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Didagelos M, Pagiantza A, Zegkos T, Zarra K, Angelopoulos V, Kouparanis A, Peteinidou E, Kassimis G, Karvounis H, Ziakas A. Low Molecular Weight Heparin in Improving RAO After Transradial Coronary Catheterization. JACC Cardiovasc Interv 2022; 15:1686-1688. [DOI: 10.1016/j.jcin.2022.05.047] [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: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 10/16/2022]
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Roy S, Choxi R, Wasilewski M, Jovin IS. Novel oral anticoagulants in the treatment of radial artery occlusion. Catheter Cardiovasc Interv 2021; 98:1133-1137. [PMID: 33989459 DOI: 10.1002/ccd.29771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/28/2021] [Accepted: 05/03/2021] [Indexed: 11/05/2022]
Abstract
Transradial access of the vascular system for coronary angiography and percutaneous coronary intervention has become the primary approach in several cardiac catheterization laboratories across the world. The paradigm shift from transfemoral access has been driven by improved outcomes in patients undergoing these cardiac procedures by transradial access. Radial artery occlusion is the most common vascular complication of transradial coronary procedures. Only a few studies have reported on the optimal treatment of radial artery occlusion, with ulnar artery compression and anticoagulation, especially with low-molecular-weight heparin, having shown the best results. In this case series, four patients who were found to have evidence of post-cardiac catheterization radial artery occlusion on ultrasound imaging were treated with a 30-day course of apixaban. Three of the four patients showed complete resolution of radial artery occlusion with addition of apixaban to current standard therapeutic strategies. This case series shows that treatment with novel oral anticoagulants can be an alternative and more convenient option compared to subcutaneous injection of low-molecular heparin for anticoagulation in patients with post-coronary angiography radial artery occlusion.
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Affiliation(s)
- Sumon Roy
- Division of Cardiology, McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA.,Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ravi Choxi
- Division of Cardiology, McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA.,Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Melissa Wasilewski
- Division of Cardiology, McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA.,Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ion S Jovin
- Division of Cardiology, McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA.,Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
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Didagelos M, Pagiantza A, Zegkos T, Papanastasiou C, Zarra K, Angelopoulos V, Kouparanis A, Peteinidou E, Sianos G, Karvounis H, Ziakas A. Low-molecular-weight-heparin in radial artery occlusion treatment: the LOW-RAO randomized study. Future Cardiol 2021; 18:91-100. [PMID: 34397270 DOI: 10.2217/fca-2021-0067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Radial artery occlusion (RAO) is the commonest complication of transradial catheterization. There is no evidence-based therapy, in the frame of a randomized control study, for the treatment of RAO. The purpose of the LOW-RAO study is to question the hypothesis if low-molecular-weight heparin is effective in the treatment of RAO after transradial coronary catheterization (both angiography and percutaneous coronary intervention). It is a prospective, open label, randomized controlled trial that will randomize 60 patients with RAO, irrespective of symptoms, into two groups, one receiving anticoagulation with low-molecular-weight heparin and the other receiving no treatment. The primary end point is improvement in radial artery patency rate at 4 weeks after the procedure. Trial registration number: NCT04196309 (ClinicalTrials.gov).
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Affiliation(s)
- Matthaios Didagelos
- 1st Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Areti Pagiantza
- 1 Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Zegkos
- 1 Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Papanastasiou
- 1 Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantina Zarra
- 1 Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Angelopoulos
- 1 Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Kouparanis
- 1 Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanouela Peteinidou
- 1 Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Sianos
- 1 Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Haralambos Karvounis
- 1 Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Ziakas
- 1 Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Rammos C, Rassaf T. Insight in the treatment of iatrogenic femoral artery pseudoaneurysms. VASA 2021; 50:163-164. [PMID: 33938229 DOI: 10.1024/0301-1526/a000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Christos Rammos
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
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Besli F, Gungoren F, Tanriverdi Z, Tascanov MB, Fedai H, Akcali H, Demirbag R. The high dose unfractionated heparin is related to less radial artery occlusion rates after diagnostic cardiac catheterisation: a single centre experience. Acta Cardiol 2021; 76:168-174. [PMID: 31869279 DOI: 10.1080/00015385.2019.1705584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Transradial approach (TRA) has increasingly become the default strategy for cardiac catheterisation. However, TRA can result in several complications; radial artery occlusion (RAO) is the most unwilling complication. Unfractionated heparin (UFH) is an effective therapy in preventing RAO. The goal of this study was to evaluate whether weight-adjusted high dose UFH reduces the rate of RAO after diagnostic cardiac catheterisation compared to weight-adjusted standard dose UFH. METHODS A total of 1215 patients screened and after exclusion criteria, 686 consecutive patients were enrolled. 100 IU/kg UFH (high dose UFH group) and 50 IU/kg UFH (standard dose UFH group) were given the patients undergoing diagnostic cardiac catheterisation. RAO was evaluated with vascular Doppler ultrasonography at 10 days after cardiac catheterisation. RESULTS Among 686 patients undergoing diagnostic cardiac catheterisation, RAO was detected in 36 (5.2%) patients. There was no significant difference with respect to baseline characteristics and co-morbid diseases between high dose UFH group and standard dose UFH group. RAO was significantly higher in standard dose UFH group than high dose UFH group (7.9% vs. 3.0%, p = .004). Multivariate logistic regression analysis was demonstrated that age (OR: 0.958, 95% CI: 0.924-0.993, p = .019) and standard dose heparin (OR: 2.811, 95% CI: 1.347-5.866, p = .006) were independent factor for RAO. CONCLUSIONS High dose UFH was independently associated with a lower rate of RAO. Given that RAO nearly affects about 10% patient underwent TRA, prefer to high dose UFH may be a reasonable choice for RAO prevention.
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Affiliation(s)
- Feyzullah Besli
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Fatih Gungoren
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Zulkif Tanriverdi
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | | | - Halil Fedai
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Huseyin Akcali
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Recep Demirbag
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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Steinmetz M, Radecke T, Boss T, Stumpf MJ, Lortz J, Nickenig G, Kania A, Rassaf T, Rammos C, Schaefer CA. Radial artery occlusion after cardiac catheterization and impact of medical treatment. VASA 2020; 49:463-466. [PMID: 32669060 DOI: 10.1024/0301-1526/a000892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Summary: Background: The transradial artery approach is the preferred access for cardiac catheterization according to current guidelines. However, the most common complication is radial artery occlusion (RAO). Despite the rare indication for surgical reopening, the occluded radial artery is not available for further procedures or as a potential bypass graft. Still, treatment regimens for RAO are scarce. We now determined whether the addition of antithrombotic to antiplatelet therapy improves the rate of partial or complete regain of patency in RAO following transradial cardiac catheterization in a retrospective analysis. Patients and methods: In a two-center tertiary referral hospital retrospective analysis 4135 files of patients who had undergone transradial catheterization were screened for documented RAO. 141 patients were identified and 138 patients with complete information on the medical regimen and ultrasound examinations for a maximum of 3 months were included in the analysis, whereas 3 patients were excluded due to missing or incomplete follow-up information. Results: 3.3% of all patients that had undergone transradial catheterization featured an oligosymptomatic RAO, confirmed by color-coded duplex sonography. 21% of patients with additional anticoagulation regained full patency vs. 9% without additional anticoagulation (p = 0.07). 40% of patients with anticoagulation featured a partial or full regain of patency vs. 16% of patients without additional anticoagulation for a maximum of 3 months treatment (p = 0.006). No major bleedings were reported during the follow-up visits. Conclusions: RAO remains a rare complication of cardiac catheterization. The addition of antithrombotic therapy for 3 months appears to safely improve the partial or even full regain of radial patency in case of postinterventional RAO.
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Affiliation(s)
- Martin Steinmetz
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Germany
| | - Tobias Radecke
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Germany
| | - Tomasz Boss
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Max J. Stumpf
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Julia Lortz
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Alexander Kania
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Tienush Rassaf
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Germany
| | - Christos Rammos
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Germany
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Parikh A, Gilchrist IC. The pulseless radial artery in transradial catheterization: challenges and solutions. Expert Rev Cardiovasc Ther 2019; 17:827-836. [DOI: 10.1080/14779072.2019.1691917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Analkumar Parikh
- Interventional Cardiology, Pennsylvania State University, College of Medicine, Penn State Heart & Vascular Institute, M.S. Hershey Medical center, Hershey, PA, USA
| | - Ian C Gilchrist
- Interventional Cardiology, Pennsylvania State University, College of Medicine, Penn State Heart & Vascular Institute, M.S. Hershey Medical center, Hershey, PA, USA
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Jovin IS, Rajab M. Arm Pain after Transradial Coronary Procedures. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:726-727. [DOI: 10.1016/j.carrev.2019.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 11/16/2022]
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