, Castro MLD, Uellendahl M, Oliveira Junior MTD, Souza OFD, Costa RAD, Coutinho RQ, Silva SCTFD, Martins SM, Brandão SCS, Buglia S, Barbosa TMJDU, Nascimento TAD, Vieira T, Campagnucci VP, Chagas ACP. Position Statement on Ischemic Heart Disease - Women-Centered Health Care - 2023. Arq Bras Cardiol 2023; 120:e20230303. [PMID: 37556656 PMCID: PMC10382148 DOI: 10.36660/abc.20230303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Walkiria Samuel Avila
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Andreia Biolo
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | | | | | | | - Celi Marques-Santos
- Universidade Tiradentes (UNIT), Aracaju, SE - Brasil
- Hospital São Lucas Rede D'Or São Luis, Aracaju, SE - Brasil
| | | | - Denise Pellegrini
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS - Brasil
| | | | - Fabiana Goulart Marcondes Braga
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Lara Terra F Carreira
- Cardiologia Nuclear de Curitiba, Curitiba, PR - Brasil
- Hospital Pilar, Curitiba, PR - Brasil
| | | | | | | | | | | | | | | | | | | | | | - Marly Uellendahl
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
- DASA - Diagnósticos da América S/A, São Paulo, SP - Brasil
| | - Mucio Tavares de Oliveira Junior
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | - Ricardo Quental Coutinho
- Faculdade de Ciências Médicas da Universidade de Pernambuco (UPE), Recife, PE - Brasil
- Hospital Universitário Osvaldo Cruz da Universidade de Pernambuco (UPE), Recife, PE - Brasil
| | | | - Sílvia Marinho Martins
- Pronto Socorro Cardiológico de Pernambuco da Universidade de Pernambuco (PROCAPE/UPE), Recife, PE - Brasil
| | | | - Susimeire Buglia
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | | | - Thais Vieira
- Universidade Tiradentes (UNIT), Aracaju, SE - Brasil
- Rede D'Or, Aracaju, SE - Brasil
- Hospital Universitário da Universidade Federal de Sergipe (UFS), Aracaju, SE - Brasil
| | | | - Antonio Carlos Palandri Chagas
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Centro Universitário Faculdade de Medicina ABC, Santo André, SP - Brasil
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Dubosq M, Renard R, Jayet J, Mercier L, Javerliat I, Castier Y, Coggia M, Coscas R. Single Primary Retrograde Access to Treat Femoro-Popliteal Occlusive Lesions. J Endovasc Ther 2023:15266028231188868. [PMID: 37515490 DOI: 10.1177/15266028231188868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
INTRODUCTION The retrograde puncture of a distal artery is considered a bailout procedure in case of anterograde approach failure for peripheral artery disease (PAD) treatment. A single primary retrograde access has been suggested as an efficient and safe option. As scant data are available, we present our results using this approach. MATERIAL AND METHODS Between August 2019 and October 2022, we performed this technique in selected patients with femoro-popliteal PAD. Chronic total occlusions (CTOs) were selected on the basis of the CTOP classification. An ultrasound-guided retrograde puncture of a tibial artery at the ankle level was performed, followed by the preferential use of 4F materials. Hemostasis of the puncture site was obtained using manual compression. Postoperative duplex scan examination systematically included an evaluation of the punctured artery. Demographics, intraoperative, and follow-up data were collected retrospectively. The results are expressed as means with standard deviations and numbers with percentages when appropriate. RESULTS In total, 55 procedures were performed in 46 patients (9 bilateral). Of these, 57% (N=26) were considered at risk for femoral puncture (obesity, history of groin surgery, challenging crossover approach) and 54% (N=25) presented with critical limb-threatening ischemia (CLTI). The TASC-II femoro-popliteal classification was generally B (60%) and also C (33%) or D (7%). Mean lesion length was 105.6±49.4 mm and 65% were CTOs. Most patients were operated in an outpatient setting (N=25; 54%) under potentialized local anesthesia (N=41, 89%). The punctured site was the posterior tibial artery in 73% (N=40). The procedure time was 65.1±25.7 minutes, and the fluoroscopy time was 10.7±8.5 minutes. The technical success rate was 100%. There were no intraoperative complications. All patients could walk the same day. One CLTI patient presented an erysipelas related to the puncture in postoperative period. At 30 days, the primary patency of the treated and the punctured arteries were 98% and 100%, respectively. CONCLUSION A single primary retrograde access can be used safely to treat femoro-popliteal PAD. It represents a valuable alternative to the femoral puncture and allows fast ambulation. Prospective and long-term studies on larger populations are necessary to confirm our results. CLINICAL IMPACT This study demonstrates that a single primary retrograde access can be used safely without damaging the punctured artery to treat femoro-popliteal lesions, especially in claudicant patients. Chronic total occlusions can be treated successfully using this technique. This approach represents a valuable alternative to the femoral puncture and allows fast ambulation without risk of major bleeding.
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Affiliation(s)
- Maxime Dubosq
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Régis Renard
- Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérémie Jayet
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lucie Mercier
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Isabelle Javerliat
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yves Castier
- Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Coggia
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Raphael Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Tsigkas G, Papanikolaou A, Apostolos A, Kramvis A, Timpilis F, Latta A, Papafaklis MI, Aminian A, Davlouros P. Preventing and Managing Radial Artery Occlusion following Transradial Procedures: Strategies and Considerations. J Cardiovasc Dev Dis 2023; 10:283. [PMID: 37504539 PMCID: PMC10380353 DOI: 10.3390/jcdd10070283] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/05/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
Τransradial artery access has recently gained widespread acceptance as the preferred approach for coronary angiography and interventions, due to its lower incidence of bleeding and vascular complications compared to transfemoral access. However, thrombotic occlusion of the radial artery has emerged as the most common complication of this method, impeding its use in future interventions, and in the creation of arteriovenous fistulae for hemodialysis patients, or as a graft for coronary artery bypasses grafting. In this comprehensive review, we delve into the anatomy of the radial artery, the pathophysiology and diagnosis of radial artery occlusion, the identification of potential risk factors and, finally, prevention and treatment strategies. We acknowledge that distal transradial access provides an effective alternative for coronary angiography and catheterizations, with a reduced incidence of radial artery occlusion.
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Affiliation(s)
- Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Amalia Papanikolaou
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Anastasios Apostolos
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
- First Department of Cardiology, Hippocration General Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Angelos Kramvis
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Filippos Timpilis
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Anastasia Latta
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | | | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, 6042 Charleroi, Belgium
| | - Periklis Davlouros
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
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Mahtta D, Manandhar P, Wegermann ZK, Wojdyla D, Megaly M, Kochar A, Virani SS, Rao SV, Elgendy IY. Outcomes and Institutional Variation in Arterial Access Among Patients With AMI and Cardiogenic Shock Undergoing PCI. JACC Cardiovasc Interv 2023; 16:1517-1528. [PMID: 37380235 DOI: 10.1016/j.jcin.2023.03.043] [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: 02/03/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Contemporary data comparing the outcomes of transradial access (TRA) vs transfemoral access (TFA) among patients presenting with acute myocardial infarction and cardiogenic shock (AMI-CS) undergoing percutaneous coronary intervention (PCI) are limited. OBJECTIVES This study examines in-hospital outcomes and institutional variation among patients with AMI-CS undergoing TRA-PCI vs TFA-PCI. METHODS Patients admitted with AMI-CS from the NCDR CathPCI registry between April 2018 and June 2021 were included. Multivariable logistic regression and inverse probability weighting models were used to assess the association between access site and in-hospital outcomes. A falsification analysis using non-access site-related bleeding was performed. RESULTS Among 35,944 patients with AMI-CS undergoing PCI, 25.6% were performed with TRA. The proportion of TRA-PCI increased over the study period (22.0% in the second quarter of 2018 vs 29.1% in the second quarter of 2021; P-trend <0.001). Significant institutional-level variability in the use of TRA-PCI was also observed: 20.9% of all sites using TRA in <2% of PCIs (low utilization) vs 1.9% of all sites using TRA in >80% of PCIs (high utilization). Patients undergoing TRA-PCI had a significantly lower adjusted incidence of major bleeding (odds ratio [OR]: 0.71; 95% confidence interval [CI]: 0.67-0.76), mortality (OR: 0.73; 95% CI: 0.69-0.78), vascular complications (OR: 0.67; 95% CI: 0.54-0.84), and new dialysis (OR: 0.86; 95% CI: 0.77-0.97). There was no difference in non-access site related bleeding (OR: 0.93; 95% CI: 0.84-1.03). Sensitivity analyses revealed similar benefit with TRA-PCI among patients without arterial cross-over. There were no significant interactions observed between TRA-PCI with mechanical circulatory support and in-hospital outcomes. CONCLUSIONS In this large nationwide contemporary analysis of patients with AMI-CS, about quarter of PCIs were performed via TRA with wide variability across US institutions. TRA-PCI was associated with significantly lower incidence of in-hospital major bleeding, mortality, vascular complications, and new dialysis. This benefit was observed irrespective of mechanical circulatory support use.
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Affiliation(s)
- Dhruv Mahtta
- Division of Cardiovascular Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | | | - Zachary K Wegermann
- Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Daniel Wojdyla
- Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael Megaly
- Willis Knighton Heart Institute, Shreveport, Louisiana, USA
| | - Ajar Kochar
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA; Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Salim S Virani
- Division of Cardiovascular Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Sunil V Rao
- NYU Langone Health System, New York, New York, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky HealthCare, Lexington, Kentucky, USA.
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Elfar S, Onsy A, Farouk MA. Clinical and Radiographic Predictors of Successful Coronary Angiography Through Right Radial Artery Access. Interv Cardiol 2023; 18:e21. [PMID: 37435602 PMCID: PMC10331560 DOI: 10.15420/icr.2023.04] [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: 01/25/2023] [Accepted: 04/23/2023] [Indexed: 07/13/2023] Open
Abstract
Background: One of the limitations of the right radial access approach is complex vessel anatomy, such as subclavian tortuosity. Several clinical predictors have been proposed for tortuosities, such as older age, female sex and hypertension. In this study, we hypothesised that chest radiography would add predictive value to the traditional predictors. Methods: This prospective blinded study included patients who underwent transradial access coronary angiography. They were classified into four groups according to difficulty: Group I, Group II, Group III and Group IV. Different groups were compared according to clinical and radiographic characteristics. Results: The study included 108 patients (54, 27, 17 and 10 patients in Groups I, II, III and IV, respectively). The rate of crossover to transfemoral access was 9.26%. Age, hypertension and female sex were associated with a greater difficulty and failure rates. Regarding radiographic parameters, a higher failure rate was associated with a higher diameter of the aortic knuckle (Group IV, 4.09 ± 1.32 cm versus Groups I, II and III combined, 3.26 ± 0.98 cm; p=0.015) and the width of the mediastinum (Group IV, 8.96 ± 2.88 cm versus Groups I, II and III combined, 7.28 ± 1.78 cm; p=0.009). The cut-off value for prominent aortic knuckle was 3.55 cm (sensitivity 70% and specificity 67.35%) and the width of mediastinum was 6.59 cm (sensitivity 90% and specificity 42.86%). Conclusion: Radiographic prominent aortic knuckle and wide mediastinum are valuable clinical parameters and useful predictors for transradial access failure caused by tortuosity of the right subclavian/brachiocephalic arteries or aorta.
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Affiliation(s)
- Sohil Elfar
- Cardiology Department, Faculty of Medicine, Port Said UniversityPort Said, Egypt
| | - Ahmed Onsy
- Cardiology Department, Faculty of Medicine, Ain Shams UniversityCairo, Egypt
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Al-Kassou B, Al-Shaikh H, Aksoy A, Shamekhi J, Zietzer A, Sugiura A, Veulemans V, Adam M, Grube E, Bakhtiary F, Zimmer S, Kelm M, Baldus S, Nickenig G, Sedaghat A. Impact of transradial versus transfemoral access for preprocedural coronary angiography on TAVR-associated complications. IJC HEART & VASCULATURE 2023; 46:101205. [PMID: 37122629 PMCID: PMC10130599 DOI: 10.1016/j.ijcha.2023.101205] [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: 01/21/2023] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023]
Abstract
Background Vascular injury and bleeding complications remain frequent after transcatheter aortic valve replacement (TAVR). Whether the access-site of preprocedural coronary angiography (CAG) affects TAVR-related complications is not known. The aim of this study was to evaluate the impact of transradial (TRA) versus transfemoral access (TFA) for preprocedural CAG on outcomes in patients undergoing subsequent TAVR. Methods The study cohort included 1002 patients undergoing transfemoral TAVR, of whom 39.4% (395/1002) had undergone radial and 60.6% (607/1002) femoral access for pre-TAVR CAG. The primary endpoint was a composite of 30-day mortality and major vascular complications after TAVR. Key secondary endpoints included VARC-3-defined complications. Results The primary endpoint occurred less frequently in patients with prior TRA (3.3%) as compared to patients with prior TFA (6.3%, p = 0.04), which was mainly driven by significantly lower rates of major vascular complications (0.8% vs 2.5%, p = 0.05). Moreover, incidences of periprocedural access-related vascular injury and unplanned endovascular interventions were lower in TRA patients (13.2% vs 18.0%, p = 0.05). The rate of major bleeding tended to be lower in the TRA (1.5%) as compared to the TFA group (3.5%) but was not significantly different (p = 0.07). Moreover, the rate of life-threatening bleeding was comparable between both groups (0.5% vs 0.8%, p = 0.71). Conclusion Transradial access for preprocedural CAG was associated with significantly lower rates of vascular complications following subsequent TAVR as compared to transfemoral access. However, despite the tendency to lower major bleedings with transradial access, no significant association was detectable between the access-site of coronary angiography and TAVR-related bleeding complications.
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Affiliation(s)
- Baravan Al-Kassou
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Hasanin Al-Shaikh
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Adem Aksoy
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jasmin Shamekhi
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Andreas Zietzer
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Verena Veulemans
- Division of Cardiology, University Hospital of Duesseldorf, Germany
- CARID, Cardiovascular Research Institute Duesseldorf, Germany
| | - Matti Adam
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Eberhard Grube
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Farhad Bakhtiary
- Heart Center, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Malte Kelm
- CARID, Cardiovascular Research Institute Duesseldorf, Germany
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Georg Nickenig
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Alexander Sedaghat
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
- RheinAhrCardio, Praxis für Kardiologie, Bad Neuenahr-Ahrweiler, Germany
- Corresponding author.
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Macdonald IR, Pickett GE, Herman C, Lee M, Volders D. All that glitters: case presentation and review of radial access complications in neurointervention. Interv Neuroradiol 2023; 29:327-331. [PMID: 35234068 PMCID: PMC10369111 DOI: 10.1177/15910199221083787] [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: 12/12/2021] [Accepted: 01/31/2022] [Indexed: 11/15/2022] Open
Abstract
Radial artery access has experienced increasing adoption and rapid expansion of indications for neurointerventional procedures. This access is an attractive neurointervention route to be considered, with many advantages over the traditional femoral access in terms of ease of vasculature navigation and decreased risk of complications such as significant bleeding. Although a promising technique for neurointerventional procedures, there are inherent and unique considerations as well as potential complications involved. The following case report highlights some of these vital concepts associated with radial artery access, including appropriate patient selection as well as assessment of arterial size in the context of neurointerventional techniques. Early identification of complications such as arterial injury and compartment syndrome, with an emphasis on appropriate draping and inter-procedure monitoring, is discussed as well as approaches for subsequent management. Finally, the issue of radiation safety in this emerging technique is considered. These concepts are critical for the successful use and the continued growth of radial artery access for neurointervention procedures.
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Affiliation(s)
- Ian R Macdonald
- Division of Neuroradiology, Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gwynedd E Pickett
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christine Herman
- Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Min Lee
- Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Volders
- Division of Neuroradiology, Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Di Santo P, Abdel-Razek O, Jung R, Parlow S, Poulin A, Bernick J, Morgan B, Robinson L, Feagan H, Wade J, Goh CY, Singh K, Froeschl M, Labinaz M, Fergusson DA, Coyle D, Kyeremanteng K, Abunassar J, Wells GA, Simard T, Hibbert B. Rationale and Design of the Rivaroxaban Post-Transradial Access for the Prevention of Radial Artery Occlusion Trial (CAPITAL-RAPTOR). BMJ Open 2023; 13:e070720. [PMID: 37173116 DOI: 10.1136/bmjopen-2022-070720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Transradial access (TRA) has rapidly emerged as the preferred vascular access site for coronary angiography and percutaneous coronary intervention. Radial artery occlusion (RAO) remains as an important complication of TRA as it precludes future ipsilateral transradial procedures. While intraprocedural anticoagulation has been studied extensively, the definitive role of postprocedural anticoagulation has not yet been established. METHODS AND ANALYSIS The Rivaroxaban Post-Transradial Access for the Prevention of Radial Artery Occlusion trial is a multicentre, prospective, randomised, open-label, blinded-endpoint design study investigating the efficacy and safety of rivaroxaban to reduce the incidence of RAO. Eligible patients will undergo randomisation to receive either rivaroxaban 15 mg once daily for 7 days or to no additional postprocedural anticoagulation. Doppler ultrasound to assess radial artery patency will be performed at 30 days. ETHICS AND DISSEMINATION The study protocol has been approved by the Ottawa Health Science Network Research Ethics Board (approval number 20180319-01H). The study results will be disseminated via conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03630055.
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Affiliation(s)
- Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Richard Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Anthony Poulin
- Division of Cardiology, Quebec Heart and Lung Institute, Quebec, Québec, Canada
| | - Jordan Bernick
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Baylie Morgan
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Lisa Robinson
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hannah Feagan
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jilliane Wade
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Cheng Yee Goh
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kuljit Singh
- Department of Cardiology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Michael Froeschl
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marino Labinaz
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Joseph Abunassar
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Trevor Simard
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Muszynski P, Richard S, Finitsis S, Humbertjean L, Audibert G, Mione G, Harsan O, Derelle AL, Liao L, Zhu F, Olivot JM, Anxionnat R, Calvet D, Gory B. Transradial access with Simmons guiding catheter for carotid artery stenting: Feasibility and procedural complications in a single-center experience. Interv Neuroradiol 2023:15910199231171845. [PMID: 37113013 DOI: 10.1177/15910199231171845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND There is an increasing number of transradial approach (TRA) for carotid artery stenting (CAS), however, similar techniques and materials as for femoral access are used. We report the results of TRA lower profile technique for CAS using a 7 F Simmons guiding catheter, especially in terms of feasibility and procedural safety in a single center. MATERIALS AND METHODS We retrospectively analyzed 68 consecutive patients with symptomatic extracranial carotid stenoses who underwent 75 CAS between January 2018 and December 2021. The success and crossover rate, procedural time, fluoroscopy, clinical outcomes, technical considerations, and procedural complications were analyzed. RESULTS TRA CAS with Simmons guiding catheter was successful in 67/75 (89.3%) cases, with a 7 (9.3%) crossover rate. Fluoroscopy mean time was 15.8 minutes. Two forearm hematomas were described. No ischemic or surgical site complications were reported. CONCLUSIONS In our experience frontline TRA with a 7 F Simmons guiding catheter is feasible with high procedural success and a low rate of access site complications.
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Affiliation(s)
- P Muszynski
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU Nancy, France
| | - S Richard
- Université de Lorraine, Nancy, France
- Department of Neurology, Stroke Unit, CHRU Nancy, France
| | - S Finitsis
- Neuroradiolology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - L Humbertjean
- Department of Neurology, Stroke Unit, CHRU Nancy, France
| | - G Audibert
- Department of intensive care unit, CHRU Nancy, France
| | - G Mione
- Department of Neurology, Stroke Unit, CHRU Nancy, France
| | - O Harsan
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU Nancy, France
| | - A L Derelle
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU Nancy, France
| | - L Liao
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU Nancy, France
- Université de Lorraine, Nancy, France
| | - F Zhu
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU Nancy, France
- Université de Lorraine, Nancy, France
| | - J M Olivot
- Department of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, France
| | - R Anxionnat
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU Nancy, France
- Université de Lorraine, Nancy, France
| | - D Calvet
- Neurology and neurovascular unit, GHU Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU Nancy, France
- Université de Lorraine, Nancy, France
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Lee P, Brennan AL, Stub D, Dinh DT, Lefkovits J, Reid CM, Zomer E, Liew D. Estimating the cost-effectiveness and return on investment of the Victorian Cardiac Outcomes Registry in Australia: a minimum threshold analysis. BMJ Open 2023; 13:e066106. [PMID: 37185178 PMCID: PMC10151970 DOI: 10.1136/bmjopen-2022-066106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES We sought to establish the minimum level of clinical benefit attributable to the Victorian Cardiac Outcomes Registry (VCOR) for the registry to be cost-effective. DESIGN A modelled cost-effectiveness study of VCOR was conducted from the Australian healthcare system and societal perspectives. SETTING Observed deaths and costs attributed to coronary heart disease (CHD) over a 5-year period (2014-2018) were compared with deaths and costs arising from a hypothetical situation which assumed that VCOR did not exist. Data from the Australian Bureau of Statistics and published sources were used to construct a decision analytic life table model to simulate the follow-up of Victorians aged ≥25 years for 5 years, or until death. The assumed contribution of VCOR to the proportional change in CHD mortality trend observed over the study period was varied to quantify the minimum level of clinical benefits required for the registry to be cost-effective. The marginal costs of VCOR operation and years of life saved (YoLS) were estimated. PRIMARY OUTCOME MEASURES The return on investment (ROI) ratio and the incremental cost-effectiveness ratio (ICER). RESULTS The minimum proportional change in CHD mortality attributed to VCOR required for the registry to be considered cost-effective was 0.125%. Assuming this clinical benefit, a net return of $A4.30 for every dollar invested in VCOR was estimated (ROI ratio over 5 years: 4.3 (95% CI 3.6 to 5.0)). The ICER estimated for VCOR was $A49 616 (95% CI $A42 228 to $A59 608) per YoLS. Sensitivity analyses found that the model was sensitive to the time horizon assumed and the extent of registry contribution to CHD mortality trends. CONCLUSIONS VCOR is likely cost-effective and represents a sound investment for the Victorian healthcare system. Our evaluation highlights the value of clinical quality registries in Australia.
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Affiliation(s)
- Peter Lee
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Cardiology Department, Alfred Hospital, Melbourne, Victoria, Australia
| | - Diem T Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
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Moț ȘDC, Șerban AM, Achim A, Dădârlat-Pop A, Tomoaia R, Pop D. Clinical Characteristics and Outcomes following Percutaneous Coronary Intervention in Unprotected Left Main Disease: A Single-Center Study. Diagnostics (Basel) 2023; 13:diagnostics13071333. [PMID: 37046550 PMCID: PMC10093002 DOI: 10.3390/diagnostics13071333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/20/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
Background: Hemodynamically significant unprotected left main (LM) coronary artery disease is a high-risk clinical condition because of the large area of myocardium at risk, and it requires prompt revascularization. Percutaneous coronary intervention (PCI) is an appropriate alternative to coronary artery bypass grafting (CABG) for revascularization of unprotected LM disease in patients with low-to-intermediate anatomic complexity or when the patient refuses CABG after adequate counseling by the heart team. Methods: We retrospectively evaluated 201 patients receiving left main (LM) provisional one-stent or two-stent procedures, and we assessed the clinical characteristics and outcomes of patients undergoing unprotected LM PCI. Results: The mean age was 66.5 ± 9.9 years, and 72% were male. The majority of the subjects presented several cardiovascular risk factors, among which arterial hypertension (179 patients, 89.5%) and dyslipidemia (173 patients, 86.5%) were the most frequent. Out of all patients, 162 (81.8%) underwent revascularization by using the one-stent technique, while the two-stent technique was used in 36 patients (18.2%). The median value of fractional flow reserve (FFR) of the side branch was 0.9 [0.85–0.95], and 135 patients (67.1%) showed a value of FFR > 0.8. One hundred nine patients (54.2%) had a stent enhancement side branch length (SESBL) > 2, with median values of 2.5 mm2 [2.1–3]. Regarding angiographic parameters, the LM area as assessed by intravascular ultrasound (IVUS) or optical coherence tomography (OCT) and the grade of stenosis as assessed by quantitative coronary angiography (QCA) were similar between groups. However, patients who required revascularization by using the two-stent technique presented more frequently with intermediate rather than low SYNTAX scores (69.4% vs. 28.4%, p < 0.0001). Also, the same group required kissing balloon inflation (KBI) more frequently (69.4% vs. 30%, p < 0.001). There were no differences regarding the success of revascularization between the use of the one-stent or two-stent technique. FFR was able to predict a SESBL > 2 mm. The cut-off value for FFR to afford the highest degree of sensitivity (74.5%) and specificity (47%) for a SESBL > 2 was >0.86, indicating a moderate accuracy (AUC = 0.61, 95% CI 0.525–0.690, p = 0.036). Conclusions: Unprotected left main PCI is a safe and effective revascularization option amongst a complex and morbid population. There were no differences regarding the success of revascularization between the use of the one-stent or two-stent technique, and there was no significant impact of KBI on side branch FFR measurements but lower side branch FFR values were correlated with angiographic side branch compromise.
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Affiliation(s)
- Ștefan Dan Cezar Moț
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Adela Mihaela Șerban
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Alexandru Achim
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
- Cardiology Department, Kantonsspital Baselland, 4410 Liestal, Switzerland
| | - Alexandra Dădârlat-Pop
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Raluca Tomoaia
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Cardiology, Clinical Rehabilitation Hospital, 400347 Cluj-Napoca, Romania
| | - Dana Pop
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Cardiology, Clinical Rehabilitation Hospital, 400347 Cluj-Napoca, Romania
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Takamatsu S, Kagiyama N, Sone N, Tougi K, Yamauchi S, Yuri T, Ii N, Sugimoto T, Masutani M, Hirohata A. Impact of radial compression protocols on radial artery occlusion and hemostasis time in coronary angiography. Cardiovasc Interv Ther 2023; 38:202-209. [PMID: 36478329 PMCID: PMC10020254 DOI: 10.1007/s12928-022-00896-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
Protocols for hemostasis after trans-radial approach (TRA) vary depending on the institute as there is no established evidence-based protocol. This study aimed to investigate the clinical implications of radial compression protocols. Consecutive patients who underwent outpatient invasive catheter angiography before and after April 2018 were treated with traditional and new protocols, respectively. Using the same hemostasis band, in the conventional protocol, fixed amount of air was removed soon after the procedure, 2 h later, and 3 h later, whereas the air was removed as much as possible every 30 min in the new protocol. A total of 1842 patients (71 ± 10 years old, 77% male) were included. Compared with the traditional protocol group (n = 1001), the new protocol group (n = 841) had a significantly lower rate of dual antiplatelet therapy (35% and 24% in the traditional and new groups, respectively, p < 0.001). The time required for complete hemostasis was approximately one-third with the new protocol (190 ± 16 and 66 ± 32 min, p < 0.001) with no clinically relevant bleeding. The incidence of radial artery occlusion (RAO) was 9.8% and 0.9% in the traditional and new protocol groups, respectively (p < 0.001). After adjusting for covariates, the new protocol was associated with a reduced risk of RAO (odds ratio 0.10, p < 0.001) and a shorter hemostasis time (odds ratio 0.01, p < 0.001). The new protocol for hemostasis after TRA was strongly associated with a shorter hemostasis time and a lower rate of RAO.
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Affiliation(s)
- Sachiko Takamatsu
- Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Nobuyuki Kagiyama
- Department of Digital Health and Telemedicine R&D, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, Japan.
- Department of Cardiovascular Biology and Medicine, Juntendo University, Tokyo, Japan.
| | - Naohiko Sone
- Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kiyotaka Tougi
- Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Shuichiro Yamauchi
- Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Takuya Yuri
- Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Nobuhisa Ii
- Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Tomoko Sugimoto
- Department of Nursing, Hakuhoukai Central Hospital, Hyogo, Japan
| | | | - Atsushi Hirohata
- Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan
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Yaser Arafath M, Bhatia V, Kumar A, Chauhan R, Prabhakar A, Gupta SK, Singh P. Adapting to transradial approach in cerebral angiography: Factors influencing successful cannulation. Neuroradiol J 2023; 36:163-168. [PMID: 35749090 PMCID: PMC10034707 DOI: 10.1177/19714009221111090] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To evaluate factors that influence the successful cannulation of intracranial vessels using a transradial approach. METHODS A total of 61 transradial diagnostic angiograms were evaluated in a tertiary care center from July 2020 to December 2021. We evaluated the learning curve and aortic arch vessel factors that may influence the cannulation of intracranial major vessels using a transradial approach. RESULTS Learning curve for the procedure was established after 21 cases. We were successful in cannulating the supra-aortic arteries except in 4 cases where we were unable to cannulate the left VA (vertebral artery). Significant positive correlation was seen between time to Sim (Simmons curve) formation and aortic arch diameter (p = .002). Significant positive correlation was also seen between left VA take-off angle and time to cannulate left VA (p = .001) and negative correlation was noted between left CCA (common carotid artery) take-off angle and time to cannulate left CCA (p = .001). CONCLUSION Transradial approach is a feasible and safe approach for performing cerebral angiography. Multiple factors can influence the procedure time and successful cannulation of intracranial vessels. With the availability of radial specific hardware in the future, procedural success and time taken to complete the procedure may improve.
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Affiliation(s)
- Mohamed Yaser Arafath
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
| | - Vikas Bhatia
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
| | - Ajay Kumar
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
| | - Rajeev Chauhan
- Department of Anaesthesia, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
| | - Anuj Prabhakar
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
| | - SK Gupta
- Department of Neurosurgery, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
| | - Paramjeet Singh
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
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Giustino G, Kyaw H, Sartori S, Farhan S, Dangas G, Sweeny J, Mehran R, Kini A, Sharma SK. Trends in Vascular Access Site Use and Outcomes in Patients Undergoing PCI. Am J Cardiol 2023; 195:1-2. [PMID: 36989603 DOI: 10.1016/j.amjcard.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Htoo Kyaw
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joseph Sweeny
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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50
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Xinyue Z, Bao Z, Wei L, Zhang Z, Hu Y, Xu D, Sun W, Xu D. Comparison of the effects of three kinds of hand exercises on improving limb function in patients after transradial cardiac catheterization. Int J Nurs Sci 2023; 10:182-188. [PMID: 37128485 PMCID: PMC10148249 DOI: 10.1016/j.ijnss.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/16/2023] [Accepted: 03/19/2023] [Indexed: 03/28/2023] Open
Abstract
Objectives This study aimed to compare effects of different hand exercises on improving limb function in patients after transradial cardiac catheterization. Methods This single-center, randomized clinical trial was conducted from August 20, 2020, to July 20, 2021, at an academic medical center. A total of 102 participants were selected from a Class A tertiary hospital in Nanjing, China and randomized into three groups: finger exercise group (n = 34), acupoint massage group (n = 34), and handgrip exercise group (n = 34). Symptoms of edema and pain were defined as primary outcomes, while skin temperature and degree of bleeding as secondary outcomes, which were monitored and measured 1, 2, and 4 h, after the intervention. Results Among the 99 participants who completed the process, the palm edema was gradually relieved in the handgrip exercise group at 2 h (H = 6.710, P = 0.035) and 4 h (H = 10.060, P < 0.001) following the intervention. The edema of fingers in the handgrip exercise group was obviously relieved at 2 h (H = 9.353, P < 0.01) and 4 h (H = 10.699, P < 0.001) following the intervention compared with the other two groups. In addition, the pain score at 4 h (H = 7.048, P = 0.029) was clearly decreased in the handgrip exercise group. However, there was no significant difference in the punctured limb's skin temperature (H = 0.922, P = 0.631) and the degree of bleeding (H = 0.123, P = 0.940) among the three groups. Conclusions We found that handgrip exercise is more effective in reducing the edema of the limbs than finger exercise and acupoint massage.
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