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Nakache A, Darmon A, Molho A, Steinecker M, Nejjari M, Digne F. Evaluation of the safety and efficacy of the Axiostat® dressing device to achieve radial artery access hemostasis: The R3A study. Catheter Cardiovasc Interv 2024. [PMID: 38881025 DOI: 10.1002/ccd.31129] [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: 03/02/2024] [Revised: 05/09/2024] [Accepted: 06/09/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Radial access is the default approach in interventional cardiology. The Axiostat® surgical hemostatic dressing, using chitosan as its active component, has demonstrated potential in accelerating blood clotting. This study aims to assess the efficacy and the safety of the Axiostat® dressing in achieving hemostasis in patients undergoing transradial coronary angioplasty (TRCA). METHODS This prospective, single-center observational study, conducted in 2022, enrolled consecutive patients undergoing TRCA, with a target of 150 participants. The primary outcome was the success rate of radial artery hemostasis at 120 min, without bleeding necessitating immediate re-compression. The secondary outcome included Axiostat® performance at 24 h and 30 days Postprocedure. RESULTS The study was terminated prematurely for ethical and patient safety reasons, after inclusion of 41 consecutive TRCA patients due to an unexpectedly high radial artery thrombosis rate (19.5%, n = 8/41) observed 24 h Postprocedure. The success rate of radial hemostasis with the Axiostat® dressing was 78.0%. Procedural details and patient characteristics were comparable between successful Axiostat® removal and device failure cases. CONCLUSION The use of the Axiostat® dressing to achieve hemostasis after TRCA is effective but is associated with an unexpectedly high incidence of radial thrombosis. Our results should encourage caution in the future evaluation and use of this device for radial artery compression following TRCA.
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Affiliation(s)
- Ariel Nakache
- Cardiology Department, Centre Cardiologique du Nord, Saint Denis, France
| | - Arthur Darmon
- Cardiology Department, Centre Cardiologique du Nord, Saint Denis, France
| | - Antoine Molho
- Cardiology Department, Centre Cardiologique du Nord, Saint Denis, France
| | | | - Mohammed Nejjari
- Cardiology Department, Centre Cardiologique du Nord, Saint Denis, France
| | - Franck Digne
- Cardiology Department, Centre Cardiologique du Nord, Saint Denis, France
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Marlowe FJA, Powell E. Evaluating the safety and efficacy of transradial approach for thrombectomy in posterior circulation stroke. A systematic literature review and meta-analysis. Interv Neuroradiol 2024; 30:317-325. [PMID: 35673707 DOI: 10.1177/15910199221107259] [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: 11/16/2022] Open
Abstract
BACKGROUND Transradial access (TRA) is becoming more popular in neurointerventional radiology procedures and has been associated with reduced mortality, morbidity and access site complications. Guidelines state that TRA is a feasible option for posterior circulation thrombectomy however the evidence base is limited and no systematic literature review has yet been undertaken to evaluate its safety and efficacy. METHODS The Cochrane Library, PubMed, Web of Science, Scopus, TRIP and Embase databases were searched. Outcomes collected included TICI scores, puncture to recanalisation time, mRS scores at 90 days and access site complications. RESULTS 291 records were identified and 31 full text articles were assessed for eligibility. Eight studies met the inclusion criteria and were meta-analysed. The rate of TICI 2b-3 was 94.7% (89.7-99.8% at 95% CI), TICI 3 was 67.9% (42.2-93.6% at 95% CI) and mRS 0-2 at 90 days was 49.8% (31.5-68.1% at 95% CI). Median puncture to reperfusion times were extracted from three studies as 24 (IQR 18-40), 24 (IQR 17.5-56.5) and 27 (IQR 24-33.5) minutes. No access site complications were reported. TICI 2b-3, TICI 3 and mRS scores were comparable to data for transfemoral access (TFA) from a large systematic review. Puncture to recanalisation times appeared lower than the TFA data but statistical comparison of this outcome was not possible. CONCLUSIONS The use of TRA in posterior circulation thrombectomy is safe and effective with comparable results to TFA. Further research with a larger sample size is required to fully investigate the potential for shortened puncture to recanalisation times.
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Affiliation(s)
| | - Eloise Powell
- Warwick Medical School, University of Warwick, Coventry, CV4 7HL, UK
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Korotkikh AV, Babunashvili AM, Kazantsev AN, Annaev ZS. A narrative review of history, advantages, future developments of the distal radial access. J Vasc Access 2024; 25:745-752. [PMID: 36262018 DOI: 10.1177/11297298221129416] [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: 11/17/2022] Open
Abstract
This article presents a historical excursus and a review of modern literature on distal radial access for interventional surgery, discussing the anatomical and physiological substantiation of the use of this access point in endovascular surgery, its advantages and disadvantages. The main considerations directly related to distal puncture, choice of instrumentation, hemostasis, possible complications, and prevention are analyzed. The major areas of interventional surgery (coronary, vascular, oncological, and neurointerventional), where the distal radial approach is actively used, are reflected and their characteristics are highlighted. In general, it has been shown that with the development of technology, improved manual skills, the widespread use of hydrophilic introducers, and modern sheathless guiding catheters, the vessel diameter, and puncture site are not decisive factors when choosing access for any type of intervention.
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Batista S, Andreão FF, Bertani R, de Barros Oliveira L, Oberman DZ, Palavani LB, Filho CAFA, de Oliveira Braga F, Machado EAT, da Mata Pereira PJ, Filho PN, Almeida Filho JA. Transradial access for the endovascular treatment of intracranial aneurysms using the Woven EndoBridge device: A systematic review and pooled analysis. Neuroradiol J 2024:19714009241240328. [PMID: 38501764 DOI: 10.1177/19714009241240328] [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: 03/20/2024] Open
Abstract
BACKGROUND The Woven EndoBridge (WEB) device is a minimally invasive endovascular treatment option for patients with cerebral aneurysms. Transradial access (TRA) is a technique that involves accessing the arterial system through the radial artery in the wrist rather than the femoral artery in the groin. Several studies have investigated the use of TRA for WEB device deployment in treating intracranial aneurysms. METHODS A systematic review was conducted to evaluate the TRA for WEB device deployment in treating intracranial aneurysms. The databases PubMed, Cochrane, Embase, Scopus, and Web of Science were searched. To reduce the risk of bias, this systematic review only included studies reporting on using TRA in WEB device deployment for intracranial aneurysm treatment with a minimum of four patients. RESULTS In this systematic review, 186 patients were included across five studies, with TRA used in 183 cases analyzed. The study population had a higher proportion of females (n = 118%-69%) than males, with a mean age of 62 years old. Among the aneurysms treated, 46 were ruptured, and 119 were located at bifurcation sites, with a mean maximum diameter/width of 6.6 mm and mean height of 5.9 mm. Adjunctive coiling was used in three cases, and adjunctive stenting was used in nine cases. In two cases, conversion to a femoral artery access was necessary. CONCLUSION The available results suggest TRA with the WEB device is a safe and effective alternative. However, using TRA versus TFA should be individualized based on patient factors and operator experience.
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Affiliation(s)
- Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Brazil
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Wang J, Ma L, Cai H, Zeng H, Pei F, Cao J, Li M, Cao G. Distal radial access for neuroangiography and neurointerventions: systematic review and meta-analysis. BMC Neurol 2023; 23:405. [PMID: 37968640 PMCID: PMC10648363 DOI: 10.1186/s12883-023-03416-y] [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: 04/21/2023] [Accepted: 09/30/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Many studies have shown that coronary angiography (CAG) and percutaneous coronary intervention (PCI) via distal radial access (DRA) are safe and effective. Safety and efficacy of neuroangiography and neurointerventions via DRA are unknown. PURPOSE Search the literatures on neuroangiography and neurointerventions via DRA and conduct a systematic review and meta-analysis. METHODS PubMed, Embase and Cochrane were searched from inception to November 10, 2022. After literature screening, data extraction and assessment of literature quality, random effects model was used for meta-analysis. RESULTS A total of 236 literatures were retrieved, and 17 literatures including 1163 patients were finally included for meta-analysis.The pooled access success rate was 0.96 (95% confidence interval, 0.94-0.98), and the heterogeneity was obvious (I2 = 55.5%). The pooled access-related complications incidence rate was 0.03 (95% confidence interval, 0.02-0.05), and the heterogeneity was not obvious (I2 = 15.8%). CONCLUSION Neuroangiography and neurointerventions via DRA may be safe and effective. DRA is an alternative access for neuroangiography and neurointerventions.
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Affiliation(s)
- Jian Wang
- Department of Neurology, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou, 341000, China
| | - Lin Ma
- Department of Ultrasonography, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou, 341000, China
| | - Huaxiu Cai
- Department of Cardiology, Ganzhou People's Hospital, Ganzhou, 341000, China
| | - Huan Zeng
- Department of Radiology and Imaging, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou, 341000, China
| | - Fang Pei
- Department of Cardiology, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou, 341000, China
| | - Jun Cao
- Department of Cardiology, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou, 341000, China
| | - Maogang Li
- Department of Neurological Surgery, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou, 341000, China.
| | - Gang Cao
- Department of Cardiology, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou, 341000, China.
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Wang Y, Zhou Y, Cui G, Xiong H, Wang DL. Transradial versus transfemoral access for posterior circulation endovascular intervention: A systematic review and meta-analysis. Clin Neurol Neurosurg 2023; 234:108006. [PMID: 37864946 DOI: 10.1016/j.clineuro.2023.108006] [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: 06/11/2023] [Revised: 07/21/2023] [Accepted: 09/29/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE Transradial access (TRA) provides a more direct entry to posterior circulation system for endovascular therapy compared to transfemoral access (TFA). This meta-analysis aims to evaluate the safety and feasibility of TRA in neurointervention of posterior circulation. MATERIALS AND METHODS A systematic search was conducted in the Wanfang Data, CBM, PubMed, Embase, Cochrane Library, Web of Science databases. The primary outcomes included total complications and access site complications. Secondary outcomes were single puncture success, procedural success, access cross-over, catheter retention time and fluoroscopy time. RESULTS Six studies encompassing 297 patients were included in the meta-analysis. Compared to the TFA group, the TRA group showed significantly decreased total complications (odds ratio [OR] = 0.29, 95% confidence interval [CI] [0.12, 0.73], p < 0.01) and access site complications (OR = 0.19, 95%CI [0.06, 0.62], p < 0.01), yet it had a longer catheter retention time (mean difference [MD] = 0.80, 95%CI [0.60, 1.00], p < 0.01). There were no significant differences in single puncture success (OR = 3.68, 95%CI[0.38, 35.86], p = 0.26), procedural success (OR = 0.30,95%CI [0.05, 1.73], p = 0.18), access cross-over (OR = 2.29, 95%CI [0.19, 28.26], p = 0.52), fluoroscopy time (MD = 0.97, 95%CI [- 0.91, 2.84], p = 0.31) between the TRA and TFA groups. CONCLUSION This meta-analysis demonstrated that TRA is a safe and feasible alternative to TFA for neurointervention in the posterior circulation. TRA showed significantly decreased total complications and access site complications, yet it had a longer catheter retention time than TFA.
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Affiliation(s)
- Ying Wang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250000, China
| | - Yi Zhou
- Department of Neurosurgery, Shandong Provincial Hospital of Traditional Chinese Medicine, Jinan, Shandong 250000, China
| | - Gang Cui
- Department of Neurosurgery, Shandong Provincial Hospital of Traditional Chinese Medicine, Jinan, Shandong 250000, China
| | - Hui Xiong
- Department of Neurosurgery, Shandong Provincial Hospital of Traditional Chinese Medicine, Jinan, Shandong 250000, China
| | - De-Liang Wang
- Department of Neurosurgery, Shandong Provincial Hospital of Traditional Chinese Medicine, Jinan, Shandong 250000, China.
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Shamkhani W, Moledina S, Rashid M, Mamas MA. Complex high-risk percutaneous coronary intervention types, trends, and outcomes according to vascular access site. Catheter Cardiovasc Interv 2023; 102:803-813. [PMID: 37750228 DOI: 10.1002/ccd.30846] [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: 10/19/2022] [Revised: 05/15/2023] [Accepted: 09/13/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Radial access is associated with improved outcomes following percutaneous coronary intervention (PCI); however, its role in complex, high-risk percutaneous coronary intervention (CHiP) remains poorly studied. METHODS We studied retrospectively all registered patients's records from the British Cardiovascular Intervention Society dataset and compared the baseline characteristics, trends and outcomes of CHiP procedures performed electively between January 2006 and December 2017 according to the access site. RESULTS Out of 137,785 CHiP procedures, 61,825 (44.9%) were undertaken via transradial access (TRA). TRA use increased over time (14.6% in 2006 to 67% in 2017). The TRA patients were older, with a greater prevalence of previous stroke, hypertension, peripheral vascular disease, and smokers. TRA was used more frequently in most CHiP procedures (elderly (51.6%), chronic renal failure (52.6%), poor left ventricular (LV) function (47.6%), left main PCI (48.0%), treatment for severe vascular calcification (50.3%); although transfemoral access (TFA) was used more commonly in those with prior history of coronary artery bypass graft surgery, and PCI to a chronic total occlusion and LV support patients. Following adjustment for differences in clinical and procedural characteristics, TFA was independently associated with higher odds for mortality [adjusted odds ratio (aOR): 1.3 (1.1-1.7)], major bleeding [aOR: 2.9 (2.3-3.4)], and MACCE (following propensity score matching) [aOR: 1.2 (1.1-1.4)]. The same was found with multiple accesses: mortality [aOR: 2.1 (1.5-2.8)], major bleeding [aOR: 5.5 (4.3-6.9)], and MACCE [aOR: 1.4 (1.2-1.7)]. CONCLUSION TRA has become the predominant access site for CHiP procedures and is associated with significantly lower mortality, major bleeding and MACCE odds than TFA.
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Affiliation(s)
- Warkaa Shamkhani
- Department of Cardiology, Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Saadiq Moledina
- Department of Cardiology, Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Muhammad Rashid
- Department of Cardiology, Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Mamas A Mamas
- Department of Cardiology, Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM, Mendes LA, Arrighi JA, Breinholt JP, Day J, Dec GW, Denktas AE, Drajpuch D, Faza N, Francis SA, Hahn RT, Housholder-Hughes SD, Khan SS, Kondapaneni MD, Lee KS, Lin CH, Hussain Mahar J, McConnaughey S, Niazi K, Pearson DD, Punnoose LR, Reejhsinghani RS, Ryan T, Silvestry FE, Solomon MA, Spicer RL, Weissman G, Werns SW. 2023 ACC/AHA/SCAI advanced training statement on interventional cardiology (coronary, peripheral vascular, and structural heart interventions): A report of the ACC Competency Management Committee. J Thorac Cardiovasc Surg 2023; 166:e73-e123. [PMID: 37269254 DOI: 10.1016/j.jtcvs.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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9
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Romeo D, Salem MM, Sioutas GS, Corral Tarbay A, Ng JJ, Aboutaleb PE, Srinivasan VM, Pukenas B, Jankowitz BT, Burkhardt JK. The impact of Verapamil for radial access in diagnostic cerebrovascular angiograms: A retrospective case-control study. Interv Neuroradiol 2023:15910199231193932. [PMID: 37574785 DOI: 10.1177/15910199231193932] [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: 08/15/2023] Open
Abstract
INTRODUCTION Different combinations of medications are utilized during wrist access for radial artery (RA) or ulnar artery (UA) catheterization in neuroendovascular procedures to preclude vasospasm. These "cocktails" commonly include the calcium channel blocker Verapamil, without established benefit. We analyze outcomes in patients with and without Verapamil in their "cocktail" by using a case-control cohort of our single-center experience. METHODS A prospective log of consecutive patients who underwent diagnostic cerebral angiograms using RA/UA access was retrospectively reviewed, and patients were grouped into Verapamil and non-Verapamil cohorts. The primary outcomes assessed were the presence of forearm skin rashes (hives) and RA/UA spasms. Our initial management included Verapamil (5 mg) in the cocktail, but Verapamil was removed after we noticed the development of hives in multiple patients immediately following its injection. RESULTS A total of 221 patients underwent 241 RA/UA diagnostic cerebral angiograms and were included in our analysis. One hundred and forty-nine patients (61.8%) underwent catheterization with Verapamil and 92 (38.2%) were catheterized without it. Four of the 149 patients in the Verapamil group (2.7%) developed hives during the procedure and were treated with Benadryl (25 mg). Of the 92 patients who did not receive Verapamil, there were zero (0%) cases of hives and one (1.1%) case of vasospasm. CONCLUSION Verapamil in the "cocktail" for wrist access diagnostic cerebral angiograms was associated with periprocedural hives, but not associated with a significant reduction in spasm compared to the non-Verapamil group. Our findings suggest that the administration of prophylactic Verapamil for these procedures may not be necessary.
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Affiliation(s)
- Dominic Romeo
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Antonio Corral Tarbay
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Jinggang Jenny Ng
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Pakinam E Aboutaleb
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
- Department of Neuroradiology, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Bryan Pukenas
- Department of Neuroradiology, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
- Department of Neuroradiology, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
- Department of Neuroradiology, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA
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Jiang F, Fan WL, Zheng W, Wu X, Hu H. Distal radial artery access is a safe and feasible technique in the anatomical snuffbox for visceral intervention. Medicine (Baltimore) 2023; 102:e33987. [PMID: 37327275 PMCID: PMC10270534 DOI: 10.1097/md.0000000000033987] [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: 02/16/2023] [Accepted: 05/22/2023] [Indexed: 06/18/2023] Open
Abstract
Regarding the site of arterial access during the intervention, transracial intervention can reduce the risk of bleeding and vessel-related complications as well as improve patient comfort. Importantly, the distal radial artery (DRA) approach may reduce the incidence of radial artery occlusion and digital ischemia, but the feasibility and safety of DRA in performing subdiaphragmatic vascular interventions remain unclear. From January 2018 to December 2019, 106 patients were admitted to our department for visceral angiography and intervention by left distal radial artery accessing in an anatomical snuffbox. In total, 152 times of vascular interventions were performed during this period. Patients demographics, procedure details, technical success, and access site-related complications were recorded and evaluated. The mean age was 58.9 (range 22-86) years. Males accounted for 80.2%. Thirty-five patients (33%) had 2 or more procedures via the DRA approach. Technical success was achieved for 96.1% of procedures (146 cases) and 3.9% of cases failed to perform the intended procedure via the DRA approach (6 cases). The 4-Fr sheath was used in 86.8% of cases, and the 5 Fr sheath was used in the rest of the 13.2% of procedures. The rate of asymptomatic radial artery occlusion was 5.7% (6 of 106 patients). No patient suffered from distal limb ischemia after a long-time follow-up. Eight patients suffered postoperative local pain, transient numbness, or local bruised in the anatomical snuffbox without major complications. Patients with postoperative complications recovered quickly by using nonsteroidal anti-inflammatory drugs or without further treatment. Left distal radial artery access is safe and feasible as a new technique for visceral angiography and intervention.
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Affiliation(s)
- Feng Jiang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wen-Long Fan
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Weiliang Zheng
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xia Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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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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12
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Hui YH, Kong CC, Wong CHJ, Au SY, Leung CY, Lee SCA, Wong SH. Feasibility and safety of left distal trans-radial approach for coronary angiogram and percutaneous coronary intervention in a center in Hong Kong. J Vasc Access 2023:11297298231173465. [PMID: 37300375 DOI: 10.1177/11297298231173465] [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: 06/12/2023] Open
Abstract
INTRODUCTION The left distal trans-radial approach is not only more convenient for the operator than the conventional left forearm radial approach, it is also more comfortable for right-hand patients during the peri-procedural period. Comparing with conventional approach, it has lower bleeding risk, less pain and lower risk of radial artery occlusion. The aim of this study was to determine the feasibility and the safety of left distal trans-radial approach for coronary angiogram and percutaneous coronary intervention in Hong Kong Chinese who had smaller body built and therefore smaller radial arterial size. METHOD In this single-center prospective study, 72 patients undergoing elective coronary angiography and/or percutaneous coronary intervention were recruited from August to October 2018. All right-handed patients aged 18 or above undergoing elective procedures during the period were recruited. Exclusion criteria were non-palpable radial arteries, pregnancies, incapability to consent, abnormal Allen's test, and emergency procedures. Sixty patients (42 males, age ranging from 45 to 86 years old) were recruited and underwent the procedures via left distal radial approach. The measurements during access establishment, the procedure details, complications, patients' satisfaction, and arterial occlusion rate were studied. RESULTS The procedures with left distal radial approach were successful in 51 patients (85%). Crossover rate to conventional right radial approach was 15% (nine patients). Among successful cases, the mean patients' satisfaction was 8.32/10 and the mean pain score was 1.6/10. Post-procedural radial artery occlusion was not encountered. CONCLUSION Left distal radial approach is a feasible alternative for patients undergoing coronary angiography and/or percutaneous coronary intervention in Hong Kong Chinese patients. It provides good comfortability with minimal pain in right-handed patients. The risk of radial artery occlusion is minimal.
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Affiliation(s)
- Yiu Hong Hui
- Division of Cardiology, Department of Medicine, Tseung Kwan O Hospital, Hong Kong SAR, Hong Kong
| | - Chun Cheong Kong
- Division of Cardiology, Department of Medicine, Tseung Kwan O Hospital, Hong Kong SAR, Hong Kong
| | - Cheuk Hon John Wong
- Division of Cardiology, Department of Medicine, Tseung Kwan O Hospital, Hong Kong SAR, Hong Kong
| | - Shek Yin Au
- Division of Cardiology, Department of Medicine, Tseung Kwan O Hospital, Hong Kong SAR, Hong Kong
| | - Chun Yu Leung
- Division of Cardiology, Department of Medicine, Tseung Kwan O Hospital, Hong Kong SAR, Hong Kong
| | - Sze Chai Arthur Lee
- Division of Cardiology, Department of Medicine, Tseung Kwan O Hospital, Hong Kong SAR, Hong Kong
| | - Shun Hei Wong
- Division of Cardiology, Department of Medicine, Tseung Kwan O Hospital, Hong Kong SAR, Hong Kong
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. JACC Cardiovasc Interv 2023; 16:1239-1291. [PMID: 37115166 DOI: 10.1016/j.jcin.2023.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. J Am Coll Cardiol 2023; 81:1386-1438. [PMID: 36801119 DOI: 10.1016/j.jacc.2022.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Korotkikh A, Babunashvili A, Kaledin A, Akhramovich R, Derkach V, Portnov R, Kartashov D, Kazantsev A. Distal Radiation Access as an Alternative to Conventional Radial Access for Coronary Angiography and Percutaneous Coronary Interventions (According to TENDERA Trial). Curr Probl Cardiol 2023; 48:101546. [PMID: 36535496 DOI: 10.1016/j.cpcardiol.2022.101546] [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: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
The aim of this study was to assess the immediate and medium-term (3 months) results of the safety and efficacy of distal radial access (DRA) in coronary interventions compared with conventional transradial radial access (TRA). TRA is the recommended access for coronary procedures because of increased safety: fewer local complications, large and small bleeding. Recently, DRA has emerged as a promising alternative access to minimize radial artery occlusion (RAO) risk, as well as other complications. A large-scale, international, randomized trial comparing medium-term results with TRA and DRA is lacking. An analysis of 776 patients of the prospective randomized TENDERA trial was carried out: the distal artery access group (DRA) - 391, the transradial access group (TRA) - 385. Statistically more often the crossover access was in the DRA group (5.1% and 0.8%, P < 0.001). The primary endpoint was early or late thrombosis/occlusion of the radial artery (RA). Secondary endpoints: (1) composite complications from access vessels; (2) access parameters. Statistically significant differences were obtained for the primary endpoint: DRA 2.7% (n = 10), TRA 6.8% (n = 26), P = 0.008. Occlusion of the distal radial artery (DRAt), with patent RA: DRA 1.3% (n = 5), TRA 0 (0), P = 0.023. At the secondary composite endpoint, statistically significant differences were obtained for the following groups of complications: BARC type I bleeding (DRA: 3.8% (n = 14), TRA: 21.7% (n = 83), P < 0.001); hematoma larger than 5 cm on day 1 (DRA: 10% [n = 37], TRA: 25.9% [n = 98], P < 0.001); hematoma larger than 5 cm on day 7 (DRA: 12.4% [n = 45], TRA: 34.6% [n = 132], P < 0.001). Of the access parameters, the following statistically significantly differed: puncture time DRA 19.0 (8.0; 50), TRA 13.5 (5.0; 29), P < 0.001; insertion of introducer DRA 42.0 (26.0; 84.0), TRA 35.0 (23.0; 55.0), P < 0.001, access artery hemostasis duration (min.) DRA 180.0 (120.0; 480.0), TRA 155.0 (115.0; 195.0), P < 0.001. The duration of the procedure and fluoroscopy, radiation dose, RA spasm in both groups had no statistically significant differences. In the TENDERA trail, DRA demonstrated efficacy and safety in interventional coronary interventions compared with TRA in the medium-term follow-up period: a statistically significant lower incidence of RA occlusion and local complications.
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Affiliation(s)
- A Korotkikh
- Cardiac Surgery Department, Cardiac Surgery Clinic, Amur State Medical Academy, Blagoveshchensk, Russia.
| | - A Babunashvili
- Endovascular Surgery Department, Center for Endosurgery and Lithotripsy, Moscow, Russia; Department of Interventional Cardioangiology, Sechenov University, Moscow, Russia
| | - A Kaledin
- Endovascular Surgery Department, Northwestern State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia
| | - R Akhramovich
- Endovascular Surgery Department, Mytishchi City Clinical Hospital, Mytishchi, Russia
| | - V Derkach
- Endovascular Surgery Department, Clinic of Innovative Surgery, Klin, Russia
| | - R Portnov
- Endovascular Surgery Department, Clinic of Innovative Surgery, Klin, Russia
| | - D Kartashov
- Endovascular Surgery Department, Center for Endosurgery and Lithotripsy, Moscow, Russia; End ovascular Surgery Department, Center for Endosurgery and Lithotripsy, Moscow Regional Research Clinical Institute named after M. F. Vladimirsky, Moscow, Russia
| | - A Kazantsev
- Vascular Surgery Department, Kostroma Regional Clinical Hospital named after E. I. Korolev, Kostroma, Russia
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Samaras A, Papadopoulos K, Giannakoulas G, Tzikas A. First-in-man transradial percutaneous closure of ventricular septal defect with an Amplatzer Duct Occluder IΙ in an adult patient: a case report. Eur Heart J Case Rep 2023; 7:ytad189. [PMID: 37123651 PMCID: PMC10134066 DOI: 10.1093/ehjcr/ytad189] [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: 09/29/2022] [Revised: 11/18/2022] [Accepted: 04/12/2023] [Indexed: 05/02/2023]
Abstract
Background Transcatheter closure of perimembranous ventricular septal defect (VSD) is a promising alternative to surgical closure but has been associated with conduction disorders. Vascular access via multiple large vessels is associated with procedure-related complications, undermining the benefit of percutaneous approaches. In this case, we present the first-in-man transcatheter closure of a perimembranous VSD with an Amplatzer Duct Occluder IΙ in an adult patient via a single transradial artery access. Case summary A 62-year-old female was admitted to the hospital due to gradually worsening fatigue and shortness of breath on exertion. Transoesophageal echocardiogram (TOE) revealed a VSD size of 4-6 mm and a left ventricular ampulla size of 12 mm. A percutaneous VSD closure with the Amplatzer Duct Occluder II was decided. The angiography and TOE showed successful device placement and excellent procedural results. The patient was discharged home the next day after the procedure. The patient did not report any post-procedural complications during the 8-month follow-up. Echocardiographic assessment showed a gradual decrease in left ventricular dimensions. Discussion Transcatheter closure of perimembranous VSD is a promising alternative to surgical closure, but it is not free of complications. Traditional VSD occluders rely on multivessel access and complex formation of arteriovenous loops. In this case, we report the feasibility of perimembranous VSD closure with an Amplatzer Duct Occluder IΙ via a single radial artery access in an adult patient. This approach is a much simpler technique with several potential advantages and should be considered in selected adult patients and in similar clinical scenarios.
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Affiliation(s)
- Athanasios Samaras
- Department of Cardiology, AHEPA University Hospital, St. Kiriakidi 1, 54636 Thessaloniki, Greece
| | - Konstantinos Papadopoulos
- Department of Cardiology, Interbalkan European Medical Center, Asklipiou 10, Pylaia, 55535 Thessaloniki, Greece
| | - George Giannakoulas
- Department of Cardiology, AHEPA University Hospital, St. Kiriakidi 1, 54636 Thessaloniki, Greece
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Huie LC, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. Circ Cardiovasc Interv 2023; 16:e000088. [PMID: 36795800 DOI: 10.1161/hcv.0000000000000088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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de Oliveira Cardoso C, de Moraes CV, Teixeira JV, Cardoso CR, Baldissera F, de Mattos EI, Siqueira MJ, Fischer L, Sebben JC, Santos Silva B, Broetto G, Antônio Mascia Gottschall C, Sarmento-Leite R. Randomized Noninferiority Trial of Radiation Exposure During Coronary Angiography: the Transradial and Transfemoral Approach by EXPERienced Operators in Daily rouTine (EXPERT) Trial. Tex Heart Inst J 2023; 50:491654. [PMID: 36944120 PMCID: PMC10178642 DOI: 10.14503/thij-22-7930] [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: 03/23/2023]
Abstract
BACKGROUND The transradial approach (TRA) to coronary angiography reduces vascular complications but is associated with greater radiation exposure than the transfemoral approach (TFA). It is unknown whether exposure remains higher when TRA is performed by experienced operators. METHODS Patients were randomly, prospectively assigned to TRA or TFA. The primary end point was patient radiation dose; secondary end points were the physician radiation dose and 30-day major adverse cardiac event rate. Coronary angiography was performed by experienced operators using a standardized protocol. RESULTS Clinical and procedural characteristics were similar between the TRA (n = 150) and TFA (n = 149) groups, and they had comparable mean (SD) radiation doses for patients (616.51 [252] vs 585.57 [225] mGy; P = .13) and physicians (0.49 [0.3] vs 0.46 [0.29] mSv; P = .32). The mean (SD) fluoroscopy time (3.52 [2.02] vs 3.13 [2.46] min; P = .14) and the mean (SD) dose area product (35,496.5 [15,670] vs 38,313.4 [17,764.9] mGy·cm2; P = .2) did not differ. None of the following factors predicted higher radiation doses: female sex (hazard ratio [HR], 0.69 [95% CI, 0.38-1.3]; P = .34), body mass index >25 (HR, 0.84 [95% CI, 0.43-1.6]; P = .76), age >65 years (HR, 1.67 [95% CI, 0.89-3.1]; P = .11), severe valve disease (HR, 1.37 [95% CI, 0.52-3.5]; P = .68), or previous coronary artery bypass graft (HR, 0.6; 95% CI, 0.2-1.8; P = .38). CONCLUSION TRA for elective coronary angiography is noninferior to TFA when performed by experienced operators.
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Affiliation(s)
- Cristiano de Oliveira Cardoso
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Program in Health Sciences (Cardiology - PPG), University Foundation of Cardiology, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cláudio Vasques de Moraes
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Julio Vinícius Teixeira
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carlos Roberto Cardoso
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Felipe Baldissera
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eduardo Ilha de Mattos
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcio José Siqueira
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Leandro Fischer
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Juliana Cañedo Sebben
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Bruna Santos Silva
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gabriel Broetto
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carlos Antônio Mascia Gottschall
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Program in Health Sciences (Cardiology - PPG), University Foundation of Cardiology, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rogério Sarmento-Leite
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Program in Health Sciences (Cardiology - PPG), University Foundation of Cardiology, Porto Alegre, Rio Grande do Sul, Brazil
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Escutia-Cuevas HH, Alcantara Melendez M, Jiménez-Valverde AS, Zaragoza-Rodriguez G, Vargas-Cruz A, Garcia-Garcia JF, Ordonez-Salazar BA, Flores-Morgado A, Orozco Guerra G, Renteria-Valencia DA. Feasibility of distal transradial access for coronary angiography and percutaneous coronary intervention: an observational and prospective study in a Latin-American Centre. Acta Cardiol 2023; 78:55-63. [PMID: 34979883 DOI: 10.1080/00015385.2021.2015546] [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: 11/01/2022]
Abstract
BACKGROUND Distal transradial access (dTRA) as a refinement of the conventional transradial access (TRA) has advantages in terms of risk of radial artery occlusion (RAO). In order to evaluate the real-world feasibility and safety of dTRA as the default access site for routine coronary angiography (CAG) and percutaneous coronary intervention (PCI) in a Latin-American centre, this prospective observational registry was conducted. METHODS Consecutive patients with a prior assessment for CAG and/or PCI were enrolled in this single-centre prospective registry from October 2018 to March 2019. The primary endpoints were the success rate of CAG and PCI. Secondary endpoints included the success rate of puncture of the distal radial artery, complications at the puncture site and puncture time. RESULTS The success rates of CAG and PCI were 100% (155/155) and 97% (69/71), respectively. Puncture time and fluoroscopic time were 52 ± 19 seconds and 16.3 ± 35.4 minutes, respectively. Haemostasis time was 142 ± 45 min. A total of 19 (12.5%) puncture site complications occurred, including 18 (11.6%) minor haematomas and one (0.6%) arterial perforation, in which the artery was patent at the one-month follow-up. Five patients complained of left thumb numbness at a one-month follow-up. No distal radial artery occlusion, pseudoaneurysm, or arteriovenous fistula occurred. CONCLUSIONS The success and complication rates of ldTRA support the feasibility and safety of this procedure using the appropriate materials in previously selected patients.
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Affiliation(s)
| | | | | | | | - Antonio Vargas-Cruz
- Department of Interventional Cardiology, National Medical Center, Mexico City, Mexico
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Bouchahda N, Ben Abdessalem MA, Ben Hlima N, Ben Messaoud M, Denguir H, Boussaada MM, Saoudi W, Jamel A, Hassine M, Bouraoui H, Mahjoub M, Mahdhaoui A, Jeridi G, Betbout F, Gamra H. Combination Therapy With Nicardipine and Isosorbide Dinitrate to Prevent Spasm in Transradial Percutaneous Coronary Intervention (from the NISTRA Multicenter Double-Blind Randomized Controlled Trial). Am J Cardiol 2023; 188:89-94. [PMID: 36481522 DOI: 10.1016/j.amjcard.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/27/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022]
Abstract
Verapamil and nitroglycerin are widely used to prevent radial artery spasm (RAS) during percutaneous cardiovascular procedures. However, these agents are not typically available in most African countries and consequently, isosorbide dinitrate is often the only spasmolytic treatment. Our aim was to compare the efficacy of isosorbide dinitrate alone versus isosorbide dinitrate used together with nicardipine to prevent RAS during transradial coronary procedures. This was a randomized controlled double-blind multicenter trial. Patients (n = 1,523) were randomized to receive either a sole therapy of isosorbide dinitrate (n = 760) or the combination of isosorbide dinitrate and nicardipine (n = 763). Our primary end point was the occurrence of RAS; defined as considerable perceived hindrance of catheter advancement. Our secondary end points were severe RAS; defined as (1) severe arm pain, (2) the need for either morphine or midazolam treatment, and (3) necessity for crossover to the contralateral radial or femoral artery. RAS incidence was reduced with the combination therapy versus isosorbide dinitrate alone (15% vs 25%, p <0.001), with a number needed to treat of 10 patients. There was also a significant reduction in the incidence of the secondary end points with combination therapy (3.6% vs 8.2%, p <0.001), with a number needed to treat of 22 patients. This result was driven by reductions in both femoral crossover (0.5% vs 2.4%, p = 0.003) and the use of morphine or midazolam injections (1.6% vs 3.5%, p = 0.02) with combination therapy. In conclusion, we demonstrated the superiority of the combination therapy of isosorbide dinitrate and nicardipine over isosorbide dinitrate alone in reducing the incidence of RAS.
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Affiliation(s)
- Nidhal Bouchahda
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16, Fattouma Bourguiba University Hospital, Rue du 1er juin, Monastir, Tunisia.
| | - Mohamed Aymen Ben Abdessalem
- Cardiology Department, Université de Sousse, Laboratoire de Recherche: interactions cardiopulmonaires LR14ES05, Farhat Hached University Hospital, Tunisia
| | - Najeh Ben Hlima
- Cardiology Department,Université de Sousse, Kairouen Ibn el Jazzar University Hospital, Tunisia
| | - Mejdi Ben Messaoud
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16, Fattouma Bourguiba University Hospital, Rue du 1er juin, Monastir, Tunisia
| | - Hichem Denguir
- Cardiology Department, University of Monastir, Gabes University Hospital, Tunisia
| | - Mohamed Mehdi Boussaada
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16, Fattouma Bourguiba University Hospital, Rue du 1er juin, Monastir, Tunisia
| | - Wassim Saoudi
- Cardiology Department, Université de Sousse, Laboratoire de Recherche: interactions cardiopulmonaires LR14ES05, Farhat Hached University Hospital, Tunisia
| | - Ahmed Jamel
- Cardiology Department,Université de Sousse, Kairouen Ibn el Jazzar University Hospital, Tunisia
| | - Majed Hassine
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16, Fattouma Bourguiba University Hospital, Rue du 1er juin, Monastir, Tunisia
| | - Hatem Bouraoui
- Cardiology Department, Université de Sousse, Laboratoire de Recherche: interactions cardiopulmonaires LR14ES05, Farhat Hached University Hospital, Tunisia
| | - Marwen Mahjoub
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16, Fattouma Bourguiba University Hospital, Rue du 1er juin, Monastir, Tunisia
| | - Abdallah Mahdhaoui
- Cardiology Department, Université de Sousse, Laboratoire de Recherche: interactions cardiopulmonaires LR14ES05, Farhat Hached University Hospital, Tunisia
| | - Gouider Jeridi
- Cardiology Department, Université de Sousse, Laboratoire de Recherche: interactions cardiopulmonaires LR14ES05, Farhat Hached University Hospital, Tunisia
| | - Fethi Betbout
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16, Fattouma Bourguiba University Hospital, Rue du 1er juin, Monastir, Tunisia
| | - Habib Gamra
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16, Fattouma Bourguiba University Hospital, Rue du 1er juin, Monastir, Tunisia
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Aksoy MN, Sahinkus S, Agac MT, Tatli E. A randomized trial comparing left distal radial versus femoral approach for coronary artery bypass graft angiography: a pilot study. Minerva Cardiol Angiol 2023; 71:27-34. [PMID: 34137239 DOI: 10.23736/s2724-5683.21.05626-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Left distal transradial angiography (ldTRA) is a new technique for radial coronary angiography and may be an alternative to conventional transfemoral angiography (TFA) in patients who had previously undergone coronary artery bypass graft (CABG) surgery. In this study we compared ldTRA with TFA in patients who had undergone CABG surgery in terms of procedural details. METHODS Fifty-seven consecutive patients with history of previous CABG among 459 patients who were admitted to coronary angiography unit (elective and acute coronary syndromes) in our center between October 2019 and February 2020 were included in the study. Consecutive patients were randomized to ldTRA (34 patients) and TFA (23 patients) group. The difference in total procedure times was defined as primary endpoint. The difference in sheat times, fluoroscopy times, contrast volume used and radiation exposure were designated as secondary endpoints. Post angiographic complications were compared between two groups. RESULTS Out of 34 patients, successful distal radial access was obtained in 25 patients (74%). Baseline demographics, contrast use and radiation exposure were similar between groups. Sheath times in ldTRA was significantly longer (P<0.001), but total procedure times were not different (18.4±7.8 vs. 14.6±6.1, P=0.07). Non-standard angiographic equipment usage was significantly higher in ldTRA procedures (80% vs. 13%, P<0.001). There was no major bleeding in neither of groups, and three minor bleedings in FA group (0% vs.13%, P=0.10). CONCLUSIONS ldTRA in patients with a palpable pulse and successful access might be used successfully for angiography in patient with previous CABG even early in an operator's experience.
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Affiliation(s)
- Muhammed N Aksoy
- Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey -
| | - Salih Sahinkus
- Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Mustafa T Agac
- Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Ersan Tatli
- Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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Curtis E, Fernandez R, Khoo J, Weaver J, Lee A, Halcomb L. Clinical predictors and management for radial artery spasm: an Australian cross-sectional study. BMC Cardiovasc Disord 2023; 23:33. [PMID: 36653743 PMCID: PMC9847059 DOI: 10.1186/s12872-023-03042-z] [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: 09/20/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The transradial approach for coronary artery catheterisation has increased in popularity compared to the transfemoral approach for patients undergoing percutaneous coronary interventions. However, radial artery spasm continues to be a major complication of the procedure. Current management strategies vary concerning radial artery spasm and there is limited evidence of practice in the Australian context. AIM To identify the predictors of radial artery spasm and the medications used for its prevention and management. METHODS A descriptive cross-sectional study was carried out over a three-month period in two tertiary hospitals in NSW, Australia. A self-administered pre-procedural survey was completed by patients undergoing coronary artery catheterisation. This survey collected socio-demographic data and assessed anxiety using the Spielberger State-Trait Anxiety Inventory. Procedural data, including length of procedure, equipment used, occurrence of radial artery spasm, and medications given, were collected post-procedure by the interventionalist. RESULTS Of the 169 participants, over half were male (59.8%) and aged 66 years or older (56.8%). Radial artery spasm was reported in 24 (14.2%) participants. Rates of spasm were significantly higher among females (66.6%, p = 0.004), those aged under 65 years (62.5%, p = 0.001) and those who reported a medical history of anxiety (33.3%, p = 0.0004). There were no significant differences in State and Trait anxiety scores among those who had RAS and those who did not. Logistic regression identified younger age as the only statistically significant predictor of RAS (OR 0.536; 95% CI 0.171-1.684; p = 0.005). To prevent radial artery spasm most patients received midazolam (n = 158; 93.5%), nitrates (n = 133; 78.7%) and/or fentanyl (n = 124; 73.4%) prophylactically. Nitrates were the most frequently administered medication to treat radial artery spasm (78.7%). CONCLUSION This study highlights that there is a need to develop a clearer understanding of the predictors of RAS, as identifying patients at risk can ensure prophylactic measures are implemented. This study identified nitrates as the preferred vasodilator as a preventative measure along with the use of sedation.
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Affiliation(s)
- Elizabeth Curtis
- Faculty of Science, Medicine and Health, University of Wollongong, Building 41 Office 220, Northfields Ave, Keiraville, NSW, 2500, Australia.
| | - Ritin Fernandez
- grid.1007.60000 0004 0486 528XFaculty of Science, Medicine and Health, University of Wollongong, Building 41 Office 220, Northfields Ave, Keiraville, NSW 2500 Australia ,grid.416398.10000 0004 0417 5393Centre for Research in Nursing and Health, St George Hospital, 28 Gray Street, Kogarah, NSW 2217 Australia
| | - John Khoo
- grid.416398.10000 0004 0417 5393Cardiology Department, St George Hospital, Grey Street, Kogarah, NSW 2217 Australia
| | - James Weaver
- grid.416398.10000 0004 0417 5393Cardiology Department, St George Hospital, Grey Street, Kogarah, NSW 2217 Australia
| | - Astin Lee
- grid.1007.60000 0004 0486 528XFaculty of Science, Medicine and Health, University of Wollongong, Building 41 Office 220, Northfields Ave, Keiraville, NSW 2500 Australia ,grid.417154.20000 0000 9781 7439Cardiology Department, The Wollongong Hospital, Crown Street, Wollongong, NSW 2500 Australia
| | - Liz Halcomb
- grid.1007.60000 0004 0486 528XFaculty of Science, Medicine and Health, University of Wollongong, Building 41 Office 220, Northfields Ave, Keiraville, NSW 2500 Australia
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Analysis of the Effectiveness of Transradial Access Puncture in the Application of Complications and Comfort after Cerebral Angiography. Emerg Med Int 2022; 2022:3457034. [PMID: 36267143 PMCID: PMC9578911 DOI: 10.1155/2022/3457034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/09/2022] [Accepted: 09/24/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the analysis of the effectiveness of transradial access puncture in the application of complications and comfort after cerebral angiography. Methods Retrospectively analyzed 80 patients who met the inclusion and exclusion criteria and were randomly divided into the control group (femoral artery group n = 40) and test group (radial artery group n = 40) using a random number table from January 2021 to January 2022 admitted to the department of neurology and department of vascular interventions in our hospital and compared the incidence of postoperative puncture site bleeding, time to first postoperative urination, and incidence of postoperative urinary retention and postoperative changes in comfort level. Results There was 1 case of postoperative puncture site bleeding in the test group and 6 cases of postoperative puncture site bleeding in the control group, with statistically significant differences (P < 0.05); the time to first urination in the test group (62.47) was significantly better than that in the control group (85.97), with statistically significant differences (P < 0.05); there were 0 cases of urinary retention in the test group and 6 cases in the control group, with statistically significant differences (P < 0.05). The GCQ scores of patients in the test group were significantly higher than those in the control group, and the difference was statistically significant (P < 0.05). Conclusion Transradial access puncture has a good clinical effect and can effectively reduce the complication rate of patients, which is worth promoting.
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Sgueglia GA, Hassan A, Harb S, Ford TJ, Koliastasis L, Milkas A, Zappi DM, Navarro Lecaro A, Ionescu E, Rankin S, Said CF, Kuiper B, Kiemeneij F. International Hand Function Study Following Distal Radial Access: The RATATOUILLE Study. JACC Cardiovasc Interv 2022; 15:1205-1215. [PMID: 35595672 DOI: 10.1016/j.jcin.2022.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/07/2022] [Accepted: 04/14/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Distal radial access (DRA) has been proposed to improve procedure ergonomics and favor radial artery patency. Although promising data, nothing is known on evolving hand function after DRA. OBJECTIVES This study sought to comprehensively evaluate hand function in patients undergoing DRA. METHODS Real-world patients undergoing DRA undertook a thorough multimodality assessment of hand function implementing multidomain questionnaires (Disabilities of the Arm, Shoulder and Hand and Levine-Katz), and motor (pinch grip test) and sensory (Semmes-Weinstein monofilaments test) examinations of both hands. All assessments were performed at preprocedural baseline and planned at 1-, 6-, and 12-month follow-up (FU). Adverse clinical and procedural events were documented too. RESULTS Data of 313 patients (220 men, age 66 ± 10 years) from 9 international centers were analyzed. The Disabilities of the Arm, Shoulder and Hand and the Levine-Katz scores slightly improved from baseline to FU (P = 0.008 and P = 0.029, respectively). Pinch strength mildly improved from baseline to FU (P < 0.001 for both the left and right hands). Similarly, touch pressure threshold appeared to faintly improve in both the left and right hands (P < 0.012 for all the sites). For both motor and sensory function tests, comparable findings were found for the DRA hand and the contralateral one, with no significant differences between them. Repeated assessment of all tests over all FU time points similarly showed lack of worsening hand function. Access-related adverse events included 19 harmless bleedings and 3 forearm radial artery and 3 distal radial artery occlusions. None affected hand function at FU. CONCLUSIONS In a systematic multidimensional assessment, DRA was not associated with hand function impairment. Moreover, DRA emerges as a safe alternative vascular access.
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Affiliation(s)
| | - Ahmed Hassan
- Cardiology Department, St. Jansdal Hospital, Harderwijk, the Netherlands; Hartdokters, Amsterdam, the Netherlands
| | - Stefan Harb
- University Heart Center, Medical University of Graz, Graz, Austria
| | - Tom J Ford
- Gosford Hospital, Gosford, New South Wales, Australia
| | | | | | | | | | | | - Stephen Rankin
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | - Bibi Kuiper
- Independent Researcher, Bussum, the Netherlands
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25
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Banerjee S, Walker M. Distal Radial Artery Access for Coronary Catheterization: A Curated Approach. JACC Cardiovasc Interv 2022; 15:1216-1218. [PMID: 35595671 DOI: 10.1016/j.jcin.2022.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Subhash Banerjee
- University of Texas Southwestern Medical Center, Dallas, Texas, USA; Veterans Affairs North Texas Health Care System, Dallas, Texas, USA.
| | - McCall Walker
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
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26
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Ford TJ, Bamford P, Barlis P, Said C. Radial Artery, Alternative Arm Access, and Related Techniques. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Gender specific performance of one- compared to two-catheter concepts in transradial coronary angiography – Insights from the randomized UDDC-Radial-Trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 43:49-54. [DOI: 10.1016/j.carrev.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/31/2022] [Accepted: 05/02/2022] [Indexed: 11/21/2022]
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28
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Osman HM, Nabil F, Anwar M. Does radial artery cannulation affect the perfusion of the dominant hand in adult patients with normal modified Allen's test undergoing cardiac surgeries? Data derived from the peripheral perfusion index. J Cardiothorac Vasc Anesth 2022; 36:3773-3779. [DOI: 10.1053/j.jvca.2022.05.026] [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: 02/20/2022] [Revised: 04/24/2022] [Accepted: 05/19/2022] [Indexed: 11/11/2022]
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29
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Korotkikh AV, Babunashvili AM, Kazantsev AN, Tarasyuk ES, Annaev ZS. Distal radial artery access in noncoronary procedures. Curr Probl Cardiol 2022:101207. [PMID: 35460683 DOI: 10.1016/j.cpcardiol.2022.101207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022]
Abstract
Since the beginning of interventional cardiology and for decades, the femoral artery has been the access of choice for both diagnostic and interventional endovascular procedures. Due to an extensive evidence base accumulated over the last 20 years, the majority of interventional cardiologists around the world prefer classical radial artery access for both elective and emergency procedures. A similar trend has been observed for distal radial artery access over the last five years. Noncoronary endovascular surgery undergoes the same stages of improvement and optimization of access, but in a more accelerated way. The goal of this review is to analyze the literature on distal radial artery access in noncoronary procedures.
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Affiliation(s)
- A V Korotkikh
- Cardiac Surgery Clinic, Amur State Medical Academy, Blagoveshchensk, Russia.
| | | | | | - E S Tarasyuk
- Amur Regional Clinical Hospital, Blagoveshchensk, Russia
| | - Z S Annaev
- Novyy Urengoy Central Hospital, Novyy Urengoy, Russia
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30
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Transradial versus Transfemoral Approach for Neuroendovascular Procedures: A Survey of Patient Preferences and Perspectives. World Neurosurg 2022; 163:e623-e627. [DOI: 10.1016/j.wneu.2022.04.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 11/23/2022]
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31
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Wang Y, Jiao H, Peng H, Liu J, Ma L, Wang J. Study of Vertebral Artery Dissection by Ultrasound Superb Microvascular Imaging Based on Deep Neural Network Model. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9713899. [PMID: 35256903 PMCID: PMC8898129 DOI: 10.1155/2022/9713899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 12/04/2022]
Abstract
To assess the diagnostic value of ultrasound Superb Microvascular Imaging (SMI) and versus Doppler ultrasound (TCD) for microvascular structure and aerodynamic changes in vertebral artery dissection (VAD). In this paper, we firstly simulate the process of clinician recognition of vertebral artery dissection and propose a combination of a priori shape information of vertebral artery dissection and deep folly convolutional networks (DFCNs) for IVUS. In this paper, 15 patients with vertebral artery dissection confirmed by SMI, digital subtraction angiography (DSA), or computed tomography angiography (CTA) from 2020 to 2021 were selected, and the true and false lumen diameters, peak systolic flow velocity (PSV), end-diastolic flow velocity (EDV) and PSV, EDV, and plasticity index (PI) of the intracranial vertebral artery were measured. Among the 15 patients with VAD, 4 (27%, 4/15) had trauma-induced secondary vertebral artery entrapment and 11 (73%, 11/15) had spontaneous entrapment without a clear cause. According to the structural characteristics of the vessels, there were 11 cases (73%, 11/15) of double-lumen, intramural hematoma, and vertebral artery dissection aneurysm, and 11 cases (73%, 11/15) of V1 segment. SMI not only provides an objective assessment of the vascular morphology and aerodynamic changes in VAD but also, in combination with TCD, can further determine the opening of the traffic branches in the posterior circulation, providing reliable information for the early diagnosis and treatment of microvascular dissection of the vertebral artery.
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Affiliation(s)
- Yanjuan Wang
- Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, NingXia 750001, China
| | - Huajie Jiao
- Department of Medical Imaging, Ningxia People's Hospital, Yinchuan, NingXia 750001, China
| | - Huihui Peng
- Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, NingXia 750001, China
| | - Jinfang Liu
- Department of Neurology, General Hospital of Ningxia Medical University, Yinchuan, NingXia 750001, China
| | - Liyuan Ma
- Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, NingXia 750001, China
| | - Jianjun Wang
- Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, NingXia 750001, China
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Sanhoury MI, Sobhy MA, Saddaka MA, Nassar MA, Elwany MN. Distal radial approach between theory and clinical practice.. Time to go distal! Egypt Heart J 2022; 74:8. [PMID: 35122566 PMCID: PMC8818067 DOI: 10.1186/s43044-022-00243-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/17/2022] [Indexed: 11/24/2022] Open
Abstract
Background Transradial access (TRA), which has a minimal risk of problems such as radial artery occlusion (RAO), hemorrhage, spasm, and so on, is now considered the standard procedure for cardiac catheterization. The aim of the study is to present the distal transradial access (d-TRA) as a possible promising novel technique in the field of cardiac coronary interventions comparing it to the standard conventional TRA using primary and secondary endpoints, exploring its benefits and drawbacks as a new experience in Alexandria University. One hundred cases with variable indications for coronary interventions were randomized to two arms using systematic random sampling method, coronary interventions in the first one were done via d-TRA (50 patients) and in the second arm via conventional TRA group (50 patients).
Results Technically, there were highly statistically significant differences between the two arms in favor of TRA regarding procedural success, number of punctures taken, Access time, Total procedural time, vasodilator used, and crossover to another access site; meanwhile safety profile parameters have showed statistically significant differences in favor of d-TRA regarding post-operative hematoma, AV fistula, post-operative pain and compression time, and there were no statistically significant differences regarding RAO although it occurred more in TRA group.
Conclusions In the realm of cardiac intervention, the distal radial approach is a promising technique. When compared to TRA, we found it to be a viable and safe method for coronary angiography and interventions and it could be a real option for the interventionists in the near future, with a lower risk of radial artery blockage and no significant differences in wrist hematoma and radial artery spasm. The success rate of d-TRA is proportional to the steepness of the operator's learning curve and the quality of the examples chosen.
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Affiliation(s)
- Mohamed I Sanhoury
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed A Sobhy
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed A Saddaka
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed A Nassar
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Mostafa N Elwany
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Reifart J, Göhring S, Albrecht A, Haerer W, Levenson B, Ringwald G, Gärtner P, Reifart N. Acceptance and safety of femoral versus radial access for percutaneous coronary intervention (PCI): results from a large monitor-controlled German registry (QuIK). BMC Cardiovasc Disord 2022; 22:7. [PMID: 35016644 PMCID: PMC8753849 DOI: 10.1186/s12872-021-02283-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 09/22/2021] [Indexed: 12/12/2022] Open
Abstract
Background In 2015 and 2018, European Society of Cardiology guidelines for percutaneous coronary intervention (PCI) favoring radial access over femoral access were published. These recommendations were based on randomized trials suggesting that patients treated radially experienced reduced bleeding complications and all-cause mortality. We aimed to assess acceptance and results of radial access in a real-world scenario by analyzing all PCI cases in the Quality Assurance in Invasive Cardiology (QuIK) registry. Methods The QuIK registry prospectively collects data on all diagnostic and interventional coronary procedures from 148 private practice cardiology centers in Germany. Major adverse cardiac and cerebrovascular events (MACE) were defined as myocardial infarction, stroke, or death during hospitalization. Results From 2012 to 2018, 189,917 patients underwent PCI via either access method. The rate of radial approach steadily increased from 13 to 49%. The groups did not differ significantly with respect to age or extent of coronary disease. Femoral approach was significantly more common in patients with ST elevation myocardial infarction and cardiogenic shock. Overall, there were significant differences in MACE (radial 0.12%; femoral 0.24%; p < 0.0009) and access site complications (radial 0.2%; femoral 0.8% (p < 0.0009). Conclusion Our data reveals an increase in use of radial access in recent years in Germany. The radial approach emerged as favorable regarding MACE in non-myocardial infarction patients, as well as favorable regarding access site complication regardless of indication for percutaneous intervention.
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Affiliation(s)
- Jörg Reifart
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany. .,DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany.
| | - Stefan Göhring
- Geschäftsstelle Qualitätssicherung Invasive Kardiologie, Idstein, Germany
| | | | - Winfried Haerer
- Herzklinik Ulm, Dr. Haerer und Partner, Überörtliche BAG, Ulm, Germany
| | | | | | - Patrick Gärtner
- Department of Cardiology, Petrus-Krankenhaus, Wuppertal, Germany
| | - Nicolaus Reifart
- Department of Cardiology, Petrus-Krankenhaus, Wuppertal, Germany
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34
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Gragnano F, Jolly S, Mehta S, Branca M, van Klaveren D, Frigoli E, Gargiulo G, Leonardi S, Vranckx P, Di Maio D, Monda E, Fimiani L, Fioretti V, Chianese S, Andò G, Esposito G, Sangiorgi G, Biondi-Zoccai G, Heg D, Calabrò P, Windecker S, Romagnoli E, Valgimigli M. Prediction of radial crossover in acute coronary syndromes: derivation and validation of the MATRIX score. EUROINTERVENTION 2021; 17:e971-e980. [PMID: 34374343 PMCID: PMC9724886 DOI: 10.4244/eij-d-21-00441] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The radial artery is recommended by international guidelines as the default vascular access in patients with acute coronary syndromes (ACS) managed invasively. However, crossover from radial to femoral access is required in 4-10% of cases and has been associated with worse outcomes. No standardised algorithm exists to predict the risk of radial crossover. AIMS We sought to derive and externally validate a risk score to predict radial crossover in patients with ACS managed invasively. METHODS The derivation cohort consisted of 4,197 patients with ACS undergoing invasive management via the randomly allocated radial access from the MATRIX trial. Using logistic regression, we selected predictors of radial crossover and developed a numerical risk score. External validation was accomplished among 3,451 and 491 ACS patients managed invasively and randomised to radial access from the RIVAL and RIFLE-STEACS trials, respectively. RESULTS The MATRIX score (age, height, smoking, renal failure, prior coronary artery bypass grafting, ST-segment elevation myocardial infarction, Killip class, radial expertise) showed a c-index for radial crossover of 0.71 (95% CI: 0.67-0.75) in the derivation cohort. Discrimination ability was modest in the RIVAL (c-index: 0.64; 95% CI: 0.59-0.67) and RIFLE-STEACS (c-index: 0.66; 95% CI: 0.57-0.75) cohorts. A cut-off of ≥41 points was selected to identify patients at high risk of radial crossover. CONCLUSIONS The MATRIX score is a simple eight-item risk score which provides a standardised tool for the prediction of radial crossover among patients with ACS managed invasively. This tool can assist operators in anticipating and better addressing difficulties related to transradial procedures, potentially improving outcomes.
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Affiliation(s)
- Felice Gragnano
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland,Division of Cardiology, Department of Translational Medicine, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Sanjit Jolly
- Department of Medicine, McMaster University, and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Shamir Mehta
- Department of Medicine, McMaster University, and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Mattia Branca
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | | | - Enrico Frigoli
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Sergio Leonardi
- University of Pavia and Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium,Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
| | - Dario Di Maio
- Division of Cardiology, Department of Translational Medicine, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Emanuele Monda
- Division of Cardiology, Department of Translational Medicine, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Luigi Fimiani
- Unit of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vincenzo Fioretti
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Salvatore Chianese
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Andò
- Unit of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy,Mediterranea Cardiocentro, Naples, Italy
| | - Dik Heg
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Paolo Calabrò
- Division of Cardiology, Department of Translational Medicine, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Enrico Romagnoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, CH-6900 Lugano, Switzerland. E-mail:
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Safety and Effectiveness of Coronary Angiography or Intervention through the Distal Radial Access: A Meta-Analysis. J Interv Cardiol 2021; 2021:4371744. [PMID: 34867106 PMCID: PMC8604602 DOI: 10.1155/2021/4371744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/26/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives Searching the literature for coronary angiography (CAG) or intervention through distal radial access (DRA) and performing a meta-analysis. Background Coronary angiography (CAG) or intervention through distal radial access (DRA) may have a similar success rate, low radial artery occlusion rate, low radial artery spasm rate, and low rate of puncture site hematoma for patients with coronary heart disease. Therefore, the randomized controlled trials (RCTs) were searched, and the data were pooled for meta-analysis to evaluate the effectiveness and safety of DRA. Methods RCTs comparing the CAG or intervention through DRA vs. transradial access (TRA) published between January 1, 2017, and May 4, 2021, were searched in the PubMed, Embase, and Cochrane databases. The endpoints included the rate of access success and the number of radial artery occlusions, radial artery spasms, and puncture site hematomas. The data were extracted, and a random-effects model was used for analysis. Results Among 204 studies, 6 RCTs (with 2825 participants) met the inclusion criteria. Compared to TRA, the access success rate in DRA (p=0.1) and the lower rate of puncture site hematoma were not significantly different (p=0.646), while the radial artery occlusion rate (p < 0.001) and radial artery spasm rate (p=0.029) were significantly lower. Conclusion In summary, DRA has a similar access success rate and incidence of hematoma at the puncture site, but a lower incidence of RAO and spasm compared to TRA. These findings demonstrated that DRA is a safe and effective access for CAG or intervention.
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Matějka J, Varvařovský I, Tužil J, Doležal T, Bobak M, Pospíchal J, Geier P, Vondrák J, Bláha K, Málek J, Staňková A, Bujdák J, Rozsíval V, Novotný V, Lazarák T, Plíva M, Večeřa J, Vojtíšek P. Accession Site Does Not Influence the Risk of Stroke after Diagnostic Coronary Angiography or Intervention: Results from a Large Prospective Registry. Cerebrovasc Dis Extra 2021; 11:122-130. [PMID: 34710868 PMCID: PMC8647137 DOI: 10.1159/000519539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Periprocedural stroke represents a rare but serious complication of cardiac catheterization. Pooled data from randomized trials evaluating the risk of stroke following cardiac catheterization via transradial versus transfemoral access showed no difference. On the other hand, a significant difference in stroke rates favoring transradial access was found in a recent meta-analysis of observational studies. Our aim was to determine if there is a difference in stroke risk after transradial versus transfemoral catheterization within a contemporary real-world registry. Methods Data from 14,139 patients included in a single-center prospective registry between 2009 and 2016 were used to determine the odds of periprocedural transient ischemic attack (TIA) and stroke for radial versus femoral catheterization via multivariate logistic regression with Firth's correction. Results A total of 10,931 patients underwent transradial and 3,208 underwent transfemoral catheterization. Periprocedural TIA/stroke occurred in 41 (0.29%) patients. Age was the only significant predictor of TIA/stroke in multivariate analysis, with each additional year representing an odds ratio (OR) = 1.09 (CI 1.05–1.13, p < 0.000). The choice of accession site had no impact on the risk of periprocedural TIA/stroke (OR = 0.81; CI 0.38–1.72, p = 0.577). Conclusion Observational data from a large prospective registry indicate that accession site has no influence on the risk of periprocedural TIA/stroke after cardiac catheterization.
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Affiliation(s)
- Jan Matějka
- Department of Cardiology, Hospital of Pardubice, Pardubice, Czechia.,Faculty of Health Studies, University of Pardubice, Pardubice, Czechia.,Academic Department of Internal Medicine, Charles University Faculty of Medicine, Hradec Králové, Czechia
| | - Ivo Varvařovský
- Department of Invasive Cardiology, Cardiology Center AGEL, Pardubice, Czechia
| | - Jan Tužil
- Value Outcomes, Prague, Czechia.,First Medical Faculty, Charles University, Prague, Czechia
| | - Tomáš Doležal
- Value Outcomes, Prague, Czechia.,Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Jan Pospíchal
- Faculty of Health Studies, University of Pardubice, Pardubice, Czechia
| | - Petr Geier
- Department of Neurology, Hospital of Pardubice, Pardubice, Czechia
| | - Jiří Vondrák
- Department of Cardiology, Hospital of Pardubice, Pardubice, Czechia.,Academic Department of Internal Medicine, Charles University Faculty of Medicine, Hradec Králové, Czechia
| | - Karel Bláha
- Department of Cardiology, Hospital of Pardubice, Pardubice, Czechia
| | - Jan Málek
- Department of Cardiology, Hospital of Pardubice, Pardubice, Czechia
| | - Alena Staňková
- Department of Cardiology, Hospital of Pardubice, Pardubice, Czechia
| | - Juraj Bujdák
- Department of Cardiology, Hospital of Pardubice, Pardubice, Czechia
| | - Vladimír Rozsíval
- Academic Department of Internal Medicine, Charles University Faculty of Medicine, Hradec Králové, Czechia.,Department of Invasive Cardiology, Cardiology Center AGEL, Pardubice, Czechia
| | - Vojtěch Novotný
- Department of Invasive Cardiology, Cardiology Center AGEL, Pardubice, Czechia
| | - Tomáš Lazarák
- Department of Invasive Cardiology, Cardiology Center AGEL, Pardubice, Czechia
| | - Milan Plíva
- Department of Invasive Cardiology, Cardiology Center AGEL, Pardubice, Czechia
| | - Jan Večeřa
- Department of Invasive Cardiology, Cardiology Center AGEL, Pardubice, Czechia
| | - Petr Vojtíšek
- Department of Cardiology, Hospital of Pardubice, Pardubice, Czechia
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Klimek K, Świątek M, Klocek K, Tworek M, Zwolski M, Milewski K, Janas A. Comparison of Safety and Efficiency between Tiger-2 Catheter with Right Radial Artery Access and Judkins Catheter with Left Radial Artery Access. J Clin Med 2021; 10:jcm10174020. [PMID: 34501468 PMCID: PMC8432482 DOI: 10.3390/jcm10174020] [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: 08/09/2021] [Revised: 08/27/2021] [Accepted: 09/06/2021] [Indexed: 12/05/2022] Open
Abstract
We sought to compare the safety and efficiency of Tiger-2 in the right radial and Judkins catheter in the left radial access. We retrospectively collected data of 487 patients, involving 172 patients after coronary angiography with Judkins on the left radial artery and 315 patients with Tiger-2 on the right radial artery access. There were no differences in baseline characteristics, except for hypertension ratio and mean age. There was a difference in pulse absence on the radial artery. The volume of contrast used was higher in the Judkins group. Both groups differed in the amount of drugs administered (NTG and heparin). Fluorescence times were comparable between groups. Radiation dosage and AK was significantly greater in the Tiger-2 group. The Tiger-2 catheters were significantly more often changed to another type of catheter (100 changes) than the Judkins (12 changes). However, there was no statistical difference in access site change. Judkins with left radial access seems to be a safer option because of the lower radiation exposure and less incidence of complications than Tiger-2 with right radial access, however, it requires a higher volume of contrast.
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Affiliation(s)
- Katarzyna Klimek
- Center of Cardiovascular Research and Development American Heart of Poland, 40-028 Katowice, Poland; (K.K.); (K.K.); (M.T.); (M.Z.)
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Mateusz Świątek
- Center of Cardiovascular Research and Development American Heart of Poland, 40-028 Katowice, Poland; (K.K.); (K.K.); (M.T.); (M.Z.)
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
- Correspondence:
| | - Konrad Klocek
- Center of Cardiovascular Research and Development American Heart of Poland, 40-028 Katowice, Poland; (K.K.); (K.K.); (M.T.); (M.Z.)
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Michał Tworek
- Center of Cardiovascular Research and Development American Heart of Poland, 40-028 Katowice, Poland; (K.K.); (K.K.); (M.T.); (M.Z.)
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Maciej Zwolski
- Center of Cardiovascular Research and Development American Heart of Poland, 40-028 Katowice, Poland; (K.K.); (K.K.); (M.T.); (M.Z.)
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Krzysztof Milewski
- The Jerzy Kukuczka Academy of Physical Education, 40-959 Katowice, Poland;
| | - Adam Janas
- Andrzej Frycz Modrzewski Kraków University, 30-075 Kraków, Poland;
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38
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Nef HM, Achenbach S, Birkemeyer R, Bufe A, Dörr O, Elsässer A, Gaede L, Gori T, Hoffmeister HM, Hofmann FJ, Katus HA, Liebetrau C, Massberg S, Pauschinger M, Schmitz T, Süselbeck T, Voelker W, Wiebe J, Zahn R, Hamm C, Zeiher AM, Möllmann H. Manual der Arbeitsgruppe Interventionelle Kardiologie (AGIK) der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e. V. (DGK). DER KARDIOLOGE 2021. [PMCID: PMC8319902 DOI: 10.1007/s12181-021-00493-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Dieses Manual zur diagnostischen Herzkatheteruntersuchung (Teil 1) ist eine Anwendungsempfehlung für interventionell tätige Ärzte, die den gegenwärtigen Kenntnisstand unter Berücksichtigung neuester Studienergebnisse wiedergibt. Hierzu wurde in den einzelnen Kapiteln speziell auf die Alltagstauglichkeit der Empfehlungen geachtet, sodass dieses Manual jedem interventionell tätigen Kardiologen als Entscheidungshilfe im Herzkatheterlabor dienen soll. Trotz der von vielen Experten eingebrachten praktischen Hinweise kann dieses Manual dennoch nicht die ärztliche Evaluation des individuellen Patienten ersetzen und damit eine Anpassung der Diagnostik bzw. Therapie ersetzen.
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Affiliation(s)
- Holger M. Nef
- Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Klinikstr. 33, 35392 Gießen, Deutschland
| | - Stephan Achenbach
- Medizinische Klinik 2, Friedrich-Alexander-Universität Erlangen Nürnberg, Erlangen, Deutschland
| | | | - Alexander Bufe
- Medizinische Klinik I, Helios Klinikum Krefeld, Krefeld, Deutschland
- Universität Witten/Herdecke, Witten, Deutschland
| | - Oliver Dörr
- Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Klinikstr. 33, 35392 Gießen, Deutschland
| | - Albrecht Elsässer
- Herz- Kreislauf-Zentrum, Universitätsklinik für Innere Medizin – Kardiologie, Klinikum Oldenburg, Oldenburg, Deutschland
| | - Luise Gaede
- Medizinische Klinik 2, Friedrich-Alexander-Universität Erlangen Nürnberg, Erlangen, Deutschland
| | - Tommaso Gori
- Zentrum für Kardiologie – Kardiologie I, Universitätsmedizin Mainz, Mainz, Deutschland
- Standort Rhein-Main, DZHK, Frankfurt am Main, Deutschland
| | - Hans M. Hoffmeister
- Klinik für Kardiologie und allgemeine Innere Medizin, Städtisches Klinikum Solingen gemeinnützige GmbH, Solingen, Deutschland
| | - Felix J. Hofmann
- Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Klinikstr. 33, 35392 Gießen, Deutschland
| | - Hugo A. Katus
- Klinik für Innere Medizin III (Kardiologie, Angiologie, Pneumologie), Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Christoph Liebetrau
- Standort Rhein-Main, DZHK, Frankfurt am Main, Deutschland
- Abteilung für Kardiologie, Campus der JLU, Kerkhoff Bad Nauheim, Bad Nauheim, Deutschland
- CCB – Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Deutschland
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, München, Deutschland
| | - Matthias Pauschinger
- Klinik für Innere Medizin 8, Schwerpunkt Kardiologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg, Deutschland
| | - Thomas Schmitz
- Klinik für Kardiologie und Angiologie, Contilia Herz- und Gefäßzentrum, Essen, Deutschland
| | - Tim Süselbeck
- Kardiologische Praxisklinik Ludwigshafen, Ludwigshafen, Deutschland
| | - Wolfram Voelker
- Medizinische Klinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Jens Wiebe
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München, Deutschland
| | - Ralf Zahn
- Medizinische Klinik B, Klinikum der Stadt Ludwigshafen am Rhein gemeinnützige GmbH, Ludwigshafen, Deutschland
- Kommission für Klinische Kardiovaskuläre Medizin, Deutsche Gesellschaft für Kardiologie, Düsseldorf, Deutschland
| | - Christian Hamm
- Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Klinikstr. 33, 35392 Gießen, Deutschland
| | - Andreas M. Zeiher
- Klinik für Kardiologie, Angiologie und Nephrologie, Universitätsklinik Frankfurt, Frankfurt, Deutschland
| | - Helge Möllmann
- Klinik für Innere Medizin I, St.-Johannes-Hospital Dortmund, Dortmund, Deutschland
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Is It Safe to Mobilize Patients Very Early After Transfemoral Coronary Procedures? (SAMOVAR): A Randomized Clinical Trial. J Cardiovasc Nurs 2021; 37:E114-E121. [PMID: 34321432 DOI: 10.1097/jcn.0000000000000845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Coronary angiography (CAG) and percutaneous coronary intervention (PCI) are performed via the femoral or radial arteries. In patients examined via transfemoral access, closure devices facilitate hemostasis, but it is unknown whether it is safe to mobilize these patients immediately and how acceptable this may be in terms of patient comfort. OBJECTIVE The aims of this study were to investigate bleeding complications in patients mobilized immediately after transfemoral CAG or PCI compared with patients on bed rest (BR) for 2 hours after the procedure and, furthermore, to investigate patient comfort in relation to mobilization and BR. METHODS SAMOVAR was a noninferiority trial with patients randomized to immediate mobilization (IM) or 2 hours of BR after transfemoral CAG or PCI and use of the AngioSeal as a closure device and reversal of heparin effect. The primary end point was development of hematoma greater than 5 cm, pseudoaneurysm, or bleeding requiring blood transfusion. Secondary end points were oozing from the puncture site, small hematoma, and patient comfort. RESULTS Of 2027 patients (IM, 1010; BR, 1017), 40% underwent PCI. The primary outcome was recorded in 0.7% patients randomized to IM versus 0.5% in BR (P = .58). There was no difference in the incidence of small hematoma, whereas persistent oozing was seen slightly more often after IM compared with BR (12% vs 9%, P = .04). Patients mobilized immediately reported less back pain and micturition problems (P < .001). CONCLUSIONS In patients who had CAG and PCI performed through transfemoral access, reversal of anticoagulation and use of closure devices allowed IM with low rates of complications and improved patient comfort.
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Khandelwal P, Majmundar N, Rodriguez GJ, Patel P, Dodson V, Singla A, Khatri R, Gupta V, Sheriff F, Vellipuram A, Cruz-Flores S, Maud A. Dual-center study comparing transradial and transfemoral approaches for flow diversion treatment of intracranial aneurysms. Brain Circ 2021; 7:65-70. [PMID: 34189348 PMCID: PMC8191526 DOI: 10.4103/bc.bc_38_20] [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: 08/15/2020] [Revised: 12/30/2020] [Accepted: 01/26/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The transfemoral approach (TFA) has been the traditional approach for neurointerventional cases. While the TFA allows for triaxial support in flow diverting stent cases, it is associated with access site complications. Recently, the transradial approach (TRA) has emerged as a safer alternative to the TFA. To the best of our knowledge, there have only been single-center studies comparing outcomes in flow diverter cases for these approaches. We demonstrate the safety and feasibility of the TRA for placement of flow diverting stents in the treatment of unruptured intracranial aneurysms at two high-volume centers. MATERIALS AND METHODS We performed a retrospective review of prospectively collected institutional databases at two high-volume neuroendovascular centers. Cases from 2016 to 2018 of unruptured intracranial aneurysms treated by flow diverting stenting accessed through either the TRA or the TFA were compared. Patient demographics, procedural and radiographic metrics including location and size of the aneurysm, size, and length of the flow diverter implant, and fluoroscopic time were recorded. Puncture site complications and length of hospital stay were also included in the data analysis. RESULTS There were three out of 29 TRA cases which were converted to the TFA. None of the TRA patients experienced site complications, whereas three TFA patients experienced site complications. While TRA and TFA patients did not differ significantly in their exposure to radiation, TRA patients experienced shorter hospital stays. CONCLUSIONS While long-term studies are still lacking regarding this approach, we demonstrate that the TRA is a safe and feasible approach for flow diverter stent placement.
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Affiliation(s)
- Priyank Khandelwal
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Neil Majmundar
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gustavo J Rodriguez
- Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Pratit Patel
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Vincent Dodson
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Amit Singla
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rakesh Khatri
- Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Vikas Gupta
- Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Faheem Sheriff
- Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Anantha Vellipuram
- Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Salvador Cruz-Flores
- Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Alberto Maud
- Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
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Zafirovska B, Jovkovski A, Vasilev I, Taravari H, Kitanoski D, Petkoska D, Paljoskovska S, Kostov J, Ho KKL, Kedev S. Ipsilateral transulnar artery approach catheterizations after failure of the radial approach-Are two sheaths in the same arm safe? Catheter Cardiovasc Interv 2021; 99:411-417. [PMID: 34047429 DOI: 10.1002/ccd.29778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/09/2021] [Indexed: 11/11/2022]
Abstract
AIMS To assess the safety and feasibility of ipsilateral transulnar access (TUA) after failure of radial access (TRA), with two sheaths placed in the radial and ulnar arteries (RA and UA) in the same arm. MATERIALS AND METHODS All consecutive patients with TUA due to inability to cross from ipsilateral TRA in the period from March 2011 until September 2020 were included in the study. We examined clinical and procedure characteristics, access site bleeding and ischemic complications and failure mode of initial TRA. Patients were assessed by duplex ultrasound post-procedure (at an average of 56 ± 31 months) and followed clinically (functional and pain assessment). RESULTS In this period, out of 51,866 patients 112 (0.2%) had a transulnar artery approach due to inability to cross from ipsilateral radial approach. Mean age of patients was 65 ± 11 years with 44% females. Cause for crossover to ipsilateral TUA was inability to cross a RA anomaly in 107 (95%) patients, mostly due to the presence of a "360°" RA loop in 88 patients. Type 3 and 4 EASY Score hematoma was present in 3 patients (2.6%). Six (5.3%) of the patients had new ipsilateral radial artery occlusion noted on duplex on follow up. There were no ulnar artery occlusions detected. There were no clinical or ischemic hand complications seen during a median 4.3 years of follow up. CONCLUSION Ipsilateral transulnar artery access following failed radial artery access crossing is safe and successful for coronary angiography and intervention with low rates of complications.
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Affiliation(s)
- Biljana Zafirovska
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Aleksandar Jovkovski
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Ivan Vasilev
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Hajber Taravari
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Darko Kitanoski
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Danica Petkoska
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Savetka Paljoskovska
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Jorgo Kostov
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
| | - Kalon K L Ho
- Interventional Cardiology Department, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Sasko Kedev
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, Macedonia
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42
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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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Sun KX, Cui B, Cao SS, Wang WJ, Yu F, Wang JW, Ding Y. A meta-analysis and cost-minimization analysis of bivalirudin versus heparin in high-risk patients for percutaneous coronary intervention. Pharmacol Res Perspect 2021; 9:e00774. [PMID: 33939886 PMCID: PMC8092421 DOI: 10.1002/prp2.774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Indexed: 11/12/2022] Open
Abstract
This meta‐analysis was performed to compare the safety, efficacy, and pharmacoeconomic of bivalirudin versus heparin in high‐risk patients for percutaneous coronary interventions (PCI). Earlier meta‐analysis comparing bivalirudin and heparin during PCI demonstrated that bivalirudin caused less bleeding with more stent thrombosis. However, little data were available on the safety of bivalirudin versus heparin in high‐risk patients for PCI. Thus, we performed a meta‐analysis to evaluate the efficacy and safety in the “high‐risk” patients. A systematic search of electronic databases was conducted up to July 30, 2020. The Cochrane Risk of Bias assessment tool was used to assess the quality of included studies. The primary outcomes were all‐cause death and major adverse cardiac events (MACE); secondary outcomes were major and minor bleeding, followed by a cost‐minimization analysis comparing bivalirudin and heparin using a local drug and medical costs reported in China. Subgroup analysis was based on the type of disease of the high‐risk population. Finally, a total of 10 randomized controlled trials involved 42,699 patients were collected. The Cochrane Risk of Bias Tool was employed to appraise the research quality. No significant difference was noted between bivalirudin and heparin regarding all‐cause death and MACE. However, subgroup analysis showed that bivalirudin caused less major bleeding in female (OR:0.65, 95% CI:0.53–0.79), diabetes (OR:0.55, 95%CI:0.42–0.73), and CKD (OR:0.59, 95%CI:0.63–1.65). The scatterers of the included literature were approximately symmetrical, and no research was outside the funnel plot. Additionally, cost‐minimization analysis showed that heparin was likely to represent a cost‐effective option compared with bivalirudin in China, with potential savings of 2129.53 Chinese Yuan (CNY) per patient for one PCI. Overall, the meta‐analysis showed that although bivalirudin appeared to have a lower risk of major bleeding rate, the overall effectiveness and safety between the two groups showed no significant difference in high‐risk patients for PCI. But the results of the cost‐minimization analysis showed that heparin could be a potential cost‐saving drug than bivalirudin in patients for PCI in China.
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Affiliation(s)
- Ke-Xin Sun
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Bin Cui
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Shan-Shan Cao
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wen-Jun Wang
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Department of Pharmacy, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Feng Yu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Jing-Wen Wang
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yi Ding
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Sattar Y, Majmundar M, Ullah W, Mamtani S, Kumar A, Robinson S, Zghouzi M, Mir T, Dhamrah U, Al-Khadra Y, Pacha HM, Darmoch F, Soud M, Hakim Z, Bagur R, Kaul P, Ijioma N, Panchal A, Shroff AR, Alraies MC. Outcomes of Transradial Versus Transfemoral Access of Percutaneous Coronary Intervention in STEMI: Systematic Review and Updated Meta-analysis. Expert Rev Cardiovasc Ther 2021; 19:433-444. [PMID: 33896335 DOI: 10.1080/14779072.2021.1915768] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Transradial (TR) percutaneous coronary intervention (PCI) is a preferable PCI route. The complication difference between TR and TF approaches is controversial. METHODS PubMed, Embase, and the Cochrane databases were queried for PCI outcomes of TR TF in STEMI for major cardiac and cerebrovascular events (MACCE), major bleeding, and mortality. The odds ratio (OR) was calculated using the random-effect model. RESULTS We included 56 studies comprising of 68,733 patients (TR, n = 26,179; TF, n = 42,537). TR-PCI was associated with statistically significant lower odds of MACCE (OR = 0.66, 95% CI: 0.49-0.88, p-value = 0.005), major bleeding (OR = 0.47, 95% CI 0.32-0.68, p-value<0.001), mortality (OR = 0.59, 95% CI 0.43-0.80, p-value<0.001) at in hospital follow-up. TR-PCI was associated with statistically significant lower MACCE (OR = 0.59, 95% CI 0.43-0.80, p-value<0.001), major bleeding (OR = 0.58, 95% CI 0.49-0.68, p-value<0.001), and mortality (OR = 0.61, 95% CI 0.44-0.86, p-value = 0.005) at 30-day follow-up. The same difference was seen at 1-year. CONCLUSION TR-PCI was associated with lower odds of MACCE, major bleeding, and mortality during short- and long-term follow-up.
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Affiliation(s)
- Yasar Sattar
- Internal Medicine , Icahn School of Medicine at Mount Sinai Elmhurst Hospital, NY, New York, USA
| | - Monil Majmundar
- New York Medical College, Metropolitan Hospital Center, New York, NY, USA
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Sahil Mamtani
- Internal Medicine, Atlantic Care Regional Medical Center, Atlantic City, NJ, USA
| | - Ashish Kumar
- Internal Medicine, St John's Medical College Hospital, Bangalore, India
| | - Sam Robinson
- Internal Medicine , Icahn School of Medicine at Mount Sinai Elmhurst Hospital, NY, New York, USA
| | - Mohamed Zghouzi
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
| | - Tanveer Mir
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
| | - Umaima Dhamrah
- Internal Medicine , Icahn School of Medicine at Mount Sinai Elmhurst Hospital, NY, New York, USA
| | - Yasser Al-Khadra
- Department of Cardiology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Homam Moussa Pacha
- McGovern Medical School, University of Texas Health Science Center, Memorial Hermann Heart & Vascular Institute, Houston, TX, USA
| | - Fahed Darmoch
- Internal Medicine, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Mohamad Soud
- Department of Cardiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Zaher Hakim
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
| | - Rodrigo Bagur
- London Health Science Centre, Western University, London, Canada
| | - Prashant Kaul
- Department of Cardiology, Piedmont Heart Institute, Atlanta, GA, USA
| | | | - Ankur Panchal
- Department of Cardiology, University of Pittsburgh Medical Center, PA, USA
| | - Adhir R Shroff
- Department of Cardiology, University of Illinois at Chicago/Jesse Brown VA Medical Center, Chicago, IL, USA
| | - M Chadi Alraies
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
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45
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Dworeck C, Redfors B, Völz S, Haraldsson I, Angerås O, Råmunddal T, Ioanes D, Myredal A, Odenstedt J, Hirlekar G, Koul S, Fröbert O, Linder R, Venetsanos D, Hofmann R, Ulvenstam A, Petursson P, Sarno G, James S, Erlinge D, Omerovic E. Radial artery access is associated with lower mortality in patients undergoing primary PCI: a report from the SWEDEHEART registry. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 9:323-332. [PMID: 33025815 PMCID: PMC7756052 DOI: 10.1177/2048872620908032] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The purpose of this observational study was to evaluate the effects of radial artery access versus femoral artery access on the risk of 30-day mortality, inhospital bleeding and cardiogenic shock in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. METHODS We used data from the SWEDEHEART registry and included all patients who were treated with primary percutaneous coronary intervention in Sweden between 2005 and 2016. We compared patients who had percutaneous coronary intervention by radial access versus femoral access with regard to the primary endpoint of all-cause death within 30 days, using a multilevel propensity score adjusted logistic regression which included hospital as a random effect. RESULTS During the study period, 44,804 patients underwent primary percutaneous coronary intervention of whom 24,299 (54.2%) had radial access and 20,505 (45.8%) femoral access. There were 2487 (5.5%) deaths within 30 days, of which 920 (3.8%) occurred in the radial access and 1567 (7.6%) in the femoral access group. After propensity score adjustment, radial access was associated with a lower risk of death (adjusted odds ratio (OR) 0.70, 95% confidence interval (CI) 0.55-0.88, P = 0.025). We found no interaction between access site and age, gender and cardiogenic shock regarding 30-day mortality. Radial access was also associated with a lower adjusted risk of bleeding (adjusted OR 0.45, 95% CI 0.25-0.79, P = 0.006) and cardiogenic shock (adjusted OR 0.41, 95% CI 0.24-0.73, P = 0.002). CONCLUSIONS In patients with ST-elevation myocardial infarction, primary percutaneous coronary intervention by radial access rather than femoral access was associated with an adjusted lower risk of death, bleeding and cardiogenic shock. Our findings are consistent with, and add external validity to, recent randomised trials.
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Affiliation(s)
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Sebastian Völz
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Inger Haraldsson
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Dan Ioanes
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Anna Myredal
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Jacob Odenstedt
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Geir Hirlekar
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Sweden
| | - Ole Fröbert
- Department of Cardiology, Örebro University, Sweden
| | - Rickard Linder
- Department of Cardiology, Karolinska University Hospital, Sweden
| | | | - Robin Hofmann
- Department of Clinical Science and Education, Karolinska Institutet, Sweden
| | | | - Petur Petursson
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Giovanna Sarno
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden
| | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
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46
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Montorsi P, Cortese B, Cernetti C, Lanzellotti D, Di Palma G, Marchese A, Cremonesi A. Transradial approach for carotid artery stenting: A position paper from the Italian Society of Interventional Cardiology (SICI-GISE). Catheter Cardiovasc Interv 2021; 97:1440-1451. [PMID: 33844439 DOI: 10.1002/ccd.29677] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/14/2021] [Accepted: 03/19/2021] [Indexed: 12/24/2022]
Abstract
Carotid artery stenting (CAS) is a valid and effective alternative to endoatherectomy when performed by experienced operators. The conventional approach used is the transfemoral one, but in the last 10 years a transradial (TR) approach, the standard access for cardiac catheterization, became widely adopted for peripheral vascular interventions, included the extracranial carotids. Preliminary experiences suggest this approach as safe and effective, especially in specific anatomical and clinical settings that have been shown to be associated with high risk of complications from the femoral route. Lacking international guidelines, this document, promoted by the Italian Society of Interventional Cardiology - Gruppo Italiano Studi Emodinamici (SICI-GISE), was drawn-up by a panel of interventional cardiologists with a documented experience on the subject, focusing on the indications, techniques and materials that should be used for this type of intervention and the most recent literature on the subject.
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Affiliation(s)
- Piero Montorsi
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Bernardo Cortese
- Cardiovascular Research Team, Fondazione Ricerca e Innovazione Cardiovascolare, San Carlo Clinic, Paderno Dugnano-Milano, Italy
| | - Carlo Cernetti
- U.O.C. Cardiologia, Ospedale San Giacomo, Castelfranco Veneto, Treviso, Italy
| | - Davide Lanzellotti
- U.O.C. Cardiologia, Ospedale San Giacomo, Castelfranco Veneto, Treviso, Italy
| | - Gaetano Di Palma
- Cardiovascular Research Team, Fondazione Ricerca e Innovazione Cardiovascolare, San Carlo Clinic, Paderno Dugnano-Milano, Italy
| | - Alfredo Marchese
- U.O.C. Cardiologia Interventistica, Anthea Hospital-GVM Care & Research, Bari, Italy
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47
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Nagaraja V, Rao SV, George S, Mamas M, Nolan J. Evidence-based arterial access site practice in patients with acute coronary syndromes: Has SAFARI-STEMI changed the landscape? Catheter Cardiovasc Interv 2021; 97:1417-1421. [PMID: 33837993 DOI: 10.1002/ccd.29684] [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: 12/08/2020] [Revised: 02/18/2021] [Accepted: 03/14/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Vinayak Nagaraja
- Keele Cardiovascular Research Group, Center for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK.,Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK.,Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Mamas Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK.,Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - James Nolan
- Keele Cardiovascular Research Group, Center for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK.,Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
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48
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Lucreziotti S, Persampieri S, Gentile D, Barbieri L, Salerno-Uriarte D, Valli F, Sabatelli L, Panzacchi G, Centola M, Carugo S. Access-site hematoma in distal and conventional transradial access: a randomized trial. Minerva Cardiol Angiol 2021; 70:129-137. [PMID: 33703855 DOI: 10.23736/s2724-5683.21.05483-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Distal transradial access (dTRA) has been recently proposed as an innovative access for coronary procedures and a valuable alternative to conventional transradial access (cTRA). The aim of this study was to assess the safety of dTRA versus cTRA in patients undergoing percutaneous coronary angiography and intervention. METHODS In this single-center randomized trial, consecutive patients admitted for stable cardiac condition or acute coronary syndrome (ACS) were assigned to dTRA or cTRA. The primary endpoint was an early discharge after transradial stenting of coronary arteries (EASY) grade ≥II access-site hematoma (ASH). Vascular access failure, radial artery occlusion (RAO) at hospital discharge , 30-day rates of death, myocardial infarction, stroke and bleeding not related to coronary artery bypass grafting were considered as secondary endpoints. RESULTS A total of 204 patients were included and randomized to dTRA (n=100) or cTRA (n=104). The two populations were similar, except for a higher percentage of ACS in the dTRA than in the cTRA group (38% versus 24%, P=0.022). The rate of EASY grade ≥II ASH was lower in dTRA than in cTRA patients, but the difference was not statistically significant (4% versus 8.4%, respectively, P=0.25). Vascular access failure was more frequent in dTRA patients than in cTRA patients (34% versus 8.7%, P<0.0001). We detected no case of RAO at hospital discharge and similar rates of 30-day adverse events in both groups. CONCLUSIONS DTRA is safe and feasible. When compared to cTRA, dTRA is technically more demanding and limited by more frequent crossover to an alternative vascular access.
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Affiliation(s)
- Stefano Lucreziotti
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy -
| | - Simone Persampieri
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Domitilla Gentile
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Lucia Barbieri
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Diego Salerno-Uriarte
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Federica Valli
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Ludovico Sabatelli
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Giovanni Panzacchi
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Marco Centola
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Stefano Carugo
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
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49
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Feasibility and initial experience of left radial approach for diagnostic neuroangiography. Sci Rep 2021; 11:1089. [PMID: 33441762 PMCID: PMC7806974 DOI: 10.1038/s41598-020-80064-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 12/16/2020] [Indexed: 01/23/2023] Open
Abstract
Neuroangiography has seen a recent shift from transfemoral to transradial access. In transradial neuroangiography, the right dominant hand is the main access used. However, the left side may be used specifically for left posterior circulation pathologies and when right access cannot be used. This study describes our initial experience with left radial access for diagnostic neuroangiography and assesses the feasibility and safety of this technique. We performed a retrospective review of a prospective database of consecutive patients between April 2018 and January 2020, and identified 20 patients whom a left radial access was used for neurovascular procedures. Left transradial neuroangiography was successful in all 20 patients and provided the sought diagnostic information; no patient required conversion to right radial or femoral access. Pathology consisted of anterior circulation aneurysms in 17 patients (85%), brain tumor in 1 patient (5%), and intracranial atherosclerosis disease involving the middle cerebral artery in 2 patients (10%). The left radial artery was accessed at the anatomic snuffbox in 18 patients (90%) and the wrist in 2 patients (10%). A single vessel was accessed in 7 (35%), two vessels in 8 (40%), three vessels in 4 (20%), and four vessels in 1 (5%). Catheterization was successful in 71% of the cases for the right internal carotid artery and in only 7.7% for the left internal carotid artery. There were no instances of radial artery spasm, radial artery occlusion, or procedural complications. Our initial experience found the left transradial access to be a potentially feasible approach for diagnostic neuroangiography even beyond the left vertebral artery. The approach is strongly favored by patients but has significant limitations compared with the right-sided approach.
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50
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Goldman DT, Bageac D, Mills A, Yim B, Yaeger K, Majidi S, Kellner CP, De Leacy RA. Transradial Approach for Neuroendovascular Procedures: A Single-Center Review of Safety and Feasibility. AJNR Am J Neuroradiol 2021; 42:313-318. [PMID: 33446499 DOI: 10.3174/ajnr.a6971] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In recent years, the transradial approach has become more widely adopted for neuroendovascular procedures. The purpose of this study was to evaluate the safety and feasibility of a transradial approach and distal transradial access for neuroendovascular procedures in a single center. MATERIALS AND METHODS Retrospective analysis was performed for all patients who underwent transradial approach or distal transradial access neuroendovascular procedures from January 2016 to August 2019 at a single center. Exclusion criteria included a Barbeau D waveform, a radial artery of <2 mm on sonographic evaluation, and known radial artery occlusion. Procedures were evaluated for technical success (defined as successful radial artery access and completion of the intended procedure without crossover to an auxiliary access site), complications, and adverse events during follow-up at 30 days. RESULTS The transradial approach or distal transradial access was attempted in 279 consecutive patients (58.1% women; median age, 57.7 years) who underwent 328 standard or distal transradial approach procedures. Two-hundred seventy-nine transradial approach and 49 distal transradial approach procedures were performed (cerebral angiography [n = 213], intracranial intervention [n = 64], head and neck intervention [n = 30], and stroke intervention [n = 21]). Technical success was 92.1%. Immediate adverse events (2.1%) included radial access site hematoma (n = 5), radial artery occlusion (n = 1), and acute severe radial artery spasm (n = 1). Thirty-day adverse events (0.3%) included a radial artery pseudoaneurysm (n = 1). Twenty-six cases (7.9%) required crossover to transfemoral access. CONCLUSIONS The transradial approach for neuroendovascular procedures is safe and feasible across a wide range of neuroendovascular interventions.
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Affiliation(s)
- D T Goldman
- From the Departments of Radiology (D.T.G., R.A.D.L.)
| | - D Bageac
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - A Mills
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - B Yim
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - K Yaeger
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - S Majidi
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - C P Kellner
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
| | - R A De Leacy
- From the Departments of Radiology (D.T.G., R.A.D.L.)
- Neurosurgery (D.B., B.Y., K.Y., S.M., C.P.K., R.A.D.L.), Icahn School of Medicine at Mount Sinai (A.M.), New York, New York
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