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Wilkinson DA, Majmundar N, Catapano JS, Cole TS, Baranoski JF, Hendricks BK, Cavalcanti DD, Frederickson VL, Ducruet AF, Albuquerque FC. Avoiding the Radial Paradox: Neuroendovascular Femoral Access Outcomes After Radial Access Adoption. Neurosurgery 2022; 90:287-292. [PMID: 34995246 DOI: 10.1227/neu.0000000000001787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Transradial access (TRA) for neuroendovascular procedures is increasing in prevalence. The safety benefits of TRA at a patient level may be offset at a population level by a paradoxical increase in transfemoral access (TFA) vascular access site complications (VASCs), the so-called "radial paradox." OBJECTIVE To study the effect of TRA adoption on TFA performance and outcomes in neuroendovascular procedures. METHODS Data were collected for all procedures performed over a 10-mo period after radial adoption at a single center. RESULTS Over the study period, 1084 procedures were performed, including 719 (66.3%) with an intent to treat by TRA and 365 (33.7%) with an intent to treat by TFA. Thirty-two cases (4.4%) crossed over from TRA to TFA, and 2 cases (0.5%) crossed over from TFA to TRA. TFA was performed in older patients (mean [standard deviation] TFA, 63 [15] vs TRA, 56 [16] years) using larger sheath sizes (≥7 French; TFA, 56.2% vs TRA, 2.3%) ( P < .001 for both comparisons). Overall, 29 VASCs occurred (2.7%), including 27 minor (TFA, 4.6% [18/395] vs TRA, 1.3% [9/689], P = .002) and 2 major (TFA, 0.3% [1/395] vs TRA, 0.1% [1/689], P > .99) complications. Independent predictors of VASC included TFA (OR 2.8, 95% confidence interval [CI] 1.1-7.4) and use of dual antiplatelet therapy (OR 4.2, 95% CI 1.6-11.1). CONCLUSION TFA remains an important access route, despite a predominantly radial paradigm, and is disproportionately used in patients at increased risk for VASCs. TFA proficiency may still be achieved in predominantly radial practices without an increase in femoral complications.
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Affiliation(s)
- D Andrew Wilkinson
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Jin X, Weng Q, Min J. To Explore the Haemostatic Effect of Compression Haemostasis Using an Ultrasonic Probe under the Guidance of Ultrasound after Radial Artery Puncture. DISEASE MARKERS 2021; 2021:7423101. [PMID: 34900029 PMCID: PMC8654528 DOI: 10.1155/2021/7423101] [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: 10/08/2021] [Accepted: 11/10/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate a new haemostasis method using an ultrasound probe to compress the radial artery and haemostasis under direct vision to replace traditional manual compression of the radial artery. METHODS According to a random number table, 240 patients with gastrointestinal tumours who had undergone arterial puncture were divided into Group A (120 cases) and Group B (120 cases). In Group A, patients were under the guidance of ultrasound to confirm the vascular port, determine the compression position of the ultrasound probe, observe the degree of vascular deformation, and press the radial artery puncture port with pressure to stop bleeding under direct vision. In Group B, traditional manual compression was used. All patients received 5 min of compression for haemostasis, and haemostasis conditions were recorded after compression and 24 hours postoperatively. RESULTS The incidence of bleeding, haematoma, and skin ecchymosis at the puncture site after 5 minutes of compression in Group A was lower than that in Group B (P < 0.05). No significant difference was found between the two groups at 24 hours after the operation (P > 0.05). CONCLUSION The method using an ultrasound probe to guide radial artery compression to haemostasis is better than traditional manual compression when applied for compression haemostasis after removing the radial artery catheter.
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Affiliation(s)
- Xianwei Jin
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, Jiangxi 330006, China
| | - Qiaoling Weng
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang University, No. 1, Minde Road, Nanchang City Jiangxi 330008, China
| | - Jia Min
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, Jiangxi 330006, China
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Piedimonte G, Bertagnin E, Castellana C, Ferrarotto L, Mangione R, Venuti G, Valvo R, Scalia M, Capodanno D, Tamburino C, La Manna A. Ultrasound versus fluoroscopy-guided femoral access for percutaneous coronary intervention of chronic total occlusions: Insights from FOUND BLOOD CTO Registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 38:61-67. [PMID: 34556431 DOI: 10.1016/j.carrev.2021.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/29/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare vascular complications in patients undergoing percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) using ultrasound guidance (USG) versus fluoroscopy guidance (FSG) for femoral access. BACKGROUND In patients undergoing PCI, using the arterial femoral access increases the risk of vascular complications compared using the radial access. USG reduces time to access, number of attempts, and vascular complications compared with FSG, but the efficacy of USG has never been tested in the setting of CTO-PCI. METHODS A total of 197 patients undergoing CTO-PCI using at least a femoral vascular access from November 2015 to September 2020 were screened. The primary outcome was a composite of local hematoma, pseudoaneurysm, retroperitoneal hemorrhage, arteriovenous fistula or hemoglobin drop ≥3 g/dL during hospitalization. The independent association between USG and the primary outcome of interest was explored. RESULTS The primary outcome occurred in 17.3% of patients. Patients in the USG group had a significantly lower incidence of vascular complications compared with patients in the FSG group (8.5% vs. 21.0%, p = 0.039), driven by a reduction of localized hematomas (3.4% vs 13.0%, p = 0.042). After adjustment for type of CTO approach and heparin dose, USG was significantly associated with a reduced relative risk of the composite primary outcome (adjusted odds ratio 0.16, 95% confidence interval 0.05 to 0.51; p = 0.002). CONCLUSION USG in CTO-PCI is associated with a decreased risk of vascular complications, primarily driven by a reduction in local hematomas, especially in complex CTO-PCI where the larger use of heparin increases the risk of vascular complications.
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Affiliation(s)
- Giulio Piedimonte
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy
| | - Enrico Bertagnin
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy
| | - Carmelo Castellana
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy
| | - Luigi Ferrarotto
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy
| | - Riccardo Mangione
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy
| | - Giuseppe Venuti
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy
| | - Matteo Scalia
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy
| | - Alessio La Manna
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy.
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4
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Changal K, Syed MA, Atari E, Nazir S, Saleem S, Gul S, Salman FNU, Inayat A, Eltahawy E. Transradial versus transfemoral access for cardiac catheterization: a nationwide pilot study of training preferences and expertise in The United States. BMC Cardiovasc Disord 2021; 21:250. [PMID: 34020605 PMCID: PMC8139069 DOI: 10.1186/s12872-021-02068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background The objective was to assess current training preferences, expertise, and comfort with transfemoral access (TFA) and transradial access (TRA) amongst cardiovascular training fellows and teaching faculty in theUnited States. As TRA continues to dominate the field of interventional cardiology, there is a concern that trainees may become less proficient with the femoral approach. Methods A detailed questionnaire was sent out to academic General Cardiovascular and Interventional Cardiology training programs in the United States. Responses were sought from fellows-in-training and faculty regarding preferences and practice of TFA and TRA. Answers were analyzed for significant differences between trainees and trainers. Results A total of 125 respondents (75 fellows-in-training and 50 faculty) completed and returned the survey. The average grade of comfort for TFA, on a scale of 0 to 10 (10 being most comfortable), was reported to be 6 by fellows-in-training and 10 by teaching faculty (p<0.001). TRA was the first preference in 95% of the fellows-in-training compared to 69% of teaching faculty (p 0.001). While 62% of fellows believed that they would receive the same level of training as their trainers by the time they graduate, only 35% of their trainers believed so (p 0.004). Conclusion The shift from TFA to radial first has resulted in significant concern among cardiovascular fellows-in training and the faculty regarding training in TFA. Cardiovascular training programs must be cognizant of this issue and should devise methods to assure optimal training of fellows in gaining TFA and managing femoral access-related complications.
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Affiliation(s)
- Khalid Changal
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA.
| | | | - Ealla Atari
- College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Salik Nazir
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
| | - Sameer Saleem
- Department of Cardiovascular Medicine, University of Kentucky, Bowling Green, USA
| | - Sajjad Gul
- Internal Medicine, St. Francis Medical Center, University of Illinois at Peoria, Peoria, USA
| | - F N U Salman
- Internal Medicine, Mercy St. Vincent Medical Center, Toledo, OH, USA
| | - Asad Inayat
- Department of Medicine, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Ehab Eltahawy
- Professor and Program Director of Cardiovascular Medicine and Interventional Cardiology, University of Toledo, 3000 Arlington Ave., MS 1118, Toledo, 43614, OH, USA.
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Ye Y, Zhao X, Du J, Zeng Y. Efficacy and safety of balloon-assisted microdissection with Sapphire® II 1.0-mm balloon in balloon-uncrossable chronic total occlusion lesions. J Int Med Res 2021; 48:300060520965822. [PMID: 33103520 PMCID: PMC7645396 DOI: 10.1177/0300060520965822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Earlier studies have shown that the balloon-assisted microdissection (BAM) technique is feasible using a 1.2- to 1.5-mm small balloon in balloon-uncrossable chronic total occlusion (CTO) lesions. This study was performed to assess the efficacy and safety of the BAM technique with a Sapphire® II 1.0-mm balloon. Methods In this retrospective study, patients undergoing percutaneous coronary intervention for CTO were consecutively screened for balloon-uncrossable CTO lesions using BAM with the Sapphire® II 1.0-mm balloon. The patients’ clinical and angiographic characteristics and procedural outcomes were collected for analyses. Results Twenty-four balloon-uncrossable CTO lesions were identified. Most of the CTO lesions were located in the right coronary artery, followed by the left anterior descending artery and left circumflex artery. The mean Japanese Multicenter CTO Registry (J-CTO) and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) scores were 1.96 and 1.38, respectively. The total technical success rates were 91.6% (22/24) and 75.00% (18/24) for the lesions that were successfully treated with BAM. No patients developed major complications with the exception of one patient who developed a femoral hematoma. Conclusion BAM with the Sapphire® II 1.0-mm balloon may be an effective and safe technique for balloon-uncrossable CTO lesions.
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Affiliation(s)
- Yicong Ye
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Xiliang Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Jianjun Du
- Department of Cardiology, Tongliao Hospital, Neimengu, China
| | - Yong Zeng
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
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Radial Approach Expertise and Clinical Outcomes of Percutanous Coronary Interventions Performed Using Femoral Approach. J Clin Med 2019; 8:jcm8091484. [PMID: 31540442 PMCID: PMC6780122 DOI: 10.3390/jcm8091484] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/09/2019] [Accepted: 09/16/2019] [Indexed: 11/30/2022] Open
Abstract
We sought to evaluate the impact of experience and proficiency with radial approach (RA) on clinical outcomes of percutaneous coronary interventions (PCI) performed via femoral approach (FA) in the “real-world” national registry. A total of 539 invasive cardiologists performing PCIs in 151 invasive cardiology centers in Poland between 2014 and 2017 were included. Proficiency threshold was set at >300 PCIs during four consecutive years per individual operator. The majority of operators performed >75% of all PCIs via RA (449 (65.4%)), 143 (20.8%) in 50–75% of cases, 62 (9.0%) in 25–50% and only 33 (4.8%) invasive cardiologists were using RA in <25% of all PCIs. Operators with the highest proficiency in RA were associated with increased risk of periprocedural death, stroke and bleeding complications at access site during angiography via FA. Similarly, higher prevalence of periprocedural mortality during PCI with FA was observed in most experienced radial operators as compared to other groups. The detrimental effect of FA utilization by the most experienced radial operators was observed in both stable angina and acute coronary syndromes. Higher experience and utilization of RA might be linked to worse outcomes of PCIs performed via femoral artery in both stable and acute settings.
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Affiliation(s)
- Rahman Shah
- Veterans Affairs Medical Center, Division of Cardiovascular Medicine, University of Tennessee, Memphis, TN 38104, USA.
| | - Babar Khan
- Veterans Affairs Medical Center, Division of Cardiovascular Medicine, University of Tennessee, Memphis, TN 38104, USA
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8
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Valgimigli M. The MATRIX trial - Author's reply. Lancet 2019; 393:1803-1804. [PMID: 31057165 DOI: 10.1016/s0140-6736(19)30049-2] [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: 12/20/2018] [Accepted: 01/03/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Marco Valgimigli
- Department of Cardiology, Inselspital, University Hospital of Bern, Bern 3010, Switzerland.
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9
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van Wiechen MP, Ligthart JM, Van Mieghem NM. Large-bore Vascular Closure: New Devices and Techniques. ACTA ACUST UNITED AC 2019; 14:17-21. [PMID: 30858887 PMCID: PMC6406132 DOI: 10.15420/icr.2018.36.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Endovascular aneurysm repair, transcatheter aortic valve implantation and percutaneous mechanical circulatory support systems have become valuable alternatives to conventional surgery and even preferred strategies for a wide array of clinical entities. Their adoption in everyday practice is growing. These procedures require large-bore access into the femoral artery. Their use is thus associated with clinically significant vascular bleeding complications. Meticulous access site management is crucial for safe implementation of large-bore technologies and includes accurate puncture technique and reliable percutaneous closure devices. This article reviews different strategies for obtaining femoral access and contemporary percutaneous closure technologies.
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Affiliation(s)
- Maarten P van Wiechen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Jurgen M Ligthart
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands
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Ross J, Vidovich MI. Relative importance of attribute preferences for radial vs. femoral arterial access: A crowdsourcing study of healthy online-recruited volunteers. Catheter Cardiovasc Interv 2018; 93:1237-1243. [PMID: 30341974 DOI: 10.1002/ccd.27941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/01/2018] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) is typically performed with vascular access provided by the radial or femoral artery. However, little is known about how patients value aspects of these different vascular access approaches. METHODS Conjoint analysis is a survey-based statistical technique used in market research that helps determine how individuals value different attributes that make up a particular product or services. We utilized conjoint analysis to assess the relative importance of four attributes associated with PCI: access site, risk of bleeding, hospital stay, and radiation exposure. Participants were healthy individuals recruited by Amazon Mechanical Turk (MTURK). After completing a conjoint analysis survey, the software Conjoint.ly was used to calculate the relative importance for these four different attributes of PCI. RESULTS The relative importance of hospital stay, radiation exposure, bleeding risk, and procedure site was 32.7% (95% CI 29.5-35.8), 27.3% (95% CI 24.8-29.8), 24.4% (95% CI 22.3-26.5), and 15.7% (95% CI 13.6-17.8), respectively. The difference between these groups was statistically significant (P-value < 0.00001). The difference between duration of hospital stay and radiation exposure was statistically significant (P-value < 0.00433). CONCLUSION Patients undergoing PCI place largest relative value on duration of hospital stay. Access site appears the least valued attribute. These findings carry implications to guide further research on access site choices and the consent process in the context of shared decision-making.
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Affiliation(s)
- Jason Ross
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Mladen I Vidovich
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
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11
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Alternative access site choice after initial radial access site failure for coronary angiography and intervention. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2018; 15:585-590. [PMID: 30344542 PMCID: PMC6188983 DOI: 10.11909/j.issn.1671-5411.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Transradial access for coronary catheterization is more technically challenging compared to the traditional transfemoral approach and radial access failure is quite common. The aim of this study is to describe the additional steps after initial radial access site failure in a high specialized forearm approach center. Methods A retrospective evaluation of all coronary catheterizations performed in our Department between January 2016 and December 2016 was performed, with focus on arterial access. Results One thousand three hundred forty six procedures were evaluated. The initial access site used was right radial [1173 procedures (87.1%)], left radial [120 procedures (8.9%)], right ulnar [7 procedures (0.5%)], left ulnar [40 procedures (2.9%)] and femoral approach [6 procedures (0.4%)]. Radial artery cannulation failure was observed in 37 procedures (2.9% of 1293 procedures with initial radial approach). Failure of procedure completion after successful radial sheath insertion was observed in 46 procedures (3.6%). The alternative access site after initial radial approach failure was contralateral radial [43 procedures (51.8%)], ipsilateral ulnar [22 procedures (26.5%), contralateral ulnar [12 patients (14.5%)] and femoral approach [6 procedures (7.2%)]. Conclusion Forearm arteries can be used as alternative access site after initial radial approach failure in order to reduce the use of femoral approach during cardiac catheterization.
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12
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Castle EV, Rathod KS, Guttmann OP, Jenkins AM, McCarthy CD, Knight CJ, O'Mahony C, Mathur A, Smith EJ, Weerackody R, Timmis AD, Wragg A, Jones DA. Routine use of fluoroscopic guidance and up-front femoral angiography results in reduced femoral complications in patients undergoing coronary angiographic procedures: an observational study using an Interrupted Time-Series analysis. Heart Vessels 2018; 34:419-426. [PMID: 30264266 DOI: 10.1007/s00380-018-1266-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
Abstract
Transradial access is increasingly used for coronary angiography and percutaneous coronary intervention, however, femoral access remains necessary for numerous procedures, including complex high-risk interventions, structural procedures, and procedures involving mechanical circulatory support. Optimising the safety of this approach is crucial to minimize costly and potentially life-threatening complications. We initiated a quality improvement project recommending routine fluoroscopic guidance (femoral head), and upfront femoral angiography should be performed to assess for location and immediate complications. We assessed the effect of these measures on the rate of vascular complications. Data were collected prospectively on 4534 consecutive patients undergoing femoral coronary angiographic procedures from 2015 to 2017. The primary end-point was any access complication. Outcomes were compared pre and post introduction including the use of an Interrupted Time-Series (ITS) analysis. 1890 patients underwent angiography prior to the introduction of routine fluoroscopy and upfront femoral angiography and 2644 post. All operators adopted these approaches. Baseline characteristics, including large sheath use, anticoagulant use and PCI rates were similar between the 2 groups. Fluoroscopy-enabled punctures were made in the 'safe zone' in over 91% of cases and upfront femoral angiography resulted in management changes i.e. procedural abandonment prior to heparin administration in 21 patients (1.1%). ITS analysis demonstrated evidence of a reduction in femoral complication rates after the introduction of the intervention, which was over and above the existing trend before the introduction (40% decrease RR 0.58; 95% CI: 0.25-0.87; P < 0.01). Overall these quality improvement measures were associated with a significantly lower incidence of access site complications (0.9% vs. 2.0%, P < 0.001). Routine fluoroscopy guided vascular access and upfront femoral angiography prior to anticoagulation leads to lower vascular complication rates. Thus, study shows that femoral intervention can be performed safely with very low access-related complication rates when fluoroscopic guidance and upfront angiography is used to obtain femoral arterial access.
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Affiliation(s)
- Emily V Castle
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK
| | - Krishnaraj S Rathod
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Oliver P Guttmann
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK
| | - Alice M Jenkins
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK
| | - Carmel D McCarthy
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK
| | - Charles J Knight
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Constantinos O'Mahony
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK
| | - Anthony Mathur
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Elliot J Smith
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Roshan Weerackody
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Adam D Timmis
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Andrew Wragg
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Daniel A Jones
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK. .,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK.
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Shah R, Askari R, Haji SA, Rashid A. Mortality and operator experience with vascular access for percutaneous coronary intervention in patients with acute coronary syndromes: A pairwise and network meta-analysis of randomized controlled trials. Int J Cardiol 2018; 248:114-119. [PMID: 28942869 DOI: 10.1016/j.ijcard.2017.05.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 02/27/2017] [Accepted: 05/05/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recently, several meta-analyses of randomized controlled trials (RCTs) have shown that transradial access (TRA) reduces mortality compared to transfemoral access (TFA). However, a critical appraisal of these RCTs suggests that the findings could have resulted from a greater incidence of adverse events in the TFA groups rather than a beneficial effect of TRA. METHODS Scientific databases and websites were searched for RCTs. Patients were divided into groups based on access type and whether the operator was a radial expert (RE) or non-radial expert (NRE). The groups were TFA-RE, TFA-NRE, TRA-RE, and TRA-NRE. Both a traditional meta-analysis and a network meta-analysis using mixed-treatment comparison models were performed. RESULTS Data from 13 trials including 15,615 patients were analyzed. The mortality rate for TFA-RE (3.54%) was more than double compared to TFA-NRE (1.61%). In pairwise meta-analysis, TFA-RE was associated with increased risk of mortality (RR: 1.72, 95% CI: 1.13-2.62; p=0.011) compared to TFA-NRE. In subgroup analysis, TFA-RE was associated with increased mortality (RR: 1.70, 95% CI: 1.24-2.34; p=0.001) compared to TRA, but TRA-NRE was not. Similarly, in mixed comparison models, TFA-RE was associated with increased mortality compared to TRA-NRE, TRA-RE, and TFA-NRE, but TFA-NRE was not, compared to TRA-RE and TRA-NRE. CONCLUSION Recently-reported survival differences between TRA and TFA may have been driven by adverse events in the TFA groups of the RCTs rather than a beneficial effect of TRA. This issue needs further investigation before labeling radial access a lifesaving procedure in invasively-managed patients with ACS.
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Affiliation(s)
- Rahman Shah
- Section of Cardiology, University of Tennessee, School of Medicine, Memphis, TN, United States; Veterans Affairs Medical Center, Memphis, TN, United States.
| | - Reza Askari
- Section of Cardiology, University of Tennessee, School of Medicine, Memphis, TN, United States
| | - Showkat A Haji
- Section of Cardiology, University of Tennessee, School of Medicine, Memphis, TN, United States
| | - Abdul Rashid
- Jackson Clinic, University of Tennessee, Jackson, TN, United States
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Badri M, Shapiro T, Wang Y, Minges KE, Curtis JP, Gray WA. Adoption of the transradial approach for percutaneous coronary intervention and rates of vascular complications following transfemoral procedures: Insights from NCDR. Catheter Cardiovasc Interv 2018; 92:835-841. [DOI: 10.1002/ccd.27490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 12/27/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Marwan Badri
- Lankenau Heart Institute; Wynnewood Pennsylvania
| | | | - Yongfei Wang
- Center for Outcomes Research and Evaluation; Yale-New Haven Hospital; New Haven Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Karl E. Minges
- Center for Outcomes Research and Evaluation; Yale-New Haven Hospital; New Haven Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Jeptha P. Curtis
- Center for Outcomes Research and Evaluation; Yale-New Haven Hospital; New Haven Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
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15
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Chatterjee A, Hillegass WB. Patient preference: An important emerging factor in operator access site selection. Catheter Cardiovasc Interv 2018; 91:25-26. [DOI: 10.1002/ccd.27457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 11/29/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Arka Chatterjee
- Cardiovascular Division, University of Alabama at Birmingham; Birmingham Alabama
| | - William B. Hillegass
- Cardiovascular Division, University of Alabama at Birmingham; Birmingham Alabama
- Department of Biostatistics; University of Alabama at Birmingham; Birmingham Alabama
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Farooq V, Goedhart D, Ludman P, de Belder MA, Harcombe A, El-Omar M. Relationship Between Femoral Vascular Closure Devices and Short-Term Mortality From 271 845 Percutaneous Coronary Intervention Procedures Performed in the United Kingdom Between 2006 and 2011: A Propensity Score-Corrected Analysis From the British Cardiovascular Intervention Society. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.116.003560. [PMID: 27225421 DOI: 10.1161/circinterventions.116.003560] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 04/17/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The impact of vascular closure devices (VCDs) via the femoral arterial access site on short-term mortality in patients undergoing percutaneous coronary intervention is currently unknown. METHODS AND RESULTS The association between femoral arterial vascular access site management (manual pressure [including external clamp] versus VCD) and 30-day mortality was examined in a national real-world registry of 271 845 patients undergoing percutaneous coronary intervention for elective, non-ST-segment-elevation myocardial infarction and ST-segment-elevation myocardial infarction indications in the United Kingdom between 2006 and 2011. Crude and propensity score-corrected analyses were performed using Cox regression, with additional analyses undertaken in clinically relevant subgroups; 40.1% (n=109 001) of subjects were treated with manual pressure and 59.9% (n=162 844) with VCD. Subjects treated with VCD had fewer comorbidities and were less likely to present with ST-segment-elevation myocardial infarction and cardiogenic shock (P<0.001). Crude 30-day mortality was lower in the group treated with VCD compared with manual pressure (hazard ratio [HR], 0.58; 95% confidence interval [CI], 0.54-0.61; 1.4% versus 2.4%, log rank P<0.0001), findings that were substantially reduced but persisted after propensity score correction (HR, 0.91; 95% CI, 0.86-0.97; 1.8% versus 2.0% versus P<0.001). A more pronounced association of VCD with a reduction in 30-day mortality was evident in females (HR, 0.85; 95% CI, 0.77-0.94; Pinteraction=0.037), presentation with acute coronary syndrome (HR, 0.88; 95% CI, 0.83-0.94; Pinteraction=0.0027), or recent lysis (HR, 0.63; 95% CI, 0.40-1.01; Pinteraction=0.0001). CONCLUSIONS When compared with manual pressure, VCD was associated with a minor short-term (30-day) prognostic benefit after propensity score correction in the global population and clinically relevant subgroups. The potential for residual confounding factors impacting on short-term mortality cannot be excluded, despite the study having measured and balanced all recorded confounder factors.
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Affiliation(s)
- Vasim Farooq
- From the Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, United Kingdom (V.F., D.G., M.E.-O.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom (A.H.)
| | - Dick Goedhart
- From the Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, United Kingdom (V.F., D.G., M.E.-O.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom (A.H.)
| | - Peter Ludman
- From the Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, United Kingdom (V.F., D.G., M.E.-O.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom (A.H.)
| | - Mark A de Belder
- From the Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, United Kingdom (V.F., D.G., M.E.-O.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom (A.H.)
| | - Alun Harcombe
- From the Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, United Kingdom (V.F., D.G., M.E.-O.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom (A.H.)
| | - Magdi El-Omar
- From the Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, United Kingdom (V.F., D.G., M.E.-O.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom (A.H.).
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Hulme W, Sperrin M, Kontopantelis E, Ratib K, Ludman P, Sirker A, Kinnaird T, Curzen N, Kwok CS, De Belder M, Nolan J, Mamas MA. Increased Radial Access Is Not Associated With Worse Femoral Outcomes for Percutaneous Coronary Intervention in the United Kingdom. Circ Cardiovasc Interv 2017; 10:e004279. [PMID: 28196898 DOI: 10.1161/circinterventions.116.004279] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 12/08/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND The radial artery is increasingly adopted as the primary access site for cardiac catheterization because of patient preference, lower bleeding rates, cost effectiveness, and reduced risk of mortality in high-risk patient groups. Concerns have been expressed that operators/centers have become increasingly unfamiliar with transfemoral access. The aim of this study was to assess whether a change in access site practice toward transradial access nationally has led to worse outcomes in percutaneous coronary intervention procedures performed through the transfemoral access approach. METHODS AND RESULTS Using the British Cardiovascular Intervention Society (BCIS) database, a retrospective analysis of 235 250 transfemoral access percutaneous coronary intervention procedures was undertaken in all 92 centers in England and Wales between 2007 and 2013. Recent femoral proportion and recent femoral volume were determined, and in-hospital vascular complications and 30-day mortality were evaluated. After case-mix adjustment, no independent association was observed between 30-day mortality for cases undertaken through the transfemoral access and center femoral proportion, the risk-adjusted odds ratio for recent femoral proportion was nonsignificant (odds ratio, 0.99; 95% confidence interval, 0.97-1.02; P=0.472 per 0.1 increase in proportion), and similarly recent femoral volume (per 100 procedures) was not found to be significant (odds ratio, 1.00; 95% confidence interval, 0.98-1.01; P=0.869). The in-hospital vascular complication rate was 1.0%, and this outcome was not significantly associated with recent femoral proportion after risk-adjustment (odds ratio, 0.97; 95% confidence interval, 0.94-1.00; P=0.060 per 0.1 increase in proportion). CONCLUSIONS The outcome gains achieved by the national adoption of radial access are not associated with a loss of femoral proficiency, and centers should be encouraged to continue to adopt radial access as the default access site for percutaneous coronary intervention wherever possible in line with current best evidence.
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Affiliation(s)
- William Hulme
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - Matthew Sperrin
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - Evangelos Kontopantelis
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - Karim Ratib
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - Peter Ludman
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - Alex Sirker
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - Tim Kinnaird
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - Nick Curzen
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - Chun Shing Kwok
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - Mark De Belder
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - James Nolan
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.)
| | - Mamas A Mamas
- From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.).
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Gili S, D'Ascenzo F, Di Summa R, Conrotto F, Cerrato E, Chieffo A, Boccuzzi G, Montefusco A, Ugo F, Omedé P, Kawamoto H, Tomassini F, Pavani M, Varbella F, Garbo R, D'Amico M, Biondi Zoccai G, Moretti C, Escaned J, Colombo A, Gaita F. Radial Versus Femoral Access for the Treatment of Left Main Lesion in the Era of Second-Generation Drug-Eluting Stents. Am J Cardiol 2017; 120:33-39. [PMID: 28487035 DOI: 10.1016/j.amjcard.2017.03.262] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/30/2017] [Accepted: 03/30/2017] [Indexed: 02/08/2023]
Abstract
Transradial access (TRA) is often avoided in favor of the transfemoral access (TFA) during percutaneous coronary interventions of the unprotected left main coronary artery (ULM), due to technical and safety concerns. The aim of this study was to compare the performance of TRA and TFA in the treatment of ULM with second-generation drug-eluting stents. Consecutive patients who underwent percutaneous coronary intervention on ULM with second-generation drug-eluting stents were retrospectively enrolled in the multicenter Failure in Left Main Study With 2nd Generation Stents (FAILS 2) registry. Patients were stratified according to the arterial access. The choice between TRA and TFA was left to each operator's preferences. Bleedings during index hospitalization were the primary end point. Secondary end points were major adverse cardiovascular events (a composite of death, reinfarction, and target lesion revascularization), the single components of major adverse cardiovascular events at follow-up and stent thrombosis. Propensity score matching was executed to account for possible confounding. Overall, 1,247 patients were enrolled (23.2% [289] of female gender, mean age 70.2 ± 10.2 years). Diagnosis at presentation was stable angina in 603 (48.7%) cases, non-ST-segment elevation acute coronary syndrome in 465 (37.3%), ST-segment elevation myocardial infarction in 117 (9.5%). Mean follow-up was 726 ± 654 days. After propensity score with matching, 354 patients were included. The primary end point was significantly reduced in patients treated with TRA (2.0% vs 4.0%, p = 0.042), whereas no differences emerged pertaining the secondary end points, including target lesion revascularization and reinfarction. In conclusion, TRA may reduce in-hospital bleedings in patients undergoing percutaneous treatment of the ULM, without increasing the rate of adverse cardiovascular events at follow-up, and may therefore be safely used in the treatment of the ULM.
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Kok MM, Weernink MGM, von Birgelen C, Fens A, van der Heijden LC, van Til JA. Patient preference for radial versus femoral vascular access for elective coronary procedures: The PREVAS study. Catheter Cardiovasc Interv 2017; 91:17-24. [PMID: 28470994 PMCID: PMC5811812 DOI: 10.1002/ccd.27039] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/05/2017] [Accepted: 02/25/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To explore patient preference for vascular access site in percutaneous coronary procedures, the perceived importance of benefits and risks of transradial access (TRA) and transfemoral access (TFA) were assessed. In addition, direct preference for vascular access and preference for shared decision making (SDM) were evaluated. BACKGROUND TRA has gained significant ground on TFA during the last decades. Surveys on patient preference have mostly been performed in dedicated TRA trials. METHODS In the PREVAS study (Clinicaltrials.gov: NCT02625493) a stated preference elicitation method best-worst scaling (BWS) was used to determine patient preference for six treatment attributes: bleeding, switch of access-site, postprocedural vessel quality, mobilization and comfort, and over-night stay. Based on software-generated treatment scenarios, 142 patients indicated which characteristics they perceived most and least important in treatment choice. Best-minus-Worst scores and attribute importance were calculated. RESULTS Bleeding risk was considered most important (attribute importance 31.3%), followed by length of hospitalization (22.6%), and mobilization(20.2%). Most patients preferred the approach of their current procedure (85.9%); however, 71.1% of patients with experience with both access routes favored TRA (P < 0.001). Most patients (38.0%) appreciated SDM, balanced between patient and cardiologist. CONCLUSIONS Patients appreciate lower bleeding risk and early ambulation, factors favoring TRA. Previous experience with a single access route has a major impact on preference, while experience with both routes generally resulted in preference for TRA. Most patients prefer balanced SDM. © 2017 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Marlies M Kok
- Thoraxcentrum Twente, Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Marieke G M Weernink
- Department of Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Clemens von Birgelen
- Thoraxcentrum Twente, Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands.,Department of Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Anneloes Fens
- Department of Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Liefke C van der Heijden
- Thoraxcentrum Twente, Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Janine A van Til
- Department of Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
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Fairley SL, Lucking AJ, McEntegart M, Shaukat A, Smith D, Chase A, Hanratty CG, Spratt JC, Walsh SJ. Routine Use of Fluoroscopic-Guided Femoral Arterial Puncture to Minimise Vascular Complication Rates in CTO Intervention: Multi-centre UK Experience. Heart Lung Circ 2016; 25:1203-1209. [DOI: 10.1016/j.hlc.2016.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 02/24/2016] [Accepted: 04/02/2016] [Indexed: 10/21/2022]
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Affiliation(s)
- William Wijns
- From Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, and Saolta University Healthcare Group, Galway, Ireland (W.W.); Cardiovascular Research Center Aalst, Belgium (W.W.); and Medizinische Klinik II, Klinikum Coburg, Coburg, Germany (S.A.P.)
| | - Stylianos A. Pyxaras
- From Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, and Saolta University Healthcare Group, Galway, Ireland (W.W.); Cardiovascular Research Center Aalst, Belgium (W.W.); and Medizinische Klinik II, Klinikum Coburg, Coburg, Germany (S.A.P.)
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Azzalini L, Jolicœur EM. The wise radialist's guide to optimal transfemoral access: Selection, performance, and troubleshooting. Catheter Cardiovasc Interv 2016; 89:399-407. [DOI: 10.1002/ccd.26577] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/22/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Lorenzo Azzalini
- Interventional Cardiology; San Raffaele Scientific Institute; Milan Italy
| | - E. Marc Jolicœur
- Dept. of Medicine; Montreal Heart Institute, Université de Montréal; Québec Canada
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Mamas MA, Nolan J, de Belder MA, Zaman A, Kinnaird T, Curzen N, Kwok CS, Buchan I, Ludman P, Kontopantelis E. Changes in Arterial Access Site and Association With Mortality in the United Kingdom: Observations From a National Percutaneous Coronary Intervention Database. Circulation 2016; 133:1655-67. [PMID: 26969759 DOI: 10.1161/circulationaha.115.018083] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 02/19/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The transradial access (TRA) site has become the default access site for percutaneous coronary intervention in the United Kingdom, with randomized trials and national registry data showing reductions in mortality associated with TRA use. This study evaluates regional changes in access site practice in England and Wales over time, examines whether changes in access site practice have been uniform nationally and across different patient subgroups, and provides national estimates for the potential number of lives saved or lost associated with regional differences in access site practice. METHODS AND RESULTS Using the British Cardiovascular Intervention Society database, we investigated outcomes for growth of TRA in different regions in England and Wales in 448 853 patients who underwent percutaneous coronary intervention from 2005 to 2012. Multiple logistic regression was used to quantify the effect of TRA on 30-day mortality and quantify lives saved and lost by differences in TRA adoption. TRA use increased from 14.0% to 58.6% in 417 038 PCI patients with large variations in different parts of the country. TRA was independently associated with a decreased risk of 30-day mortality (odds ratio=0.70; 95% confidence interval=0.66-0.74), with significant but small differences observed across different regions. The number of estimated lives saved was 450 (95% confidence interval=275-650), and we estimate that an additional 264 (95% confidence interval=153-399) lives would have been saved if TRA adoption were uniform nationally. CONCLUSIONS TRA has become the dominant percutaneous coronary intervention approach in the United Kingdom, with a wide variation in different parts of the country. Changes in practice have contributed to mortality reductions, and inequalities have resulted in missed opportunities for further improvements.
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Affiliation(s)
- Mamas A Mamas
- From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.).
| | - James Nolan
- From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.)
| | - Mark A de Belder
- From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.)
| | - Azfar Zaman
- From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.)
| | - Tim Kinnaird
- From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.)
| | - Nick Curzen
- From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.)
| | - Chun Shing Kwok
- From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.)
| | - Iain Buchan
- From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.)
| | - Peter Ludman
- From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.)
| | - Evangelos Kontopantelis
- From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.)
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Azzalini L, Tosin K, Chabot-Blanchet M, Avram R, Ly HQ, Gaudet B, Gallo R, Doucet S, Tanguay JF, Ibrahim R, Grégoire JC, Crépeau J, Bonan R, de Guise P, Nosair M, Dorval JF, Gosselin G, L'Allier PL, Guertin MC, Asgar AW, Jolicœur EM. The Benefits Conferred by Radial Access for Cardiac Catheterization Are Offset by a Paradoxical Increase in the Rate of Vascular Access Site Complications With Femoral Access: The Campeau Radial Paradox. JACC Cardiovasc Interv 2015; 8:1854-64. [PMID: 26604063 DOI: 10.1016/j.jcin.2015.07.029] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 07/30/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to assess whether the benefits conferred by radial access (RA) at an individual level are offset by a proportionally greater incidence of vascular access site complications (VASC) at a population level when femoral access (FA) is performed. BACKGROUND The recent widespread adoption of RA for cardiac catheterization has been associated with increased rates of VASCs when FA is attempted. METHODS Logistic regression was used to calculate the adjusted VASC rate in a contemporary cohort of consecutive patients (2006 to 2008) where both RA and FA were used, and compared it with the adjusted VASC rate observed in a historical control cohort (1996 to 1998) where only FA was used. We calculated the adjusted attributable risk to estimate the proportion of VASC attributable to the introduction of RA in FA patients of the contemporary cohort. RESULTS A total of 17,059 patients were included. At a population level, the VASC rate was higher in the overall contemporary cohort compared with the historical cohort (adjusted rates: 2.91% vs. 1.98%; odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.17 to 1.89; p = 0.001). In the contemporary cohort, RA patients experienced fewer VASC than FA patients (adjusted rates: 1.44% vs. 4.19%; OR: 0.33, 95% CI: 0.23 to 0.48; p < 0.001). We observed a higher VASC rate in FA patients in the contemporary cohort compared with the historical cohort (adjusted rates: 4.19% vs. 1.98%; OR: 2.16, 95% CI: 1.67 to 2.81; p < 0.001). This finding was consistent for both diagnostic and therapeutic catheterizations separately. The proportion of VASCs attributable to RA in the contemporary FA patients was estimated at 52.7%. CONCLUSIONS In a contemporary population where both RA and FA were used, the safety benefit associated with RA is offset by a paradoxical increase in VASCs among FA patients. The existence of this radial paradox should be taken into consideration, especially among trainees and default radial operators.
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Affiliation(s)
- Lorenzo Azzalini
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Kunle Tosin
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Robert Avram
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Hung Q Ly
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Benoit Gaudet
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Richard Gallo
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Serge Doucet
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Réda Ibrahim
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Jean C Grégoire
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Jacques Crépeau
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Raoul Bonan
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Pierre de Guise
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Mohamed Nosair
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Gilbert Gosselin
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | | | - Anita W Asgar
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - E Marc Jolicœur
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
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25
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Uddin M, Bundhoo S, Mitra R, Ossei-Gerning N, Morris K, Anderson R, Kinnaird T. Femoral Access PCI in a Default Radial Center Identifies High-Risk Patients With Poor Outcomes. J Interv Cardiol 2015; 28:485-92. [DOI: 10.1111/joic.12226] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Muezz Uddin
- Department of Cardiology; University Hospital of Wales, Heath Park, Cardiff CF14 4XW; United Kingdom
| | - Shantu Bundhoo
- Department of Cardiology; University Hospital of Wales, Heath Park, Cardiff CF14 4XW; United Kingdom
| | - Rito Mitra
- Department of Cardiology; University Hospital of Wales, Heath Park, Cardiff CF14 4XW; United Kingdom
| | - Nicholas Ossei-Gerning
- Department of Cardiology; University Hospital of Wales, Heath Park, Cardiff CF14 4XW; United Kingdom
| | - Keith Morris
- Cardiff Metropolitan University, Cardiff CF5 2YB; United Kingdom
| | - Richard Anderson
- Department of Cardiology; University Hospital of Wales, Heath Park, Cardiff CF14 4XW; United Kingdom
| | - Tim Kinnaird
- Department of Cardiology; University Hospital of Wales, Heath Park, Cardiff CF14 4XW; United Kingdom
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Abstract
The hybrid algorithim approach, together with innovative new technologies, has lead to increased interest in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and increasing procedural success rates. Unlike non-CTO PCI, there is an increased rate of femoral access. When considering arterial access in CTO PCI, a balance is needed between anticipated procedural difficulty, planned CTO strategy and the desire to minimise the risk of vascular access-related complications. We review the evidence for best practice with respect to femoral puncture technique and also assess the technologies and techniques available to place larger inner diameter catheters into the radial artery.
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Affiliation(s)
- David Smith
- Regional Cardiac Centre, Morriston Hospital, Swansea, UK
| | - Ahmed Hailan
- Regional Cardiac Centre, Morriston Hospital, Swansea, UK
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27
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Azzalini L, Jolicoeur EM. The use of radial access decreases the risk of vascular access-site-related complications at a patient level but is associated with an increased risk at a population level: the radial paradox. EUROINTERVENTION 2014; 10:531-2. [DOI: 10.4244/eijv10i4a92] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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28
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Bradley SM, Rao SV, Curtis JP, Parzynski CS, Messenger JC, Daugherty SL, Rumsfeld JS, Gurm HS. Change in hospital-level use of transradial percutaneous coronary intervention and periprocedural outcomes: insights from the national cardiovascular data registry. Circ Cardiovasc Qual Outcomes 2014; 7:550-9. [PMID: 24899678 PMCID: PMC5173329 DOI: 10.1161/circoutcomes.114.001020] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Whether increasing use of radial access has improved percutaneous coronary intervention outcomes remains unknown. We sought to determine the relationship between increasing facility-level use of transradial percutaneous coronary intervention (TRI) and periprocedural outcomes. METHODS AND RESULTS Within the National Cardiovascular Data Registry CathPCI Registry, we estimated the risk-adjusted association between hospital category of change in TRI use (during the 3-year period from 2009 to 2012) and trends in access site and overall bleeding, fluoroscopy time, and contrast use among 818 facilities with low baseline TRI use. There were 4 categories of hospital change in TRI use: very low (baseline, 0.2% increasing to 1.8% at the end of 3 years), low (0.9% increasing to 8.9%), moderate (1.6% increasing to 27.2%), and high (1.0% increasing to 45.1%). Risk-adjusted access site bleeding decreased over time for all hospital categories; however, the rate of decline varied across hospital categories (P for interaction, <0.001). The decrease in access site bleeding was significantly greater for hospitals with moderate or high increases in TRI use (relative risk, 0.45, 95% confidence interval, 0.36-0.56) when compared with that of very low or low hospitals (relative risk, 0.65; 95% confidence interval, 0.58-0.74; P for comparison, 0.002). Similar findings were observed for overall bleeding. An increase in fluoroscopy time (≈1.3 minutes) was noted at hospitals with moderate and high use of TRI (P=0.01). Trends in contrast use were similar across hospital categories. CONCLUSIONS In a national sample of hospitals performing percutaneous coronary intervention, bleeding rates decreased over time for all hospital categories of change in TRI use. The decline in bleeding outcomes was larger at hospitals with increased adoption of TRI when compared with hospitals with minimal or no change in TRI use.
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Affiliation(s)
- Steven M Bradley
- From the Veterans Affairs Eastern Colorado Health Care System and the Colorado Cardiovascular Outcomes Research Consortium, Denver (S.M.B., J.S.R.); University of Colorado School of Medicine, Aurora (S.M.B., J.C.M., S.L.D., J.S.R.); The Duke Clinical Research Institute, Durham, NC (S.V.R.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation and the Yale University School of Medicine, CT (J.P.C., C.S.P.); and University of Michigan Medical School, Ann Arbor (H.S.G.).
| | - Sunil V Rao
- From the Veterans Affairs Eastern Colorado Health Care System and the Colorado Cardiovascular Outcomes Research Consortium, Denver (S.M.B., J.S.R.); University of Colorado School of Medicine, Aurora (S.M.B., J.C.M., S.L.D., J.S.R.); The Duke Clinical Research Institute, Durham, NC (S.V.R.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation and the Yale University School of Medicine, CT (J.P.C., C.S.P.); and University of Michigan Medical School, Ann Arbor (H.S.G.)
| | - Jeptha P Curtis
- From the Veterans Affairs Eastern Colorado Health Care System and the Colorado Cardiovascular Outcomes Research Consortium, Denver (S.M.B., J.S.R.); University of Colorado School of Medicine, Aurora (S.M.B., J.C.M., S.L.D., J.S.R.); The Duke Clinical Research Institute, Durham, NC (S.V.R.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation and the Yale University School of Medicine, CT (J.P.C., C.S.P.); and University of Michigan Medical School, Ann Arbor (H.S.G.)
| | - Craig S Parzynski
- From the Veterans Affairs Eastern Colorado Health Care System and the Colorado Cardiovascular Outcomes Research Consortium, Denver (S.M.B., J.S.R.); University of Colorado School of Medicine, Aurora (S.M.B., J.C.M., S.L.D., J.S.R.); The Duke Clinical Research Institute, Durham, NC (S.V.R.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation and the Yale University School of Medicine, CT (J.P.C., C.S.P.); and University of Michigan Medical School, Ann Arbor (H.S.G.)
| | - John C Messenger
- From the Veterans Affairs Eastern Colorado Health Care System and the Colorado Cardiovascular Outcomes Research Consortium, Denver (S.M.B., J.S.R.); University of Colorado School of Medicine, Aurora (S.M.B., J.C.M., S.L.D., J.S.R.); The Duke Clinical Research Institute, Durham, NC (S.V.R.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation and the Yale University School of Medicine, CT (J.P.C., C.S.P.); and University of Michigan Medical School, Ann Arbor (H.S.G.)
| | - Stacie L Daugherty
- From the Veterans Affairs Eastern Colorado Health Care System and the Colorado Cardiovascular Outcomes Research Consortium, Denver (S.M.B., J.S.R.); University of Colorado School of Medicine, Aurora (S.M.B., J.C.M., S.L.D., J.S.R.); The Duke Clinical Research Institute, Durham, NC (S.V.R.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation and the Yale University School of Medicine, CT (J.P.C., C.S.P.); and University of Michigan Medical School, Ann Arbor (H.S.G.)
| | - John S Rumsfeld
- From the Veterans Affairs Eastern Colorado Health Care System and the Colorado Cardiovascular Outcomes Research Consortium, Denver (S.M.B., J.S.R.); University of Colorado School of Medicine, Aurora (S.M.B., J.C.M., S.L.D., J.S.R.); The Duke Clinical Research Institute, Durham, NC (S.V.R.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation and the Yale University School of Medicine, CT (J.P.C., C.S.P.); and University of Michigan Medical School, Ann Arbor (H.S.G.)
| | - Hitinder S Gurm
- From the Veterans Affairs Eastern Colorado Health Care System and the Colorado Cardiovascular Outcomes Research Consortium, Denver (S.M.B., J.S.R.); University of Colorado School of Medicine, Aurora (S.M.B., J.C.M., S.L.D., J.S.R.); The Duke Clinical Research Institute, Durham, NC (S.V.R.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation and the Yale University School of Medicine, CT (J.P.C., C.S.P.); and University of Michigan Medical School, Ann Arbor (H.S.G.)
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Piccolo R, Galasso G, Capuano E, De Luca S, Esposito G, Trimarco B, Piscione F. Transradial versus transfemoral approach in patients undergoing percutaneous coronary intervention for acute coronary syndrome. A meta-analysis and trial sequential analysis of randomized controlled trials. PLoS One 2014; 9:e96127. [PMID: 24820096 PMCID: PMC4018335 DOI: 10.1371/journal.pone.0096127] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/03/2014] [Indexed: 11/19/2022] Open
Abstract
Background Transfemoral approach (TFA) remains the most common vascular access for percutaneous coronary intervention (PCI) in many countries. However, in the last years several randomized trials compared transradial approach (TRA) with TFA in patients with acute coronary syndrome (ACS), but only few studies were powered to estimate rare events. The aim of the current study was to clarify whether TRA is superior to TFA approach in patients with ACS undergoing percutaneous coronary intervention. A meta-analysis, meta-regression and trial sequential analysis of safety and efficacy of TRA in ACS setting was performed. Methods and Results Medline, the Cochrane Library, Scopus, scientific session abstracts and relevant websites were searched. Data concerning the study design, patient characteristics, risk of bias, and outcomes were extracted. The primary endpoint was death. Secondary endpoints were: major bleeding and vascular complications. Outcomes were assessed within 30 days. Eleven randomized trials involving 9,202 patients were included. Compared with TFA, TRA significantly reduced the risk of death (odds ratio [OR] 0.70; 95% confidence interval [CI], 0.53–0.94; p = 0.016), but this finding was not confirmed in trial sequential analysis, indicating that sufficient evidence had not been yet reached. Furthermore, TRA compared with TFA reduced the risk of major bleeding (OR 0.60; 95% CI, 0.41–0.88; p = 0.008) and vascular complications (OR 0.35; 95% CI, 0.28–0.46; p<0.001); these findings were supported by trial sequential analyses. Conclusions In patients with ACS undergoing PCI, a lower risk of death was observed with TRA. Nevertheless, the association between mortality and TRA in ACS setting should be interpreted with caution because it is based on insufficient evidence. However, because of the clinical relevance associated with major bleeding and vascular complications reduction, TRA should be recommended as first-choice vascular access in patients with ACS undergoing cardiac catheterization.
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Affiliation(s)
- Raffaele Piccolo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Gennaro Galasso
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- * E-mail:
| | - Ernesto Capuano
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Stefania De Luca
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Federico Piscione
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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