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Lee WC, Wu PJ, Fang CY, Fang HY, Wu CJ, Liu PY. The comparison of efficacy and safety between transradial and transfemoral approach for chronic total occlusions intervention: a meta-analysis. Sci Rep 2022; 12:7591. [PMID: 35534603 PMCID: PMC9085849 DOI: 10.1038/s41598-022-11763-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/18/2022] [Indexed: 11/25/2022] Open
Abstract
This meta-analysis compared the outcomes of transradial access (TRA) and transfemoral access (TFA) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in recent decades. We searched multiple databases for articles published between January 1, 2015, and December 31, 2020. Six observational studies with 11,736 patients were analyzed. Data included baseline demographics, Japan-chronic total occlusion (J-CTO) score, sheath size, PCI vessel, retrograde method, procedural time, fluoroscopy time, and contrast volume. The more prevalent target CTO vessel was the left coronary artery in the TRA group and the right coronary artery in the TFA group. Higher J-CTO score, longer procedural time, and more contrast volume were seen in the TFA group. In comparison, the TRA group had better procedural success rate (odds ratio (OR), 0.846; 95% confidence interval (CI) 0.749-0.956) and less vascular complications (OR, 0.323; 95% CI 0.203-0.515), but similar retrograde success rate (OR, 0.965; 95% CI 0.382-2.435). In-hospital death (OR, 0.527; 95% CI 0.187-1.489) and major adverse cardiovascular events (OR, 0.729; 95% CI 0.504-1.054) did not differ between the groups. Overall, fewer vascular complications and higher procedural success rates were noted in the TRA CTO PCI population. However, similar retrograde success rates and clinical outcomes were noted between the groups.
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Affiliation(s)
- Wei-Chieh Lee
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan, ROC
| | - Po-Jui Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Ping-Yen Liu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC.
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd. North District, Tainan, 70403, Taiwan, ROC.
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Bajraktari G, Rexhaj Z, Elezi S, Zhubi-Bakija F, Bajraktari A, Bytyçi I, Batalli A, Henein MY. Radial Access for Coronary Angiography Carries Fewer Complications Compared with Femoral Access: A Meta-Analysis of Randomized Controlled Trials. J Clin Med 2021; 10:jcm10102163. [PMID: 34067672 PMCID: PMC8156941 DOI: 10.3390/jcm10102163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND AIM In patients undergoing diagnostic coronary angiography (CA) and percutaneous coronary interventions (PCI), the benefits associated with radial access compared with the femoral access approach remain controversial. The aim of this meta-analysis was to compare the short-term evidence-based clinical outcome of the two approaches. METHODS The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) comparing radial versus femoral access for CA and PCI. We identified 34 RCTs with 29,352 patients who underwent CA and/or PCI and compared 14,819 patients randomized for radial access with 14,533 who underwent procedures using femoral access. The follow-up period for clinical outcome was 30 days in all studies. Data were pooled by meta-analysis using a fixed-effect or a random-effect model, as appropriate. Risk ratios (RRs) were used for efficacy and safety outcomes. RESULTS Compared with femoral access, the radial access was associated with significantly lower risk for all-cause mortality (RR: 0.74; 95% confidence interval (CI): 0.61 to 0.88; p = 0.001), major bleeding (RR: 0.53; 95% CI:0.43 to 0.65; p ˂ 0.00001), major adverse cardiovascular events (MACE)(RR: 0.82; 95% CI: 0.74 to 0.91; p = 0.0002), and major vascular complications (RR: 0.37; 95% CI: 0.29 to 0.48; p ˂ 0.00001). These results were consistent irrespective of the clinical presentation of ACS or STEMI. CONCLUSIONS Radial access in patients undergoing CA with or without PCI is associated with lower mortality, MACE, major bleeding and vascular complications, irrespective of clinical presentation, ACS or STEMI, compared with femoral access.
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Affiliation(s)
- Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (A.B.); (I.B.); (M.Y.H.)
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
- Medical Faculty, University of Prishtina “Hasan Prishtina”, 10000 Prishtina, Kosovo
- UBT College, 10000 Prishtina, Kosovo
- Correspondence:
| | - Zarife Rexhaj
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
| | - Shpend Elezi
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
- Medical Faculty, University of Prishtina “Hasan Prishtina”, 10000 Prishtina, Kosovo
| | - Fjolla Zhubi-Bakija
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
| | - Artan Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (A.B.); (I.B.); (M.Y.H.)
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
| | - Ibadete Bytyçi
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (A.B.); (I.B.); (M.Y.H.)
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
| | - Arlind Batalli
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
- Medical Faculty, University of Prishtina “Hasan Prishtina”, 10000 Prishtina, Kosovo
| | - Michael Y. Henein
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (A.B.); (I.B.); (M.Y.H.)
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Aldoori JS, Mohammed AI. Transradial approach for coronary angiography and percutaneos coronary intervention: personal experience. Egypt Heart J 2019; 71:10. [PMID: 31659542 PMCID: PMC6820845 DOI: 10.1186/s43044-019-0006-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/16/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The transradial approach (TRA) has already become popular worldwide, but only recently has gained acceptance among Iraqi interventional cardiologists. The aim of this study is to document single operator experience with TRA and to test the benefit of assessing dual hand circulation before the TRA. It was an observational prospective study. Over a 2-year period (Jan 1, 2015, to Dec 31, 2016), 1561 patients underwent transradial coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) by a single operator. Patients were divided into two groups: A (the first 450 patients), in which dual hand circulation was assessed by Allen's test or plethysmography/oximetry test before TRA, and B (1111 patients) in which TRA was done without assessing dual hand circulation. RESULTS A total of 1561 patients were included, 69.1% males and 30.9% females. The mean age was (57 ± 10.0) years. We performed 1684 procedures (1005 CAG and 679 PCIs). The total transradial success rate was 95.6%, and PCI procedural success rate was 96.5%. The crossover rate from radial to femoral access was 4.4%. The primary causes for crossover were severe tortuosity of the aorta and brachiocephalic trunk, radial artery spasm, puncture failure, and radial loop. The main complication was radial artery occlusion (RAO) (3.7%). There were no cases of hand ischemia or complications that need surgical repair or blood transfusion. No statistically significant difference between groups A and B was observed regarding hand ischemia, the incidence of RAO, or the crossover rate. CONCLUSIONS TRA is safe and can be applied in the majority of cases. The routine assessment of dual hand circulation before TRA might not be necessary.
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Affiliation(s)
- Jaafar Sadeq Aldoori
- Department of Cardiology, Slemani Cardiac Hospital (SCH), Qanat street, Sulaymaniyah, Region of Kurdistan 46001 Iraq
| | - Ali Ibrahem Mohammed
- College of Medicine, University of Sulaimani, Sulaymaniyah, Region of Kurdistan Iraq
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Ahn SG, Lee JW, Youn YJ, Lee SH, Cho JH, Kang WC, Park JP, Shin WY, Lim SH, Choi YJ, Kim K, Lim DS, Chun W, Kim JH, Yoon J. In-hospital outcome differences between transradial and transfemoral coronary approaches: Data from the Korean percutaneous coronary intervention registry. Catheter Cardiovasc Interv 2019; 94:378-384. [PMID: 30604498 DOI: 10.1002/ccd.28032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 12/02/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We aimed to investigate specific subgroups in which the benefit of transradial coronary interventions (TRIs) would be enhanced. BACKGROUND The advantage of TRIs over transfemoral coronary interventions (TFIs) might differ according to a given clinical condition, urgency of the procedure, and operator volume pattern. METHODS Using a cohort from the 2014 Korean Percutaneous Coronary Intervention Registry, in-hospital outcomes of the TRI group (n = 22,993) were matched to those of the TFI group (n = 15,581). After propensity score matching, the composite endpoints between the groups and subgroups for all-cause death, nonfatal myocardial infarctions (MIs), or transfusions were analyzed. RESULTS The composite endpoints occurred less frequently in the TRI group than the TFI group [2.1% vs. 5.5%, OR 0.63, 95% CI 0.55-0.72]. The TRI group had a lower rate of death (OR 0.44, 95% CI 0.33-0.60) and nonfatal MI (OR 0.66, 95% CI 0.54-0.81) than the TFI group. The TRI group required fewer transfusions than the TFI group (OR 0.72, 95% CI 0.59-0.88). TRI benefits were consistent across subgroups except patients with chronic kidney disease and those treated in low tertile PCI volume centers. The favorable outcome of TRI was greater in the elderly (≥75 years), patients with ST-elevation MI, those who underwent emergent PCI, and those treated in high tertile PCI volume hospitals (P for the interaction <0.001 for all). CONCLUSIONS Compared to TFI, TRI had favorable composite in-hospital outcomes. TRI benefits were pronounced in high-risk clinical settings and in high PCI volume centers.
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Affiliation(s)
- Sung Gyun Ahn
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Jun-Won Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Young Jin Youn
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Seung-Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Jang Hyun Cho
- Department of Cardiology, St. Carollo Hospital, Republic of Korea
| | - Woong Chol Kang
- Department of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jong-Pil Park
- Division of Cardiology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Won-Yong Shin
- Department of Cardiology, Soon Chun Hyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Seong-Hoon Lim
- Division of Cardiovascular disease, College of Medicine, Dankook University Hospital, Cheonan, Republic of Korea
| | - Yu Jeong Choi
- Eulji University School of Medicine, Division of Cardiology, Eulji Medical Center, Daejeon, Republic of Korea
| | - Kyungsoo Kim
- Department of Cardiology, Hanyang University Hospital, Seoul, Republic of Korea
| | - Do-Sun Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Woojung Chun
- Department of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Ju Han Kim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Republic of Korea
| | - Junghan Yoon
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
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Kolkailah AA, Alreshq RS, Muhammed AM, Zahran ME, Anas El‐Wegoud M, Nabhan AF. Transradial versus transfemoral approach for diagnostic coronary angiography and percutaneous coronary intervention in people with coronary artery disease. Cochrane Database Syst Rev 2018; 4:CD012318. [PMID: 29665617 PMCID: PMC6494633 DOI: 10.1002/14651858.cd012318.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the major cause of mortality worldwide. Coronary artery disease (CAD) contributes to half of mortalities caused by CVD. The mainstay of management of CAD is medical therapy and revascularisation. Revascularisation can be achieved via coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Peripheral arteries, such as the femoral or radial artery, provide the access to the coronary arteries to perform diagnostic or therapeutic (or both) procedures. OBJECTIVES To assess the benefits and harms of the transradial compared to the transfemoral approach in people with CAD undergoing diagnostic coronary angiography (CA) or PCI (or both). SEARCH METHODS We searched the following databases for randomised controlled trials on 10 October 2017: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Web of Science Core Collection. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform in August 2017. There were no language restrictions. Reference lists were also checked and we contacted authors of included studies for further information. SELECTION CRITERIA We included randomised controlled trials that compared transradial and transfemoral approaches in adults (18 years of age or older) undergoing diagnostic CA or PCI (or both) for CAD. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. At least two authors independently screened trials, extracted data, and assessed the risk of bias in the included studies. We contacted trial authors for missing information. We used risk ratio (RR) for dichotomous outcomes and mean difference (MD) or standardised mean difference (SMD) for continuous data, with their 95% confidence intervals (CIs). All analyses were checked by another author. MAIN RESULTS We identified 31 studies (44 reports) including 27,071 participants and two ongoing studies. The risk of bias in the studies was low or unclear for several domains. Compared to the transfemoral approach, the transradial approach reduced short-term net adverse clinical events (NACE) (i.e. assessed during hospitalisation and up to 30 days of follow-up) (RR 0.76, 95% CI 0.61 to 0.94; 17,133 participants; 4 studies; moderate quality evidence), cardiac death (RR 0.69, 95% CI 0.54 to 0.88; 11,170 participants; 11 studies; moderate quality evidence). However, short-term myocardial infarction was similar between both groups (RR 0.91, 95% CI 0.81 to 1.02; 19,430 participants; 11 studies; high quality evidence). The transradial approach had a lower procedural success rate (RR 0.97, 95% CI 0.96 to 0.98; 25,920 participants; 28 studies; moderate quality evidence), but was associated with a lower risk of all-cause mortality (RR 0.77, 95% CI 0.62 to 0.95; 18,955 participants; 10 studies; high quality evidence), bleeding (RR 0.54, 95% CI 0.40 to 0.74; 23,043 participants; 20 studies; low quality evidence), and access site complications (RR 0.36, 95% CI 0.22 to 0.59; 16,112 participants; 24 studies; low quality evidence). AUTHORS' CONCLUSIONS Transradial approach for diagnostic CA or PCI (or both) in CAD may reduce short-term NACE, cardiac death, all-cause mortality, bleeding, and access site complications. There is insufficient evidence regarding the long-term clinical outcomes (i.e. beyond 30 days of follow-up).
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Affiliation(s)
- Ahmed A Kolkailah
- John H. Stroger, Jr. Hospital of Cook CountyDepartment of MedicineChicagoILUSA
| | | | - Ahmed M Muhammed
- Faculty of Medicine, Ain Shams UniversityDepartment of CardiologyCairoEgypt
| | - Mohamed E Zahran
- Faculty of Medicine, Ain Shams UniversityDepartment of CardiologyCairoEgypt
| | - Marwah Anas El‐Wegoud
- Egyptian Center for Evidence Based Medicine (ECEBM)8 Masaken Hayet El Tadrees Ain Shams University, El Khalifa El Maamoun St.CairoEgypt11646
| | - Ashraf F Nabhan
- Ain Shams UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine16 Ali Fahmi Kamel StreetHeliopolisCairoEgypt11351
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Coronary Angiography Safety between Transradial and Transfemoral Access. Cardiol Res Pract 2016; 2016:4013843. [PMID: 27885351 PMCID: PMC5112320 DOI: 10.1155/2016/4013843] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 09/18/2016] [Indexed: 11/17/2022] Open
Abstract
Background and Aim. The aim of study was to evaluate safety, feasibility, and procedural variables of transradial approach compared with transfemoral approach in a standard population of patients undergoing coronary catheterization as one of the major criticisms of the transradial approach is that it takes longer overall procedure and fluoroscopy time, thereby causing more radiation exposure. Method. Between January 2015 and December 2015, a total of 1,997 patients in LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, India, undergoing coronary catheterization were randomly assigned to the transradial or transfemoral approach. Result. Successful catheterization was achieved in 1045 of 1076 patients (97.1%) in the transradial group and in 918 of 921 patients (99.7%) in the transfemoral group (p = 0.001). Comparing the transradial and transfemoral approaches, fluoroscopy time (2.46 ± 1.22 versus 2.83 ± 1.31 min; p = 0.32), procedure time (8.89 ± 2.72 versus 9.33 ± 2.82 min; p = 0.56), contrast volume (67.52 ± 22.54 versus 71.63 ± 25.41 mL; p = 0.32), radiation dose as dose area product (24.2 ± 4.21 versus 22.3 ± 3.46 Gycm2; p = 0.43), and postprocedural rise of serum creatinine (6 ± 4.5% versus 8 ± 2.6%; p = 0.41) were not significantly different while vascular access site complications were significantly lower in transradial group than transfemoral group (3.9% versus 7.6%; p = 0.04). Conclusion. The present study shows that transradial access for coronary angiography is safe among patients compared to transfemoral access with lower rate of local vascular complications.
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Zahran ME, Alreshq RS, Kolkailah AA, Abdelazeem MA, Nabhan AF. Transradial versus transfemoral approach for diagnostic coronary angiography and percutaneous coronary intervention in patients with coronary artery disease. Hippokratia 2016. [DOI: 10.1002/14651858.cd012318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mohamed E Zahran
- Faculty of Medicine, Ain Shams University; Department of Cardiology; Cairo Egypt
| | - Rabah S Alreshq
- Faculty of Medicine, Ain Shams University; Department of Cardiology; Cairo Egypt
| | - Ahmed A Kolkailah
- Faculty of Medicine, Ain Shams University; Department of Cardiology; Cairo Egypt
| | - Mohamed A Abdelazeem
- Faculty of Medicine, Ain Shams University; Department of Cardiology; Cairo Egypt
| | - Ashraf F Nabhan
- Ain Shams University; Department of Obstetrics and Gynaecology, Faculty of Medicine; 16 Ali Fahmi Kamel Street Heliopolis Cairo Egypt 11351
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Yin WH, Tseng CK, Tsao TP, Jen HL, Huang WP, Huang CL, Wang JJ, Young MS. Transradial versus transfemoral rotablation for heavily calcified coronary lesions in contemporary drug-eluting stent era. J Geriatr Cardiol 2015; 12:489-496. [PMID: 26512239 PMCID: PMC4605943 DOI: 10.11909/j.issn.1671-5411.2015.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/13/2015] [Accepted: 02/26/2015] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Although radial access for drug-eluting stent (DES) combined with rotational atherectomy (RA) in patients with calcified coronary lesions may be associated with a lower risk of major bleeding complications and obtain favorable clinical results compared with femoral access, the long-term outcome data of this approach were limited in contemporary DES era. METHODS & RESULTS This retrospective study sought to compare in-hospital and long-term outcomes for patients undergoing RA via the transradial (TR) and transfemoral (TF) route in 126 consecutive patients (59 radial, 67 femoral) from 2009 to 2014. TR RA procedures were performed in 44/62 (71%) by the three TR operators, compared with 15/64 (23%) by the four TF operators in the present study. Significantly smaller diameter guide catheters and burrs (1.39 ± 0.16 mm vs. 1.53 ± 0.24 mm, P = 0.001) were used in the TR group. Procedural success rates were similar in both TR and TF groups. There was a significantly less major access site bleeding complications in favor of radial artery access (2% vs. 16%, P = 0.012). The incidence of in-hospital death or myocardial infarction was low in both groups. Although a trend of lower adverse event rate was demonstrated in the TR group compared with the TF one, no statistical significance (21% vs. 27%, P = 0.135) was detected. CONCLUSIONS Radial access, a useful alternative to femoral access for RA and DES, can be safely and successfully performed on up to 71% of the patients with heavily calcified coronary lesions needing RA by experienced TR operators.
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Affiliation(s)
- Wei-Hsian Yin
- Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, China
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, China
- Cardiovascular Research Centre, School of Medicine, National Yang-Ming University, Taipei, Taiwan, China
| | - Chin-Kun Tseng
- Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, China
| | - Tien-Ping Tsao
- Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, China
| | - Hsu-Lung Jen
- Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, China
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, China
| | - Wen-Pin Huang
- Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, China
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, China
| | - Chien-Lung Huang
- Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, China
| | - Jiann-Jong Wang
- Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, China
| | - Mason Shing Young
- Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, China
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9
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Effect of percutaneous coronary intervention on heart rate recovery in patients with coronary artery disease. Coron Artery Dis 2015; 26:442-7. [PMID: 25974268 DOI: 10.1097/mca.0000000000000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to investigate the effect of percutaneous coronary intervention (PCI) on heart rate recovery (HRR) in patients with angiographically defined coronary artery disease, and to search for a noninvasive method for evaluating the effect of revascularization. METHODS From June 2012 to July 2013, 56 consecutive male patients with coronary artery disease were enrolled in the PCI group. Correspondingly, in the control group there were 56 consecutive male patients with chest pain but a normal coronary artery verified by angiography. The exercise treadmill test was performed 3 days before and 7 days after intervention in the PCI group, and 3 days before angiography in the control group. RESULTS The peak heart rate, metabolic equivalents, and the Duke score were notably lower in the PCI group before intervention compared with the control group (P<0.01). In contrast, preintervention ST depression in the PCI group was significantly higher than that in the control group (P<0.01). Preintervention HRR values from 1 to 6 min were much lower in the PCI group compared with the control group (P<0.01). HRR values from 1 to 6 min in the PCI group post intervention increased significantly compared with preintervention HRR values (P<0.01), especially at 3, 4, 5, and 6 min. HRR values at 1, 2, and 3 min increased sharply post intervention. CONCLUSION Successful revascularization through PCI could improve HRR in patients with major coronary artery involvement. Moreover, HRR measurement may be used as a noninvasive method for evaluating the effect of revascularization.
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Choi JH, Seo JM, Lee DH, Park K, Kim YD. Clinical utility of new bleeding criteria: A prospective study of evaluation for the Bleeding Academic Research Consortium definition of bleeding in patients undergoing percutaneous coronary intervention. J Cardiol 2015; 65:324-9. [DOI: 10.1016/j.jjcc.2014.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/29/2014] [Accepted: 06/20/2014] [Indexed: 11/16/2022]
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Asrar ul Haq M, Williams P, Mutha V, Wilson AM, Barlis P. A twist in the transradial coronary catheterisation. Heart Lung Circ 2013; 23:e84-7. [PMID: 24176486 DOI: 10.1016/j.hlc.2013.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 08/11/2013] [Accepted: 09/28/2013] [Indexed: 11/27/2022]
Abstract
The transradial approach for coronary angiography was first described in 1989. With the advent of modern equipment and improved technology it has recently gained significant interest amongst interventional cardiologists. As compared to femoral access, the radial approach has the major advantages of lower access site complication rates, cost-effectiveness, and shorter hospital stays. Further clinical benefits of lower morbidity and cardiac mortality in patients with ST-elevation myocardial infarction have been shown recently. Rare vascular complications may include radial artery spasm, dissection, occlusion, perforation or compartment syndrome. Here, we present two unusual cases of an entrapped catheter in the radial artery and their outcomes.
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Affiliation(s)
- Muhammad Asrar ul Haq
- Department of Cardiology, The Northern Hospital, Victoria, Australia; Department of Medicine, University of Melbourne, Australia.
| | - Paul Williams
- Department of Cardiology, St Vincent Hospital, Victoria, Australia
| | - Vivek Mutha
- Department of Cardiology, The Northern Hospital, Victoria, Australia; Department of Medicine, University of Melbourne, Australia
| | - Andrew M Wilson
- Department of Medicine, University of Melbourne, Australia; Department of Cardiology, St Vincent Hospital, Victoria, Australia
| | - Peter Barlis
- Department of Cardiology, The Northern Hospital, Victoria, Australia; Department of Medicine, University of Melbourne, Australia; Department of Cardiology, St Vincent Hospital, Victoria, Australia
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MOON KEONWOONG, KIM JIHOON, KIM JUYOUN, JUNG MIHYANG, KIM GEEHEE, YOO KIDONG, KIM CHULMIN. Reducing Needle-To-Balloon Time by Using a Single Guiding Catheter during Transradial Primary Coronary Intervention. J Interv Cardiol 2012; 25:330-6. [DOI: 10.1111/j.1540-8183.2011.00717.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Moon KW, Kim JH, Yoo KD, Oh SS, Kim DB, Kim CM. Evaluation of Radial Artery Atherosclerosis by Intravascular Ultrasound. Angiology 2012; 64:73-9. [DOI: 10.1177/0003319712437030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Keon-Woong Moon
- Department of Internal Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Ji-Hoon Kim
- Department of Internal Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Ki-Dong Yoo
- Department of Internal Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Su-Sung Oh
- Department of Internal Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Dong-Bin Kim
- Department of Internal Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Chul-Min Kim
- Department of Internal Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, South Korea
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