1
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Grégory J, Ronot M, Laurent V, Chabrot P, de Baere T, Chevallier P, Vilgrain V, Aubé C. French Interventional Radiology Centers' Uptake of Transradial Approach and Outpatient Hepatocellular Carcinoma Intra-Arterial Treatments. Cardiovasc Intervent Radiol 2024; 47:432-440. [PMID: 37930400 DOI: 10.1007/s00270-023-03578-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/01/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE This study aims to investigate the uptake of transradial approach (TRA) and outpatient setting for transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) in the treatment of hepatocellular carcinoma (HCC) among French interventional radiology centers. MATERIALS AND METHODS This cross-sectional study was based on a 34-question survey assessing center activity, radial access, and outpatient care. The survey was developed by a working group, tested by two external experts, and distributed to active members of two French radiological societies via a web-based self-reporting questionnaire in March 2022. The survey remained open for eight weeks, with two reminder emails sent to non-responders. Only one answer per center was considered. RESULTS Of the 44 responding centers, 39% (17/44) performed TRA for TACE and/or TARE, with post-procedure patient comfort as main motivation. Among the 27 centers not performing TRA, 33% (9/27) reported a lack of technical experience, but all 27 intended to adopt TRA within two years. Only six centers performed TACE or TARE in an outpatient setting. Reasons limiting its implementation included TACE for HCC not being a suitable intervention (61%, 27/44) and organizational barriers (41%, 18/44). Among centers not performing outpatient TACE or TARE, 34% (13/38) said "No," 34% (13/38) said "Maybe," and 32% (12/38) said "Yes" when asked about adopting it within two years. CONCLUSION French interventional radiologists have low TRA uptake for HCC treatment, but TRA adoption potential exists. Respondents were uncertain about performing TACE or TARE in an outpatient setting within a 2-year horizon.
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Affiliation(s)
- Jules Grégory
- Université Paris Cité, Paris, France.
- Radiology Department, Hôpital Beaujon, AP-HP.Nord, FHU MOSAIC, 100 boulevard du Général Leclerc, 92210, Clichy, France.
- Inserm INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004, Paris, France.
| | - Maxime Ronot
- Université Paris Cité, Paris, France
- Radiology Department, Hôpital Beaujon, AP-HP.Nord, FHU MOSAIC, 100 boulevard du Général Leclerc, 92210, Clichy, France
- Centre de Recherche sur L'Inflammation, Inserm, U1149, 75006, Paris, France
| | - Valérie Laurent
- Department of Radiology, Nancy University Hospital, Université de Lorraine, 54500, Vandoeuvre-Lès-Nancy, France
| | - Pascal Chabrot
- Department of Radiology, University Hospital Center, Hospital Gabriel Montpied, 58, Rue Montalembert, 63000, Clermont-Ferrand, France
| | - Thierry de Baere
- Department of Interventional Radiology, Gustave RoussyUniversité Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Patrick Chevallier
- Department of Diagnosis and Interventional Imaging, University Hospital of Nice, 151 Route de Saint Antoine de Ginestière, 06200, Nice, France
| | - Valérie Vilgrain
- Université Paris Cité, Paris, France
- Radiology Department, Hôpital Beaujon, AP-HP.Nord, FHU MOSAIC, 100 boulevard du Général Leclerc, 92210, Clichy, France
- Centre de Recherche sur L'Inflammation, Inserm, U1149, 75006, Paris, France
| | - Christophe Aubé
- Département de Radiologie, centre hospitalier universitaire d'Angers, 4 rue Larrey, 49 933, Angers, France
- Laboratoire HIFIH, UPRES 3859, Université d'Angers, 49 045, Angers, France
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2
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Inomata Y, Hanaoka Y, Koyama JI, Yamazaki D, Kitamura S, Nakamura T, Horiuchi T. Left Transradial Access Using a Radial-Specific Neurointerventional Guiding Sheath for Coil Embolization of Anterior Circulation Aneurysm Associated With the Aberrant Right Subclavian Artery: Technical Note and Literature Review. World Neurosurg 2023; 178:126-131. [PMID: 37506842 DOI: 10.1016/j.wneu.2023.07.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Aberrant right subclavian artery (ARSA) is a rare condition, but the most common anomaly of the aortic arch. Although neurointerventions via transradial access (TRA) are becoming increasingly popular worldwide, transradial carotid cannulation has been extremely challenging in patients with an ARSA. Herein, we present a case of ARSA-associated anterior communicating artery (ACoA) aneurysm that was successfully treated with a radial-specific 6F Simmons guiding sheath via left TRA. We also review the relevant literature. METHODS A 68-year-old-woman who was diagnosed as having an ARSA-associated ACoA aneurysm underwent simple coiling via left TRA. After the 6F Simmons guiding sheath was engaged into the right common carotid artery using the pull-back-technique, transradial quadraxial system (6F Simmons guiding sheath/6F intermediate catheter/3.2F intermediate catheter/coil-delivery microcatheter) was implemented. RESULTS Simple coiling of the aneurysm was successfully achieved without catheter kinking or system instability. The postprocedural course was uneventful. A follow-up magnetic resonance angiography showed no evidence of recanalization 1 years 9 months after the procedure. CONCLUSIONS Transradial anterior circulation intervention has been rarely used for patients with an ARSA due to unfavorable catheter trajectory. Left TRA using the 6F Simmons guiding sheath is a useful treatment option to address anterior circulation interventions for patients with an ARSA. Preoperative diagnosis of ARSA is necessary for the application of our method.
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Affiliation(s)
- Yuki Inomata
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan.
| | - Jun-Ichi Koyama
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Daisuke Yamazaki
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoshi Kitamura
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Takuya Nakamura
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
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3
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Wang K, Wen L, Xie L, Zhao M, Liu X, Luo X, Jin J, Qin Z. Giant thoracic hematoma post-transradial coronary angiography: a case report and review of the literature. BMC Cardiovasc Disord 2023; 23:442. [PMID: 37679725 PMCID: PMC10485974 DOI: 10.1186/s12872-023-03466-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Although there are cardiac interventional procedures, certain transradial access complications might be life-threatening. CASE PRESENTATION A 67-year-old male was admitted for coronary angiography due to chest tightness and shortness of breath on exertion. Hours after the right transradial access angiography, the patients complained the right side of chest pain. Emergent chest X-ray revealed a giant mass in the right chest. The right radial artery was reaccessed and subsequent arteriograms confirmed that the presence of a rupture of the branch of right internal mammary artery. Simultaneously, a microcoil was implanted to seal the perforation. The perforation caused a thoracic hematoma measuring 13.8 cm × 6.7 cm, along with a decrease in hemoglobin concentration from 14.1 g/dL to a minimum of 7.8 g/dL. Additionally, the drainage of the hematoma and red blood cells transfusion were carried out. Further, the patient underwent ascending aortic replacement, aortic valve replacement, mitral valve replacement, and thoracic hematoma removal. Postoperative echocardiography showed that the prosthetic valves were properly positioned and functioning normally. The patient recovered well after the surgery and remained event-free during the latest 14moth follow-up period. CONCLUSIONS Vascular perforation and subsequent hematoma might occur due to guidewire maneuvering during transradial approach. Awareness of prevention, early recognition and management of access complications may help reduce the occurrence and severity of complications related to the transradial approach.
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Affiliation(s)
- Ke Wang
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Li Wen
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Xie
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Maoyu Zhao
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xi Liu
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xiaolin Luo
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Jun Jin
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China.
| | - Zhexue Qin
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China.
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4
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Yaser Arafath M, Bhatia V, Kumar A, Chauhan R, Prabhakar A, Gupta SK, Singh P. Adapting to transradial approach in cerebral angiography: Factors influencing successful cannulation. Neuroradiol J 2023; 36:163-168. [PMID: 35749090 PMCID: PMC10034707 DOI: 10.1177/19714009221111090] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To evaluate factors that influence the successful cannulation of intracranial vessels using a transradial approach. METHODS A total of 61 transradial diagnostic angiograms were evaluated in a tertiary care center from July 2020 to December 2021. We evaluated the learning curve and aortic arch vessel factors that may influence the cannulation of intracranial major vessels using a transradial approach. RESULTS Learning curve for the procedure was established after 21 cases. We were successful in cannulating the supra-aortic arteries except in 4 cases where we were unable to cannulate the left VA (vertebral artery). Significant positive correlation was seen between time to Sim (Simmons curve) formation and aortic arch diameter (p = .002). Significant positive correlation was also seen between left VA take-off angle and time to cannulate left VA (p = .001) and negative correlation was noted between left CCA (common carotid artery) take-off angle and time to cannulate left CCA (p = .001). CONCLUSION Transradial approach is a feasible and safe approach for performing cerebral angiography. Multiple factors can influence the procedure time and successful cannulation of intracranial vessels. With the availability of radial specific hardware in the future, procedural success and time taken to complete the procedure may improve.
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Affiliation(s)
- Mohamed Yaser Arafath
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
| | - Vikas Bhatia
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
| | - Ajay Kumar
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
| | - Rajeev Chauhan
- Department of Anaesthesia, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
| | - Anuj Prabhakar
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
| | - SK Gupta
- Department of Neurosurgery, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
| | - Paramjeet Singh
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and
Research, Chandigarh, India
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5
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Ito H, Uchida M, Kaji T, Fukano T, Hagiwara Y, Takasuna H, Murata H. Left Distal Transradial Approach for the Treatment of a Sacral Extradural Arteriovenous Fistula: Technical Note and Literature Review. World Neurosurg 2023; 174:25-29. [PMID: 36894006 DOI: 10.1016/j.wneu.2023.02.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Sacral extradural arteriovenous fistula (SEAVF) is relatively rare, and its etiology is unknown. They are mostly fed by the lateral sacral artery (LSA). For endovascular treatment, both the stability of the guiding catheter and accessibility of the microcatheter to the fistula distal to the LSA is required for sufficient embolization of the fistulous point. Cannulation of these vessels requires either crossover at the aortic bifurcation or retrograde cannulation using the transfemoral approach. However, atherosclerotic femoral and tortuous aortoiliac vessels can make the procedure technically difficult. Although the right transradial approach (TRA) can reduce this difficulty by straightening the access route, a potential risk remains for cerebral embolism because it passes the aortic arch. Herein, we present a case of successful embolization of a SEAVF using a left distal TRA. METHODS We report a case of a 47-year-old man with SEAVF treated with embolization using a left distal TRA. Lumbar spinal angiography showed a SEAVF with an intradural vein through the epidural venous plexus fed by the left LSA. A 6-French guiding sheath was cannulated into the internal iliac artery via the descending aorta using the left distal TRA. A microcatheter could be advanced into the extradural venous plexus over the fistula point from the intermediate catheter placed at the LSA. Embolization with coils and n-butyl cyanoacrylate was successfully performed. RESULTS The SEAVF completely disappeared on neuroimaging, and the patient gradually recovered. CONCLUSIONS Left distal TRA could be a useful, safe, and less invasive option for the embolization of SEAVF, especially for patients with high-risk factors for aortogenic embolism or puncture site complications.
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Affiliation(s)
- Hidemichi Ito
- The Departments of Neurosurgery, St. Marianna University School of Medicine, Kanagawa, Japan.
| | - Masashi Uchida
- The Departments of Neurosurgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Tomohiro Kaji
- The Departments of Neurosurgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Takayuki Fukano
- The Departments of Neurology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yuta Hagiwara
- The Departments of Neurology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Hiroshi Takasuna
- The Departments of Neurosurgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Hidetoshi Murata
- The Departments of Neurosurgery, St. Marianna University School of Medicine, Kanagawa, Japan
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6
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Kedev S. Pumping up to release: A simple way to dilate radial artery through prolonged upper arm occlusion. Cardiovasc Revasc Med 2023; 51:43-44. [PMID: 36805281 DOI: 10.1016/j.carrev.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Sasko Kedev
- University Clinic of Cardiology, Medical Faculty, University St Cyril and Methodius, Skopje, Macedonia.
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7
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Beyranvand M, Mohammadi Z, Asadpour Piranfar M, Gachkar L. Effects of Verapamil on the Reduction of Radial Artery Thrombosis after Coronary Angiography: A Randomized Clinical Trial. J Tehran Heart Cent 2022; 17:180-185. [PMID: 37143751 PMCID: PMC10154116 DOI: 10.18502/jthc.v17i4.11604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 09/05/2022] [Indexed: 05/06/2023] Open
Abstract
Background The trans-radial approach significantly reduces access bleeding and underlying vascular complications and is associated with lower health care costs than the transfemoral approach. One of the most common complications, however, is radial artery occlusion (RAO). Methods This study investigates the effects of verapamil on radial artery thrombosis in patients referred to Taleghani Hospital in Tehran between 2020 and 2021. Patients were randomized into 2 groups: the first group received verapamil, nitroglycerin, and heparin and the second group nitroglycerin and heparin. To randomly assign 100 cases to the 2 experimental and control groups, we first formed a framework for sampling 100 people (from 1 to 100); then, based on the table of random numbers, we assigned the first 50 numbers to the experimental group and the remainder to the control group. The 2 groups were compared for radial artery thrombosis. Results This study evaluated 100 candidates for coronary angiography in 2 groups of 50 with and without verapamil. The mean age was 58.6±11.2 years in the group with verapamil and 58.1±12.7 years in the group without verapamil (P=0.84). The difference between the 2 groups in terms of heart failure was statistically significant (P<0.028). The prevalence of clinical thrombosis was 2.0% in the group with verapamil and 22.0% in the group without verapamil (P<0.004). The prevalence of ultrasound-confirmed thrombosis was 4.0% in the group with verapamil and 36.0% in the group without verapamil (P<0.001). Conclusion Intra-arterial injection of verapamil added to heparin and nitroglycerine during trans-radial angiography could significantly reduce RAO.
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Affiliation(s)
- Mohammadreza Beyranvand
- Department of Cardiology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Mohammadi
- Department of Cardiology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author:Zahra Mohammadi, Assistant of Cardiology, Department of Cardiology, Taleghani Hospital, Tabnak Street, Velenjak Region, Chamran High Way, Tehran. Iran, Tel: + 98 21 2243-2560. Fax: +98 21 22432570. E-mail: .
| | - Mohammad Asadpour Piranfar
- Department of Cardiology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Latif Gachkar
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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8
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Caton MT, Smith ER, Baker A, Dowd CF, Higashida RT. Transradial Approach for Thoracolumbar Spinal Angiography and Tumor Embolization: Feasibility and Technical Considerations. Neurointervention 2022; 17:100-105. [PMID: 35340197 PMCID: PMC9256468 DOI: 10.5469/neuroint.2022.00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/10/2022] [Indexed: 11/24/2022] Open
Abstract
The transradial approach (TRA) is an effective and safe alternative to transfemoral access for diagnostic neuroangiography and craniocervical interventions. While the technical aspects of supraclavicular intervention are well-described, there are little data on the TRA for thoracolumbar angiography and intervention. The authors describe the feasibility of the TRA for preoperative thoracic tumor embolization, emphasizing technique, device selection, navigation, and catheterization of thoracolumbar segmental arteries. This approach extends the benefits of TRA to spinal interventional neuroradiology.
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Affiliation(s)
- Michael Travis Caton
- Department of Neurointerventional Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Eric Robert Smith
- Department of Neurointerventional Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Amanda Baker
- Department of Neurointerventional Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Christopher Foley Dowd
- Department of Neurointerventional Radiology, University of California San Francisco, San Francisco, CA, USA.,Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Randall T Higashida
- Department of Neurointerventional Radiology, University of California San Francisco, San Francisco, CA, USA.,Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
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9
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Aminian A, Sgueglia GA, Wiemer M, Gasparini GL, Kefer J, Ruzsa Z, van Leeuwen MA, Vandeloo B, Ungureanu C, Kedev S, Iglesias JF, Leibundgut G, Ratib K, Bernat I, Barriocanal I, Borovicanin V, Saito S. Distal versus conventional radial access for coronary angiography and intervention: Design and rationale of DISCO RADIAL study. Am Heart J 2022; 244:19-30. [PMID: 34666014 DOI: 10.1016/j.ahj.2021.10.180] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/02/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Transradial access (TRA) has become the default access method for coronary diagnostic and interventional procedures. As compared to transfemoral access, TRA has been shown to be safer, cost-effective and more patient-friendly. Radial artery occlusion (RAO) represents the most frequent complication of TRA, and precludes future coronary procedures through the radial artery, the use of the radial artery as a conduit for coronary artery bypass grafting or as arteriovenous fistula for patients on hemodialysis. Recently, distal radial access (DRA) has emerged as a promising alternative to TRA, yielding potential for minimizing the risk of RAO. However, an international multicenter randomized comparison between DRA, and conventional TRA with respect to the rate of RAO is still lacking. TRIAL DESIGN DISCO RADIAL is a prospective, multicenter, open-label, randomized, controlled, superiority trial. A total of 1300 eligible patients will be randomly allocated to undergo coronary angiography and/or percutaneous coronary intervention (PCI) through DRA or TRA using the 6 Fr Glidesheath Slender sheath introducer. Extended experience with both TRA and DRA is required for operators' eligibility and optimal evidence-based best practice to reduce RAO systematically implemented by protocol. The primary endpoint is the incidence of forearm RAO assessed by vascular ultrasound at discharge. Several important secondary endpoints will also be assessed, including access-site cross-over, hemostasis time, and access-site related complications. SUMMARY The DISCO RADIAL trial will provide the first large-scale multicenter randomized evidence comparing DRA to TRA in patients scheduled for coronary angiography or PCI with respect to the incidence of RAO at discharge.
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10
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Yamazaki K, Hanaoka Y, Koyama JI, Yamazaki D, Fujii Y, Ogiwara T, Horiuchi T. Contralateral transradial access for coil embolization of distal anterior cerebral artery aneurysm associated with a steep ipsilateral A1-A2 angle. J Stroke Cerebrovasc Dis 2022; 31:106299. [PMID: 35033987 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/25/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Endovascular treatment of distal anterior cerebral artery aneurysms is commonly addressed via the ipsilateral A1 segment of the anterior cerebral artery. However, when the parent pericallosal artery has a sharp ipsilateral A1-A2 angle, catheterization through the ipsilateral A1 segment can potentially result in vessel injury, catheter kinking, and/or compromised/stagnant anterior cerebral artery flow. Here, we present a case of a distal anterior cerebral artery aneurysm associated with a steep ipsilateral A1-A2 angle treated with contralateral transradial coil embolization. CASE PRESENTATION A 91-year-old woman presented with a ruptured left distal anterior cerebral artery aneurysm at the A3 segment. The parent pericallosal artery had a steep ipsilateral A1-A2 angle. To safely achieve coil embolization of the aneurysm, a contralateral transradial system via the right A1 segment was employed. Although a secondary ipsilateral transradial system was required for contrast injection, aneurysm obliteration was successfully achieved without vessel injury or system instability. CONCLUSION The A1-A2 angle can be a key anatomical factor in the endovascular treatment of distal anterior cerebral artery aneurysms. The contralateral transradial system is a useful treatment option for distal anterior cerebral artery aneurysms associated with sharp ipsilateral A1-A2 angles. However, if the distal anterior cerebral artery aneurysm cannot be clearly visualized through the contralateral system, an ipsilateral system will be required for contrast injection.
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11
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Tyler Z, Guttmann OP, Savvatis K, Jones D, O'Mahony C. Is This the Prime Time for Transradial Access Left Ventricular Endomyocardial Biopsy? Interv Cardiol 2021; 16:e29. [PMID: 34733353 PMCID: PMC8548872 DOI: 10.15420/icr.2021.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/24/2021] [Indexed: 11/23/2022] Open
Abstract
Left ventricular endomyocardial biopsy (EMB) is an essential tool in the management of myocarditis and is conventionally performed via transfemoral access (TFA). Transradial access EMB (TRA-EMB) is a novel alternative and the authors sought to determine its safety and feasibility by conducting a systematic review of the literature. Medline was searched in 2020, and cohort demographics, procedural details and complications were extracted from selected studies. Four observational studies with a combined total of 496 procedures were included. TRA-EMB was most frequently performed with a sheathless MP1 guide catheter via the right radial artery. The most common complication was pericardial effusion (up to 11% in one study), but pericardial drainage for tamponade was rare (one reported case). Death and mitral valve damage have not been reported. TRA-EMB was successful in obtaining samples in 99% of reported procedures. The authors concluded that TRA-EMB is a safe and feasible alternative to TFA-EMB and the most common complication is uncomplicated pericardial effusion.
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Affiliation(s)
| | - Oliver P Guttmann
- St Bartholomew's Hospital London, UK.,UCL Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London London, UK
| | - Konstantinos Savvatis
- St Bartholomew's Hospital London, UK.,UCL Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London London, UK
| | | | - Constantinos O'Mahony
- St Bartholomew's Hospital London, UK.,UCL Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London London, UK
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12
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Hanaoka Y, Koyama JI, Yamazaki D, Fujii Y, Ogiwara T, Horiuchi T. Transradial quadraxial system for coil embolization of distal anterior cerebral artery aneurysms: A radial-first center case series and literature review. J Neuroradiol 2021; 49:169-172. [PMID: 34634296 DOI: 10.1016/j.neurad.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Endovascular treatment is technically challenging as distal anterior cerebral artery (DACA) aneurysms have distal location, small-caliber parent artery, and small size/wide neck. This study evaluated the feasibility and safety of the transradial approach (TRA) with a radial-specific neurointerventional guiding sheath as the first-line technique for DACA aneurysms. METHODS We retrospectively analyzed an institutional database of consecutive patients with DACA aneurysm who underwent coil embolization using TRA. Ten consecutive patients were included in this study. After the radial-specific 6F Simmons guiding sheath (0.088″ inner diameter) was completely engaged into the target common carotid artery, a quadraxial system (6F Simmons guiding sheath/6F intermediate catheter/3.2F intermediate catheter/single microcatheter) was used for embolization. Then, we assessed for procedural success, angiographic outcomes, and procedure-related or vascular access site complications. RESULTS Embolization procedures were conducted using simple coiling in eight and stent-assisted coiling with the trans-cell approach in two patients. The embolization procedure was successful in all patients (n = 10). Moreover, none presented with catheter kinking, parent artery flow stagnation, or system instability during the procedure. Immediate postprocedural angiography revealed complete obliteration in six and residual neck in four patients. Then, eight patients underwent follow-up angiography at a mean of 7.1 months, and none developed recanalization or required retreatment. The postprocedural course was uneventful, and there were no complications. CONCLUSION The transradial quadraxial system had the ability to achieve sufficient stability and kink resistance in DACA aneurysm embolization. Thus, this method was feasible and safe and had a high success rate.
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Affiliation(s)
- Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Jun-Ichi Koyama
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Daisuke Yamazaki
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yu Fujii
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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13
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Xie L, Wei X, Xie Z, Jia S, Xu S, Wang K. Feasibility of Distal Radial Access for Coronary Angiography and Percutaneous Coronary Intervention: A Single Center Experience. Cardiology 2021; 146:531-537. [PMID: 34365454 DOI: 10.1159/000517076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 05/05/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Asymptomatic radial artery occlusion remains the most common complication in transradial coronary interventional procedure. To prevent radial artery occlusion, distal transradial access (dTRA) has been suggested recently. In this article, we aim to describe our experience and to assess feasibility and safety of this new access site for routine coronary angiography (CAG) and percutaneous coronary intervention (PCI). METHODS We retrospective analyzed 1,063 consecutive patients who were assigned to undergo CAG or procedural PCI through dTRA between 1 January 2018 and 31 December 2019 at Affiliated Zhongshan Hospital of Dalian University. The size of radial sheath used was 5 or 6 French. The sheath was removed at procedure termination, and hemostasis was obtained by compression bandage with gauze. The success rate of dTRA access defined by successful radial artery cannulation on the first dTRA side attempted, the cause of access failure, the hemostasis duration, the incidence of post-catheterization radial artery occlusion, and the other access-related complications including hematoma of forearm and thumb numbness were assessed. RESULTS Radial artery cannulation via dTRA was successful in 953 of 1,063 patients with a success rate of 89.7%. Mean age of successful cases was 64.6 ± 11.2 years (26-94 years) with 339 (35.6%) women. A total of 363 (38.1%) cases were PCI. Among them, 95 cases (10%) underwent urgent PCI, including primary PCI in 64 patients with ST-segment elevation myocardial infarction and immediate PCI (<2 h from hospital admission) in 31 patients with very high-risk non-ST-segment elevation acute coronary syndrome. A total of 269 (28.2%) cases were via left dTRA. The 6 French sheath was used in 602 (63.2%) cases. Hemostasis was obtained within 2 h in 853 (89.5%) patients. There were 110 (10.3%) procedural failures: 59 (5.6%) cases of artery puncture failure, 49 (4.9%) cases of guide wire insertion failure, and 2 (0.2%) cases of sheath insertion failure. Complications potentially related to distal radial access included radial artery occlusion at the access site (13 cases, 1.4%), forearm radial artery occlusion (4 cases, 0.4%), hematoma of forearm (5 cases, 0.5%), and transient thumb numbness (2 cases, 0.2%). CONCLUSION dTRA is a feasible and safe access and can be used as a rational alternative to traditional radial access for routine coronary interventional procedure.
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Affiliation(s)
- Lianna Xie
- Cardiology Department, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Xianjing Wei
- Cardiology Department, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Zezhou Xie
- Cardiology Department, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Shengying Jia
- Cardiology Department, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Siwei Xu
- Cardiology Department, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Kaijun Wang
- Cardiology Department, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
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14
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Alkagiet S, Petroglou D, Nikas DN, Kolettis TM. Access-site Complications of the Transradial Approach: Rare But Still There. Curr Cardiol Rev 2021; 17:279-293. [PMID: 32814536 PMCID: PMC8640860 DOI: 10.2174/1573403x16999200819101923] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/07/2020] [Accepted: 07/21/2020] [Indexed: 11/22/2022] Open
Abstract
In the past decade, the Transradial Approach (TRA) has constantly gained ground among interventional cardiologists. TRA’s anatomical advantages, in addition to patients’ acceptance and financial benefits, due to rapid patient mobilization and shorter hospital stay, made it the default approach in most catheterization laboratories. Access-site complications of TRA are rare and usually of little clinical impact, thus, they are often overlooked and underdiagnosed. Radial Artery Occlusion (RAO) is the most common, followed by radial artery spasm, perforation, hemorrhagic complications, pseudoaneurysm, arterio-venous fistula, and even rarer complications, such as nerve injury, sterile granuloma, eversion endarterectomy or skin necrosis. Most of them are conservatively treated, but rarely, surgical treatment may be needed and late diagnosis may lead to life-threatening situations, such as hand ischemia or compartment syndrome and tissue loss. Additionally, some complications may eventually lead to TRA failure and switch to a different approach. On the other hand, it is the opinion of the authors that non-occlusive radial artery injury, commonly included in TRA’s complications in the literature, should be regarded more as an anticipated functional and anatomical cascade, following radial artery puncture and sheath insertion.
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Affiliation(s)
- Stelina Alkagiet
- Cardiology Department, G. Papanikolaou General Hospital, Thessaloniki, Greece
| | | | - Dimitrios N Nikas
- 1st Cardiology Department, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Theofilos M Kolettis
- 1st Cardiology Department, School of Medicine, University of Ioannina, Ioannina, Greece
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15
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Tan WN, Rajadurai A, Balakrishnan D. Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistula via Radial Artery and Median Cubital Vein. Neurointervention 2021; 16:194-198. [PMID: 34107596 PMCID: PMC8261111 DOI: 10.5469/neuroint.2021.00157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/18/2021] [Accepted: 05/25/2021] [Indexed: 11/24/2022] Open
Abstract
Cavernous sinus dural arteriovenous fistula (CS-DAVF) is an arteriovenous shunt where there is fistulous blood flow from the dural arteries from the internal or external carotid artery into the cavernous sinus. The current mainstay of therapy is endovascular treatment. We present a case of restrictive type of CS-DAVF in a 75-year-old male who presented with right eye symptoms. He was treated with embolisation using trans-radial artery access for angiographic runs and a median cubital vein access navigating into the cavernous sinus for coil deployment. This technique completely avoids the conventional technique of a femoral approach and confines all access to the arm. Therefore, there are less risks and complications associated with an arm access, improves patients' comfort and mobility post procedure. Transradial artery and cubital vein access allows for a safe and convenient alternative technique using the arm as compared with conventional transfemoral approach for treatment of CS-DAVF.
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Affiliation(s)
- Wen Nian Tan
- Department of Radiology, Hospital Sungai Buloh, Selangor, Malaysia
| | - Arvin Rajadurai
- Department of Radiology, Hospital Sungai Buloh, Selangor, Malaysia
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16
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Chen SH, Suazo R, Saini V, Abecassis IJ, Yavagal D, Starke RM, Peterson EC. Radial Artery Access for Cerebral Angiography: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 20:E431-E432. [PMID: 33861323 DOI: 10.1093/ons/opab071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/24/2021] [Indexed: 11/14/2022] Open
Abstract
A number of studies have demonstrated that the radial artery is a safer access site than the femoral artery for endovascular procedures.1-4 In the prospective randomized studies comparing transradial and transfemoral approaches for cardiac procedures, there was a 60% reduction in access site complications as well as significant decreases in all-cause mortality with the transradial approach as compared to transfemoral, which has led to the adoption of a radial first strategy.5-7 Neurointerventional studies have demonstrated similar safety benefits as well as improved patient preference.8-14 In this video, a patient presented with an unruptured anterior communicating artery aneurysm and consented to a transradial artery diagnostic cerebral angiogram. This technical video demonstrates the key preprocedural preparation, room setup, patient positioning, steps for radial artery, and distal radial artery puncture and sheath placement. Distal transradial artery access is our preferred approach for diagnostic cerebral angiography because of an improved safety profile and procedural ergonomics. In cases in which a larger radial artery is advantageous such as for neurointerventions requiring larger systems, a standard transradial approach may be performed.9 In this video, a full 6-vessel cerebral angiogram is performed, followed by our arteriotomy closure technique using our standard equipment including a 10-cm 5 French Glidesheath Slender (Terumo, Japan), 100-cm hydrophilic coated 5 French Simmons 1 catheter (Merit OEM), 0.035 hydrophilic coated guidewire, and SafeGuard closure device (Merit, Salt Lake City, Utah).
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Affiliation(s)
- Stephanie H Chen
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Roberto Suazo
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vasu Saini
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Isaac Josh Abecassis
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dileep Yavagal
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eric C Peterson
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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17
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Iezzi R, Campenni P, Posa A, Parello A, Rodolfino E, Marra AA, Ratto C, Manfredi R. Outpatient Transradial Emborrhoid Technique: A Pilot Study. Cardiovasc Intervent Radiol 2021; 44:1300-1306. [PMID: 33977328 DOI: 10.1007/s00270-021-02856-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine whether outpatient transradial emborrhoid technique can be performed safely and effectively in the treatment of symptomatic hemorrhoids. MATERIALS AND METHODS The transradial emborrhoid technique was used to treat 12 patients with symptomatic hemorrhoids in an outpatient setting during a 4-month period. After percutaneous catheterization of the left radial artery, a 5-Fr sheath was introduced to catheterize the inferior mesenteric artery and a microcatheter was advanced into the branches of the superior rectal artery for embolization with 0.018-inch detachable coils (Interlock and IDC-interlocking detachable coils). After embolization, the sheath was withdrawn and puncture site hemostasis was achieved using a wrist band. All patients were evaluated 6 h after the procedure to determine whether they meet the discharge criteria and were discharged the following day. The results of the emborrhoid treatment were assessed at the 4-week follow-up. RESULTS The emborrhoid technique was successful in all patients. There was no major complication associated with the procedure. All patients met the discharge criteria 6 h after the procedure. Reduction of local edema and of hemorrhoidal congestion was observed in all patients. At the follow-up visit, the mean Rorvik score (HDSS + SHS-HD) decreased from 31.50 (7.50) to 13.11 (8.33) (p < .001). CONCLUSIONS Transradial rectal artery embolization is a safe and effective treatment option for patients with chronic symptoms of hemorrhoid disease.
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Affiliation(s)
- Roberto Iezzi
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia - Istituto Di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A Gemelli 8, 00168, Rome, Italy. .,Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Paola Campenni
- Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A Gemelli 8, 00168, Rome, Italy
| | - Alessandro Posa
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia - Istituto Di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A Gemelli 8, 00168, Rome, Italy
| | - Angelo Parello
- Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A Gemelli 8, 00168, Rome, Italy
| | - Elena Rodolfino
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia - Istituto Di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A Gemelli 8, 00168, Rome, Italy
| | - Angelo Alessandro Marra
- Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A Gemelli 8, 00168, Rome, Italy
| | - Carlo Ratto
- Università Cattolica del Sacro Cuore, Rome, Italy.,Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A Gemelli 8, 00168, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia - Istituto Di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A Gemelli 8, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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18
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Besli F, Gungoren F, Tanriverdi Z, Tascanov MB, Fedai H, Akcali H, Demirbag R. The high dose unfractionated heparin is related to less radial artery occlusion rates after diagnostic cardiac catheterisation: a single centre experience. Acta Cardiol 2021; 76:168-174. [PMID: 31869279 DOI: 10.1080/00015385.2019.1705584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Transradial approach (TRA) has increasingly become the default strategy for cardiac catheterisation. However, TRA can result in several complications; radial artery occlusion (RAO) is the most unwilling complication. Unfractionated heparin (UFH) is an effective therapy in preventing RAO. The goal of this study was to evaluate whether weight-adjusted high dose UFH reduces the rate of RAO after diagnostic cardiac catheterisation compared to weight-adjusted standard dose UFH. METHODS A total of 1215 patients screened and after exclusion criteria, 686 consecutive patients were enrolled. 100 IU/kg UFH (high dose UFH group) and 50 IU/kg UFH (standard dose UFH group) were given the patients undergoing diagnostic cardiac catheterisation. RAO was evaluated with vascular Doppler ultrasonography at 10 days after cardiac catheterisation. RESULTS Among 686 patients undergoing diagnostic cardiac catheterisation, RAO was detected in 36 (5.2%) patients. There was no significant difference with respect to baseline characteristics and co-morbid diseases between high dose UFH group and standard dose UFH group. RAO was significantly higher in standard dose UFH group than high dose UFH group (7.9% vs. 3.0%, p = .004). Multivariate logistic regression analysis was demonstrated that age (OR: 0.958, 95% CI: 0.924-0.993, p = .019) and standard dose heparin (OR: 2.811, 95% CI: 1.347-5.866, p = .006) were independent factor for RAO. CONCLUSIONS High dose UFH was independently associated with a lower rate of RAO. Given that RAO nearly affects about 10% patient underwent TRA, prefer to high dose UFH may be a reasonable choice for RAO prevention.
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Affiliation(s)
- Feyzullah Besli
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Fatih Gungoren
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Zulkif Tanriverdi
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | | | - Halil Fedai
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Huseyin Akcali
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Recep Demirbag
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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19
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Goland J, Doroszuk G, Ypa P, Leyes P, Garbugino S. Outpatient treatment of cerebral aneurysms: A case series. Surg Neurol Int 2020; 11:400. [PMID: 33274113 PMCID: PMC7708966 DOI: 10.25259/sni_569_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/24/2020] [Indexed: 01/10/2023] Open
Abstract
Background: Major advances in the endovascular treatment of cerebral aneurysms have reduced the incidence of intra- and postprocedural complications. The length of stay after treatment for incidental aneurysms remains between early next-day discharge and 2 days. We hypothesized that discharging patients the same day would not be associated with any increase in the rate of postdischarge adverse events. Methods: We retrospectively reviewed the charts of patients who underwent an elective coiling procedure between 2015 and 2020 at three centers and were discharged from hospital on the same day as the procedure. Patients were clinically evaluated 6 h, 1 week, and 6 months after the procedure, with repeat cerebral angiography performed 1 year after the procedure. Results: Eleven eligible patients underwent outpatient treatment of 12 aneurysms treated through the wrist. No complications were identified within 1 week of the procedure. Clinical evaluation 6 months after treatment also failed to reveal any complication associated with the procedure. Only one of the seven patients who underwent 1 year angiography required retreatment. Conclusion: It is possible to safely perform coiled embolization of cerebral aneurysms in select outpatients with unruptured cerebral aneurysms.
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Affiliation(s)
- Javier Goland
- Department of Neurosurgery, University of Buenos Aires, Buenos Aires.,Neurointervention Section, Hospital El Cruce, Florencio Varela.,Neurointervention Section, Sanatorio Anchorena, San Martín
| | - Gustavo Doroszuk
- Neurointervention Section, Hospital El Cruce, Florencio Varela.,Neurointervention Section, Sanatorio Anchorena, San Martín
| | - Paula Ypa
- Department of Neurosurgery, University of Buenos Aires, Buenos Aires.,Neurointervention Section, Sanatorio Anchorena, San Martín
| | - Paula Leyes
- Neurointervention Section, Hospital El Cruce, Florencio Varela
| | - Silvia Garbugino
- Department of Neurosurgery, University of Buenos Aires, Buenos Aires
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20
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Romano DG, Frauenfelder G, Tartaglione S, Diana F, Saponiero R. Trans-Radial Approach: technical and clinical outcomes in neurovascular procedures. CVIR Endovasc 2020; 3:58. [PMID: 33030621 PMCID: PMC7544797 DOI: 10.1186/s42155-020-00152-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/14/2020] [Indexed: 12/03/2022] Open
Abstract
Background To evaluate efficacy and safety of Trans-Radial Approach (TRA) in cerebral angiography for diagnostic and therapeutic purpose. Methods We retrospectively included consecutive patients eligible for TRA cerebral angiography at our Institution between September 2019 and January 2020. Cerebral DSA was classified in diagnostic (one-vessel imaging) or therapeutic (emergency/elective). Technical and clinical outcome were recorded for each group. Results A total of 61 TRA angiographies were evaluated. Right-sided TRA was obtained in 85,2% of all cases. Interventional procedures included 11 strokes, 2 ruptured aneurysms, 2 unrupted aneurysms, 1 DAVF and 3 symptomatic atheromatous intracranial stenosis. Successful TRA angiographies were obtained in 97,6% and 94,7% for diagnostic and therapeutic group, respectively. No major radial artery complications were recorded. Mean puncture-to-final angiogram was 11 and 62 min for diagnostic and therapeutic groups, respectively. Mean radial compression maintenance was 4 h, allowing patients discharge within 6 h in all cases undergone diagnostic angiography. Conclusions TRA could be a valid technique in terms of efficacy and safety both for diagnostic and therapeutic cerebral angiographies, with low complication rate.
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Affiliation(s)
- D G Romano
- Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo 1, 84100, Salerno, Italy
| | - G Frauenfelder
- Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo 1, 84100, Salerno, Italy.
| | - S Tartaglione
- Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo 1, 84100, Salerno, Italy
| | - F Diana
- Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo 1, 84100, Salerno, Italy
| | - R Saponiero
- Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo 1, 84100, Salerno, Italy
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21
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Zalocar LAD, Doroszuk G, Goland J. Transradial approach and its variations for neurointerventional procedures: Literature review. Surg Neurol Int 2020; 11:248. [PMID: 32905334 PMCID: PMC7468190 DOI: 10.25259/sni_366_2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/23/2020] [Indexed: 12/20/2022] Open
Abstract
Background: The transfemoral approach (TFA) has been the standard in neuroradiology over the years. However, the transradial approach (TRA) and its variants offer several benefits over the TFA. Methods: Review of the literature about TRA and its variations. We present our results for different neurointerventional procedures at our institution between January 2018 and December 2019. Results: We wrote an educational review describing anatomical and technical aspects, advantages, and complications of this approach. In the past year we increased the percentage of neurointerventional procedures performed through radial or ulnar arteries. Conclusion: There are clearly proven benefits of employing a wrist approach in patients for neurointerventional procedures and its utilization should especially be considered on a daily basis.
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Affiliation(s)
| | - Gustavo Doroszuk
- Neurointervention Section, Hospital El Cruce Néstor Kirchner, Florencio Varela
| | - Javier Goland
- Neurointervention Section, Hospital El Cruce Néstor Kirchner, Florencio Varela.,Department of Neurosurgery, University of Buenos Aires, Buenos Aires, Argentina
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22
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Kiat JTC, Lung AWS, Tang CC. When one complication begets another - A case report of radial artery pseudoaneurysm following radial artery occlusion post-transradial coronary angiography. J Cardiol Cases 2020; 22:52-4. [PMID: 32774519 DOI: 10.1016/j.jccase.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/14/2020] [Accepted: 04/03/2020] [Indexed: 11/21/2022] Open
Abstract
The transradial approach for coronary angiography and intervention is the preferred approach because of its superior safety profile as compared to the transfemoral approach. However, like all procedures, transradial approach is not free from complications. In this case, we describe a unique case of a large symptomatic radial artery pseudoaneurysm requiring urgent surgical intervention. The pseudoaneurysm developed after treatment with a short duration of subcutaneous low molecular weight heparin for radial artery occlusion that occurred a day after transradial coronary catheterization. The pseudoaneurysm was repaired successfully and there was no recurrence during subsequent follow-up. Access-related complications post transradial approach are generally uncommon and this is the first reported case of radial artery occlusion further complicated by a large pseudoaneurysm to the best of our knowledge. Preventive measures are crucial in reducing radial artery occlusion while we recommend an individualized approach based on clinical history coupled with anatomic features of pseudoaneurysm in managing radial artery pseudoaneurysm. 〈Learning objective: Access-related complications post transradial approach coronary angiography, while rare, can still occur. Preventive measures as well as close monitoring post angiography are crucial in the prevention as well as early detection of access-related complications. Management of radial artery pseudoaneurysm should be individualized based on clinical context as well as anatomic characteristics of the pseudoaneurysm.〉.
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23
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Allende-Carrera R, Viana-Rojas JA, Saldierna-Galván A, López-Quijano JM, Rivera-Arellano JDJ, Leiva-Pons JL, Carrillo-Calvillo J. Feasibility of single catheter intervention for multivessel coronary artery disease using transradial approach. Arch Cardiol Mex 2020; 89:147-153. [PMID: 31702741 DOI: 10.24875/acme.m19000037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective The objective of the study was to describe the feasibility of single catheter intervention using the transradial approach for percutaneous coronary intervention (PCI). Background The transradial approach for PCIs has fewer vascular events and complications and lower mortality rate. However, complications can result from forearm artery tortuosity, a longer learning curve and artery spasm that can complicate, delay and impede coronary artery interventions. The latter is usually exacerbated by the changing and manipulation of catheters. Methods We performed a study using a single catheter on patients undergoing coronary assessment and treatment. Procedural outcomes including success, procedural time, bleeding, access site complications, and contrast used were all analyzed. Results We included 327 patients, of whom 70% were male. The mean age was 63.3 ± 11.1 years, mean height was 165.9 ± 7.7 cm, mean weight was 73.3 ± 11.3 kg, and mean body index was 26.5 ± 3.5 kg/m2. Contrast use averaged 158.5 ± 60.5 ml. Three vessels were treated in 3% of all cases, two vessels in 32%, and one vessel in 65%. Procedural success was achieved in 94.5% of the cases. A second catheter was required in 9 cases (2.7%), and crossover to the femoral approach was performed in 9 cases (2.7%) due to a lack of support, artery spasm, difficult anatomy, or the need for a larger catheter. Three complications were related to access, including a Class 2 hematoma that was treated conservatively with no further complications. Conclusions Our study showed that using a single catheter to perform both diagnostic and therapeutic procedures has a higher success rate, lower spasm incidence, and fewer complications than reported in literature.
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Affiliation(s)
- Ricardo Allende-Carrera
- Departamento de Cardiología, Hospital de Especialidades Médicas de la Salud, San Luis Potosí, México
| | - Jesús A Viana-Rojas
- Departamento de Cardiología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City. México
| | | | - Juan M López-Quijano
- Departamento de Cardiología, Hospital Central "Dr. Ignacio Morones Prieto" San Luis Potosí, San Luis Potosí. México
| | - José de J Rivera-Arellano
- Departamento de Cardiología, Hospital Central "Dr. Ignacio Morones Prieto" San Luis Potosí, San Luis Potosí. México
| | - José L Leiva-Pons
- Departamento de Cardiología, Hospital Central "Dr. Ignacio Morones Prieto" San Luis Potosí, San Luis Potosí. México
| | - Jorge Carrillo-Calvillo
- Departamento de Cardiología, Hospital Central "Dr. Ignacio Morones Prieto" San Luis Potosí, San Luis Potosí. México
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Abstract
This review summarizes the impact of transradial access for cardiac catheterization and percutaneous coronary intervention related to patient satisfaction, patient safety, and health care costs. In studies comparing transradial versus transfemoral approach, transradial access causes less bleeding and less vascular access site complications and provides a mortality benefit in patients with acute coronary syndromes. Transradial access improves patient satisfaction related to site tolerability by reducing pain and discomfort, and facilitating early ambulation with reduced length of stay. Taken in total, the existing randomized and observational data strongly support radial access for improved safety, patient satisfaction, and significant cost savings.
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Affiliation(s)
- Samuel M Lindner
- Cardiovascular Division, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8086, St Louis, MO 63110, USA; Barnes-Jewish Hospital, 660 S Euclid Avenue, Campus Box 8086, St Louis, MO 63110, USA
| | - Christian A McNeely
- Cardiovascular Division, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8086, St Louis, MO 63110, USA; Barnes-Jewish Hospital, 660 S Euclid Avenue, Campus Box 8086, St Louis, MO 63110, USA
| | - Amit P Amin
- Cardiovascular Division, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8086, St Louis, MO 63110, USA; Barnes-Jewish Hospital, 660 S Euclid Avenue, Campus Box 8086, St Louis, MO 63110, USA; Center for Value and Innovation, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8086, St Louis, MO 63110, USA.
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Kern JA, Medina FA, Lee L, Kaur K, Nathan S, Blair JEA. Use of Prospective Radiobrachial Angiography in Transradial Cardiac Catheterization and Intervention. Cardiovasc Revasc Med 2020; 21:797-803. [PMID: 31786141 DOI: 10.1016/j.carrev.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 09/17/2019] [Accepted: 10/02/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study examined the utility of prospective radiobrachial angiography (pRBA) in transradial coronary angiography and intervention as a method for reducing procedural complications. BACKGROUND A growing body of evidence has supported the transradial approach (TRA) as superior to the transfemoral approach (TFA) due to advantages such as reduced bleeding and improved outcomes in high-risk patients. However, TRA has a higher failure rate than TFA, and has seen slow rates of adoption among United States operators. METHODS This was a retrospective, single center, case-control analysis of coronary angiography procedures, performed by two experienced operators at the University of Chicago Medical Center between October 28, 2015 and July 21, 2017. Operator 1 began using pRBA during the study, whereas Operator 2 used pRBA in all TRA procedures. There were 567 patients stratified into three groups based on operator and pRBA use. Comparisons of procedural outcomes for Operator 1 before and after adoption of pRBA, and of outcomes between Operator 1 and Operator 2 were made. RESULTS Use of pRBA was associated with reduced overall procedural complication rates (2.5% versus 10.4%, p = 0.004), driven primarily by reflexive radiobrachial angiography (rRBA) after resistance or pain was encountered (8.6% versus 0.0%, p = 0.0001) for Operator 1. A slight reduction in contrast associated with pRBA for Operator 1 was noted, but no difference in procedural time, radiation dose, or additional equipment used across groups was found. No significant difference in adverse procedural outcomes between the pRBA groups of Operator 1 and Operator 2 were observed. In patients with radiobrachial variants in anatomy, use of pRBA was associated with shorter times to cross anatomic lesions, shorter procedure times, reduced use of extra catheters, and less perforations and crossovers compared to patients requiring rRBA. Lack of pRBA was associated with higher procedural complications (hazard ratio 1.08, 95% CI, 1.03-1.13, p = 0.004). CONCLUSION pRBA may be a useful tool for mitigating procedural complications, reducing time needed to cross difficult radiobrachial anatomy, and reducing the need to utilize additional equipment in TRA. pRBA may offer operators a tool to improve outcomes and increase adoption of this approach.
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Allende-Carrera R, Viana-Rojas JA, Saldierna-Galván A, López-Quijano JM, Rivera-Arellano JDJ, Leiva-Pons JL, Carrillo-Calvillo J. Feasibility of single catheter intervention for multivessel coronary artery disease using transradial approach. Arch Cardiol Mex 2019; 89:160-166. [PMID: 31314014 DOI: 10.24875/acm.m19000024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective The objective of the study was to describe the feasibility of single catheter intervention using the transradial approach for percutaneous coronary intervention (PCI). Background The transradial approach for PCIs has fewer vascular events and complications and lower mortality rate. However, complications can result from forearm artery tortuosity, a longer learning curve and artery spasm that can complicate, delay and impede coronary artery interventions. The latter is usually exacerbated by the changing and manipulation of catheters. Methods We performed a study using a single catheter on patients undergoing coronary assessment and treatment. Procedural outcomes including success, procedural time, bleeding, access site complications, and contrast used were all analyzed. Results We included 327 patients, of whom 70% were male. The mean age was 63.3 ± 11.1 years, mean height was 165.9 ± 7.7 cm, mean weight was 73.3 ± 11.3 kg, and mean body index was 26.5 ± 3.5 kg/m2. Contrast use averaged 158.5 ± 60.5 ml. Three vessels were treated in 3% of all cases, two vessels in 32%, and one vessel in 65%. Procedural success was achieved in 94.5% of the cases. A second catheter was required in 9 cases (2.7%), and crossover to the femoral approach was performed in 9 cases (2.7%) due to a lack of support, artery spasm, difficult anatomy, or the need for a larger catheter. Three complications were related to access, including a Class 2 hematoma that was treated conservatively with no further complications. Conclusions Our study showed that using a single catheter to perform both diagnostic and therapeutic procedures has a higher success rate, lower spasm incidence, and fewer complications than reported in literature.
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Affiliation(s)
- Ricardo Allende-Carrera
- Departamento de Cardiología, Hospital de Especialidades Médicas de la Salud, San Luis Potosí. México
| | - Jesús A Viana-Rojas
- Departamento de Cardiología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City. México
| | | | - Juan M López-Quijano
- Departamento de Cardiología, Hospital Central "Dr. Ignacio Morones Prieto" San Luis Potosí, San Luis Potosí. México
| | - José de J Rivera-Arellano
- Departamento de Cardiología, Hospital Central "Dr. Ignacio Morones Prieto" San Luis Potosí, San Luis Potosí. México
| | - José L Leiva-Pons
- Departamento de Cardiología, Hospital Central "Dr. Ignacio Morones Prieto" San Luis Potosí, San Luis Potosí. México
| | - Jorge Carrillo-Calvillo
- Departamento de Cardiología, Hospital Central "Dr. Ignacio Morones Prieto" San Luis Potosí, San Luis Potosí. México
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Abstract
Objectives To evaluate the feasibility, efficiency, and safety of the transradial approach (TRA) for cerebral angiography versus the transfemoral approach (TFA) in patients. Methods In this trial, 2314 patients underwent cerebral angiography, with 1085 patients undergoing the procedure via radial access and 1229 via transfemoral access. The arterial puncture time, operation success rate, oppression time on puncture points, local vascular complication incidence (including bleeding, hematoma, and pseudoaneurysm), deep venous thrombosis of lower limbs (DVT), and bradycardia/hypotension were observed and compared between the two groups. Results Of the patients who underwent cerebral angiography via radial access, the procedure was successful in 1070 patients; compared with 1219 patients with transfemoral access, there was no significant difference (P > 0.05) in the success rate or the arterial puncture time. Radial access patients were less likely to present with oppression time on puncture points, local vascular complications, DVT, and bradycardia/hypotension compared with femoral access patients. Conclusions For patients undergoing cerebral angiography, radial and femoral approaches are both safe and effective. However, the lower rate of local vascular complications may be a reason to use the radial approach.
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Affiliation(s)
- Ziliang Wang
- Department of Intervention, Henan Provincial People's Hospital,Henan University, Zhengzhou, Henan, China
| | - Jinchao Xia
- Department of Intervention, Henan Provincial People's Hospital,Henan University, Zhengzhou, Henan, China
| | - Wei Wang
- Henan Provincial Medical Association, Zhengzhou, 450000, Henan, China
| | - Gangqin Xu
- Department of Intervention, Henan Provincial People's Hospital,Henan University, Zhengzhou, Henan, China
| | - Jianjun Gu
- Department of Intervention, Henan Provincial People's Hospital,Henan University, Zhengzhou, Henan, China
| | - Yongfeng Wang
- Department of Intervention, Henan Provincial People's Hospital,Henan University, Zhengzhou, Henan, China
| | - Tianxiao Li
- Department of Intervention, Henan Provincial People's Hospital,Henan University, Zhengzhou, Henan, China
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Abstract
Transradial approach for cardiac catheterization is a viable alternative to transfemoral approach given its ease of access, lessened complication risk, and post procedural comfort for patients. Radial pseudoaneurysm presents as a rare complication in less than 1% of these procedures. The use of external compression banding is an approach that shows promise as a noninvasive attempt towards resolving this complication. However, it has been documented in very few reports. We describe a case of an 82-year-old woman who underwent transradial approach to cardiac catheterization, and developed a radial pseudoaneurysm following the procedure as confirmed by Doppler ultrasonography. We used compressive banding as a technique to attempt to resolve this radial pseudoaneurysm. Following a strict protocol of pneumatic banding, repeat ultrasonography revealed complete resolution of radial pseudoaneurysm. This case highlights a potentially noninvasive technique that could serve as a first-line approach towards resolving this rare phenomenon.
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Affiliation(s)
- Syed Iftikhar
- Department of Internal Medicine, UC Riverside School of Medicine/Riverside Community Hospital, Riverside, CA 92501, USA
| | - Asma Jamil
- Department of Internal Medicine, UC Riverside School of Medicine/Riverside Community Hospital, Riverside, CA 92501, USA
| | - Javad Savoj
- Department of Internal Medicine, UC Riverside School of Medicine/Riverside Community Hospital, Riverside, CA 92501, USA
| | - Patrick Hu
- Department of Cardiology, UC Riverside School of Medicine/Riverside Community Hospital, Riverside, CA 92501, USA
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Lee WC, Fang HY, Wu CJ. Percutaneous Coronary Intervention for Tortuous Left Anterior Descending Artery with Bioresorbable Vascular Scaffold via the Transradial Approach. Acta Cardiol Sin 2018; 34:530-532. [PMID: 30449995 PMCID: PMC6236573 DOI: 10.6515/acs.201811_34(6).20180818b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Sultan EZM, Rabea HM, Abdelmeguid KR, Mahmoud HB. Transradial artery approach in STEMI patients reperfused early and late by either primary PCI or pharmaco-invasive approach. Egypt Heart J 2018; 70:1-7. [PMID: 29622990 PMCID: PMC5883500 DOI: 10.1016/j.ehj.2017.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 04/21/2017] [Indexed: 11/30/2022] Open
Abstract
There was a non-significant difference regarding LVEF and TIMI flow between both PPCI and PI. Myocardium wall preservation was significant in early PI (P = 0.023) Mean procedural and fluoroscopic time were 35.1 ± 6.1 and 6.3 ± 0.9 min. No reported entry site complications also no difference in primary end point (P = 0.326). It is safe and effective to use TRA in STEMI patients who reperfused by either early or late PPCI or PI.
The purpose of the study was to investigate the safety and efficacy of transradial artery approach (TRA) in STEMI patients who reperfused early (≤3 h from symptoms onset) or late (>3 h from symptoms onset) by either PPCI or pharmaco-invasive strategy (PI), thrombolysis followed by CA. Therefore, a total 143 STEMI patients (who were presented within 12 h from symptoms onset or 12–24 h with an evidence of ongoing ischemia or suffered from an acute STEMI were randomized for either PI or PPCI. Eighty-two patients were assigned to PI arm while the rest assigned were to PPCI arm. Patients who were taken to a non-PCI capable hospital received streptokinase and were then transferred to our Hospital for CA. TRA was used in the catheterization laboratory for all patients. Each arm was divided according to reperfusion time into early and late subgroups. A primary endpoint was death, shock, congestive heart failure, or reinfarction up to 30 days. There was a non-significant difference regarding LVEF in both arms. Myocardium wall preservation was significant in the early PI arm (P = 0.023). TIMI flow had no discrepancy between both arms (P = 0.569). Mean procedural and fluoroscopic time were 35.1 ± 6.1 and 6.3 ± 0.9 min. There were no reported entry site complications. There was no difference in primary endpoint complications (P = 0.326) considering the different times of patients’ reperfusion (early; P = 0.696 vs. late; P = 0.424). In conclusion, it is safe and effective to use TRA in STEMI patients who reperfused by either early or late PPCI or PI. We recommend PI for STEMI patients with delay presentation if PPCI is not available.
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Affiliation(s)
- El-Zahraa M Sultan
- Clinical Pharmacist, Cardiovascular Department, Beni-Suef Hospital University, Egypt
| | - Hoda M Rabea
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | | | - Hesham B Mahmoud
- Prof. of Cardiology, Beni-Suef Hospital University, Beni-Suef, Egypt
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Felekos I, Hussain R, Patel SJ, Pavlidis AN. Balloon-assisted tracking: A practical solution to avoid radial access failure due to difficult anatomical challenges. Cardiovasc Revasc Med 2017; 19:564-569. [PMID: 29306669 DOI: 10.1016/j.carrev.2017.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 11/15/2022]
Abstract
AIM The balloon assisted tracking (BAT) technique is utilised to overcome various anatomical difficulties during radial procedures when standard measures such as adequate sedation, pain relief, vasodilators and use of hydrophilic guidewires, fail. The aim of this study was to evaluate the success rates of the BAT technique in overcoming anatomical difficulties during radial coronary interventional procedures. METHODS We retrospectively reviewed 1100 consecutive patients undergoing coronary procedures from the transradial approach (TRA) between May 2015 and May 2017. Anatomic variations and equipment used were recorded from procedure logs. RESULTS Overall 30 patients (2.72%) required the use of BAT. Mean age was 66.7years, with a range from 48 to 90years (53.3% female). Out of these 30 cases, 86.7% patients underwent percutaneous coronary intervention (PCI) while the remaining patients underwent coronary angiography alone. Acute coronary syndrome cases represented 63.3% of the cases while the remaining patients were elective procedures. Anatomical difficulties included severe, non-resolving radial spasm (66.6%), catheter induced radial or brachial perforation (16.6%), small calibre and/or diseased radial artery (10.0%), severe radial, branchial and/or subclavian tortuosity (3.0%) and radial loops (3.0%). Anatomical difficulties were overcome in all cases (100%). Coronary angiography and/or PCI were successfully completed in all 30 cases without the need for obtaining alternative arterial access. Mean added procedural time was 131s. There were no procedure related complications. CONCLUSION Balloon assisted tracking is a highly successful and safe technique for overcoming various anatomical difficulties at the level of the radial, brachial or subclavian arteries, which minimises the need for alternative arterial access.
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Affiliation(s)
| | | | - Sundip J Patel
- St. Thomas Hospital, London, UK; Queen Elizabeth Hospital, Woolwich, London, UK
| | - Antonis N Pavlidis
- St. Thomas Hospital, London, UK; Queen Elizabeth Hospital, Woolwich, London, UK
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Rigatelli G, Zuin M, Dell'Avvocata F, Vassiliev D. Topical anaesthesia before transradial approach for supraoartic vessels angiography and stenting in the elderly: a feasible alternative. J Geriatr Cardiol 2017; 14:644-8. [PMID: 29238366 DOI: 10.11909/j.issn.1671-5411.2017.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Rigattieri S, Valsecchi O, Sciahbasi A, Tomassini F, Limbruno U, Marchese A, La Manna A, Mauro C, Varbella F, Berti S, Tarantino FF, Musumeci G. Current practice of transradial approach for coronary procedures: A survey by the Italian Society of Interventional Cardiology (SICI-GISE) and the Italian Radial Club. Cardiovasc Revasc Med 2017; 18:154-9. [PMID: 28119043 DOI: 10.1016/j.carrev.2017.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/06/2017] [Accepted: 01/11/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Transradial approach (TRA) for percutaneous coronary procedures is associated with improved patient outcome and is being increasingly adopted worldwide. We surveyed Italian interventional cardiologists in order to take a snapshot of the current practice of TRA. METHODS A web-based questionnaire was emailed to all members of the Italian Society of Interventional Cardiology. RESULTS The survey was taken by 508 respondents. Cardiogenic shock and chronic total occlusions represented the principal limitations to TRA. Right TRA was the default approach for 81% of respondents. Both diagnostic and interventional procedures were routinely performed through 6 Fr sheaths (83% and 93%, respectively); dedicated TRA curves were used in 11% of diagnostic and in about 3% of interventional procedures. Almost 70% of the operators did not assess dual hand circulation. In case of crossover, the contralateral radial artery was the preferred site (57%). Radial artery hemostasis was mostly achieved by pneumatic bracelet (64%) and patency of the radial artery during hemostasis was ensured in 60% of cases. Pre-discharge patency of the radial artery was routinely assessed by almost 60% of respondents. For diagnostic procedures, adequate heparin anticoagulation (5000IU) was only given by 45% of operators. Most respondents believed that TRA is associated with greater radiation exposure for both the patient (82%) and the operator (98%) as compared to transfemoral approach. CONCLUSIONS This survey provides contemporary data about the adoption of TRA in Italy and gives interesting insights about several technical and clinical issues related to the practice of this vascular approach for coronary procedures.
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Abstract
Historically, the majority of coronary procedures have been performed via the femoral artery. However, since the inception of the transradial approach, a number of studies have confirmed that this technique is associated with a significant reduction in vascular complications, equivalent procedure times and radiation exposure to femoral procedures, the ability to perform complex coronary interventions, early ambulation and patient preference. Over the last decade, this has led to an exponential rise in the use of the transradial access site, with several potential technical challenges becoming increasingly recognised. However, with greater experience and technological advancement these potential obstacles may be overcome. The following review highlights the potential challenges and suggests several tips to assist transradial operators with recognising and overcoming these challenges.
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Affiliation(s)
- Kully Sandhu
- Cardiology Department, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Robert Butler
- Cardiology Department, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - James Nolan
- Cardiology Department, Royal Stoke University Hospital, Stoke-on-Trent, UK
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Kherad B, Köhncke C, Spillmann F, Post H, Noutsias M, Pieske B, Krackhardt F, Tschöpe C. Postprocedural radial artery occlusion rate using a sheathless guiding catheter for left ventricular endomyocardial biopsy performed by transradial approach. BMC Cardiovasc Disord 2016; 16:253. [PMID: 27931184 PMCID: PMC5146854 DOI: 10.1186/s12872-016-0432-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/02/2016] [Indexed: 01/25/2023] Open
Abstract
Background For coronary interventions the arterial access via the radial artery is associated with fewer vascular access site complications, and has been shown to reduce major bleeding when compared to the femoral approach. But the endomyocardial biopsy (EMB) approach is usually done by a transfemoral or cervical access known to be associated with an increased risk of artery puncture and its potential complications (i.e., false aneurysm, artery-venous fistula) and needs post-procedural immobilization. A transradial approach for EMBs is not standardized. The aim of our study is to validate safety and efficacy of the transradial access approach for left ventricular EMB, and to define patients eligible for a safe and successful procedure. Methods and Results We evaluated the transradial access using a 7.5 F sheathless multipurpose guiding catheter to obtain EMBs from the left ventricle (LV). 18 patients were included. The transradial success rate was 100% (18/18). There were no periprocedural cardiac complications. Immediate post-procedural ambulation could be achieved in all patients. Although radial artery pulse was confirmed by ultrasonic vascular Doppler after removal of the guide in 100% (18/18) of the patients, 50% (9/18) of the patients showed occlusion of the radial artery RAO) by duplex sonography proximal to the access site. 33% (3/9) of the patients in the RAO group and 11,1% (1/9) of the patients in the patent radial artery (RAP) group, respectively, experienced mild pain after the procedure in the right lower arm. Colour Doppler ultrasonography of the right radial artery performed 24 h after the procedure revealed radial occlusion in 50% (9/18) of the patients. The diameter of the radial artery was significantly smaller in the RAO group (p = 0,034), peak systolic velocity (PSV) of the right ulnar artery was significantly higher in the RAO group (p = 0.012). Peak systolic velocity of the opposite radial artery was significantly lower in the RAO group (p = 0,045). Gender, sex, diabetes, radial artery inner diameter ≤2.5 mm and lower peak systolic velocity of < 50 cm/s are predictors of RAO. Conclusion The present study demonstrates the safety and efficacy of a transradial access for EMB using a highly hydrophilic sheathless guiding catheter.
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Affiliation(s)
- Behrouz Kherad
- Department of Cardiology, Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany.,Privatpraxis Dr. Kherad, Große Hamburger Straße 5-11, 10115, Berlin, Germany
| | - Clemens Köhncke
- Department of Cardiology, Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Frank Spillmann
- Department of Cardiology, Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Heiner Post
- Department of Cardiology, Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Michel Noutsias
- Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Burkert Pieske
- Department of Cardiology, Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany.,German Heart Center (Deutsches Herzzentrum Berlin, (DHZB)), Berlin, Germany.,Deutsches Zentrum für Herz Kreislaufforschung (DZHK) - Standort Berlin/Charité, Campus Rudolf Virchow, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Florian Krackhardt
- Department of Cardiology, Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany. .,Berlin Center for Regenerative Therapies (BCRT), Campus Virchow Klinikum (CVK), Berlin, Germany. .,Deutsches Zentrum für Herz Kreislaufforschung (DZHK) - Standort Berlin/Charité, Campus Rudolf Virchow, Augustenburger Platz 1, 13353, Berlin, Germany.
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Potdar A, Sapkal G, Sharma S. Triple vessel percutaneous coronary intervention in a patient with situs inversus dextrocardia using a transradial approach. Indian Heart J 2016; 68 Suppl 2:S32-S35. [PMID: 27751321 PMCID: PMC5067737 DOI: 10.1016/j.ihj.2016.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 02/14/2016] [Accepted: 03/07/2016] [Indexed: 12/03/2022] Open
Abstract
Situs inversus dextrocardia is a challenging situation for an interventional cardiologist. This report presents a rare case where multivessel percutaneous coronary intervention was performed in a single sitting using transradial approach. The challenges encountered in the procedure and clues to successful outcome are discussed.
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Affiliation(s)
- Anil Potdar
- Director, Parisoha Foundation, H.J. Doshi Ghatkopar Hindusabha Hospital, Ghatkopar (West), Mumbai, Maharashtra 400 086, India
| | - Ganeshrao Sapkal
- Senior Registrar, Department of Cardiology, Bombay Hospital Institute of Medical Sciences, Bombay Hospital, 12, New Marine Lines, Mumbai, Maharashtra 400 020, India.
| | - Satyavan Sharma
- Professor and Head of Cardiology, Department of Cardiology, Bombay Hospital Institute of Medical Sciences, Bombay Hospital, 12, New Marine Lines, Mumbai, Maharashtra 400 020, India
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Bazemore TC, Rao SV. Controversies in the Management of ST-Segment Elevation Myocardial Infarction: Transradial Versus Transfemoral Approach. Interv Cardiol Clin 2016; 5:513-522. [PMID: 28581999 DOI: 10.1016/j.iccl.2016.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article discusses the controversies surrounding the use of transradial versus transfemoral approaches in the management of patients with ST-segment elevation myocardial infarction, beginning with a review of the benefits of transradial percutaneous coronary intervention (PCI) in this population. The unanswered questions about the mechanism underlying the mortality benefit of transradial PCI are discussed, concluding with recommendations for safe and effective strategies for adoption of the transradial approach to optimize outcomes in these high-risk patients.
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Affiliation(s)
- Taylor C Bazemore
- Department of Internal Medicine, Duke University Medical Center, Box 3182, Durham, NC 27710, USA.
| | - Sunil V Rao
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, 2100 Erwin Road, Durham, NC 27705, USA; Department of Cardiology, Durham VA Medical Center, 508 Fulton Street, 111A, Durham, NC 27705, USA
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Sato T, Irie T, Yamane M. Transradial retrieval of unintentionally extracted stent deployed 8 months prior during percutaneous coronary intervention to the stent-jailed side branch. Cardiovasc Interv Ther 2017; 32:181-5. [PMID: 26968171 DOI: 10.1007/s12928-016-0389-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 03/01/2016] [Indexed: 10/22/2022]
Abstract
We experienced a case in which a previously deployed stent was extracted during a percutaneous coronary intervention to the stent-jailed side branch by the transradial approach. The stent was dislodged in the radial artery, was fully expanded, and partially deformed, making it difficult to retrieve via the radial sheath. Using a handmade flared guiding catheter, the expanded deformed stent was successfully retrieved via a 6-Fr radial sheath.
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Patel T, Shah S, Pancholy S. Transradial bilateral common iliac ostial stenting using simultaneous hugging stent (SHS) technique. Cardiovasc Revasc Med 2016; 17:202-5. [PMID: 26804292 DOI: 10.1016/j.carrev.2015.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/02/2015] [Accepted: 12/08/2015] [Indexed: 11/17/2022]
Abstract
Current literature has limited reports of iliac artery interventions performed via transradial approach (TRA). We report four successive cases of bilateral common iliac ostial stenting using simultaneous hugging stent (SHS) technique through bilateral TRA. This technique allows the patient and the operator to exploit the benefits of TRA while treating this complex substrate.
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Affiliation(s)
- Tejas Patel
- Apex Heart Institute, Ahmedabad, India; Department of Cardiology, Sheth V.S. General Hospital and Smt. N.H.L. Municipal Medical College, Ahmedabad-380 006, India.
| | - Sanjay Shah
- Apex Heart Institute, Ahmedabad, India; Department of Cardiology, Sheth V.S. General Hospital and Smt. N.H.L. Municipal Medical College, Ahmedabad-380 006, India
| | - Samir Pancholy
- Department of Cardiology, Wright Center for Graduate Medical Education, The Commonwealth Medical College, Scranton, PA, USA
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Lee HW, Cha KS, Ahn J, Choi JC, Oh JH, Choi JH, Lee HC, Yun E, Jang HY, Choi JH, Hong TJ, Jeong MH, Ahn Y, Chae SC, Kim YJ. Comparison of transradial and transfemoral coronary intervention in octogenarians with acute myocardial infarction. Int J Cardiol 2015; 202:419-24. [PMID: 26433163 DOI: 10.1016/j.ijcard.2015.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 06/21/2015] [Accepted: 09/04/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The transradial (TR) approach for percutaneous coronary intervention (PCI) is challenging and associated with failure in elderly patients. We compared the TR and transfemoral (TF) approaches in patients>80 years with acute myocardial infarction (MI) undergoing PCI. METHODS A total of 1945 (7.2%) octogenarians were enrolled from among 27,129 patients in the Korea Acute Myocardial Infarction Registry. The TR group (n=336, 17.3%) was compared with the TF group (n=1609, 82.7%) in the overall and propensity-matched cohorts with respect to procedural success, complications, in-hospital mortality, and one-year mortality and total major adverse cardiac event (MACE; death, MI, and revascularization) rate. RESULTS In the overall cohort, the TR group had lower incidence of Killip class III or IV compared to the TF group. The disease extent and lesion severity were similar between groups, as was the procedural success rate (97.7% vs. 98.3%); however, in-hospital complications were significantly lower in the TR group (8.1% vs. 20.3%). In-hospital mortality was significantly lower in the TR group than the TF group (3.4% vs. 11.4%), as were the one-year mortality and total MACE (9.8% vs. 18.4% and 13% vs. 21.9%, respectively). These outcomes were consistent in the propensity-matched cohort. The TR approach was found to be a significant predictor of low in-hospital mortality (OR 0.355, 95% CI 0.139-0.907), but not of one-year mortality (OR 0.644, 95% CI 0.334-1.240). CONCLUSIONS In octogenarians with acute MI undergoing PCI, the TR approach was more effective than the TF approach as it had lower complication rate and better clinical outcomes with comparable procedural success.
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Affiliation(s)
- Hye Won Lee
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Kwang Soo Cha
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea; Medical Research Institute, Pusan National University Hospital, Busan, South Korea.
| | - Jinhee Ahn
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Jung Cheon Choi
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Jun-Hyok Oh
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Jung Hyun Choi
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Han Cheol Lee
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Eunyoung Yun
- Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Hye Yoon Jang
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Jong Hyun Choi
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Taek Jong Hong
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Shung Chull Chae
- Department of Cardiology, Kyungpook National University Hospital, Daegu, South Korea
| | - Young Jo Kim
- Department of Cardiology, Yeungnam University Hospital, Daegu, South Korea
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Lee DG, Lee DH, Shim JH, Suh DC. Feasibility of the Transradial or the Transbrachial Approach in Various Neurointerventional Procedures. Neurointervention 2015; 10:74-81. [PMID: 26389010 PMCID: PMC4571557 DOI: 10.5469/neuroint.2015.10.2.74] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 07/06/2015] [Indexed: 11/26/2022] Open
Abstract
Purpose The generally preferred vascular access for neurointerventional procedures is the transfemoral approach (TFA). In complicated cases such as patients with aortic diseases or tortuous vessels, transradial or transbrachial approaches (TRA or TBA) could be good alternatives. The purpose of this study is to review a single medical center experience using the alternative accesses. Materials and Methods We reviewed the medical records of 30 TRA and 10 TBA cases among 2,073 cases treated between January 2010 and July 2013. We reviewed and analyzed the frequency of TRA and TBA, the reason the operator had chosen the TRA or TBA, the category of the procedure, caliber of the sheath, the success rate, and the complications rates. Results The most common reason the non-TFA route was chosen was due to the patient's tortuous vascular system (n=24, 60%). The most common category of intervention was balloon angioplasty and/or stent placement (n=18, 45%). The largest caliber of the introducing sheath was 6 Fr in TRA and 7 Fr in TBA. Procedural success was achieved in 37 cases (success rate: 92.5%), and in three cases it failed. Six patients with complications were reported. Among them, four cases of minor complications (10%) occurred. There was no serious complication directly related to the access problem. Conclusion Both TRA and TBA can be good alternative access routes when TFA is not appropriate in various neurointervential procedures.
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Affiliation(s)
- Dong Geun Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Department of Neurology, Sejong General Hospital, Bucheon, Korea
| | - Deok Hee Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Ho Shim
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Department of Radiology, Ulsan Hospital, Ulsan, Korea
| | - Dae Chul Suh
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ulucan S, Kaya Z, Keser A, Katlandur H, Özdil H, Ateş İ, Ulgen MS. Outcomes of transradial primary percutaneous intervention from a tertiary cardiac centre in Turkey. Int J Clin Exp Med 2015; 8:11404-11411. [PMID: 26379956 PMCID: PMC4565339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 05/31/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The aim was to study transradial approach (TRA) and transfemoral approach (TFA) in terms of feasibility, effectiveness, usefulness, and procedure characteristics in patients having ST-segment elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PCI). Along with the said aim, major adverse cardiovascular events (MACE) at follow-up were also compared. METHODS The present study was conducted on 344 consecutive patients having ST-segment elevation myocardial infarction and qualifying for PCI. Patients were classified into two groups according to radial and femoral approaches. Patients were followed-up for MACE. RESULTS PCI was found to be successful in all patients. In TRA group the time between the end of the intervention to removal of the sheath, and duration of mobilization and hospitalization were significantly shorter when compared to TFA group (12 ± 2 minutes vs. 240 ± 12 minutes; P = 0.001, 13 ± 2 hours vs. 22 ± 2 hours; P = 0.001, and 96 ± 45 hours vs. 125 ± 55 hours; P = 0.001, respectively). In TRA group, two patients had hematomas greater than 2 cm while fourteen patients in TFA group had hematomas greater than 5 cm (1% vs. 8%; P = 0.002). TRA group had lower in-hospital MACE rates (5% vs. 11%; P = 0.036). The long terms MACE rates of the groups were similar (23% vs. 22%; P = 0.888). CONCLUSIONS In patients with STEMI, PCI via TRA had the same effectiveness as TFA. Moreover, Time to ambulation and rates of bleeding complications were reduced by TRA, which allowed early rehabilitation. TRA reduced the incidence of in-hospital MACEs.
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Affiliation(s)
- Seref Ulucan
- Department of Cardiology, Mevlana University, School of MedicineKonya, Turkey
| | - Zeynettin Kaya
- Department of Cardiology, Mevlana University, School of MedicineKonya, Turkey
| | - Ahmet Keser
- Department of Cardiology, Mevlana University, School of MedicineKonya, Turkey
| | - Hüseyin Katlandur
- Department of Cardiology, Mevlana University, School of MedicineKonya, Turkey
| | - Hüseyin Özdil
- Department of Cardiology, Mevlana University, School of MedicineKonya, Turkey
| | - İsmail Ateş
- Department of Cardiology, Kazakh National University of S. D. AsfendiyarovAlmaty, Kazakhstan
| | - Mehmet S Ulgen
- Department of Cardiology, Mevlana University, School of MedicineKonya, Turkey
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Perez AB, Rimac G, Plourde G, Poirier Y, Costerousse O, Bertrand OF. The Transradial Approach and Antithrombotic Therapy: Rationale and Outcomes. Interv Cardiol Clin 2015; 4:213-223. [PMID: 28582052 DOI: 10.1016/j.iccl.2015.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article reviews antithrombotic strategies for percutaneous coronary interventions according to the access site and the current evidence with the aim of limiting ischemic complications and preventing radial artery occlusion (RAO). Prevention of RAO should be part of the quality control of any radial program. The incidence of RAO postcatheterization and interventions should be determined initially using the echo-duplex and then frequently assessed using the more cost-effective pulse oximetry technique. Any evidence of higher risk of RAO should prompt internal analysis and multidisciplinary mechanisms to be put in place.
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Affiliation(s)
- Alberto Barria Perez
- Quebec Heart-Lung Institute, 2725, Chemin Sainte Foy, Quebec City, Quebec G1V 4G5, Canada
| | - Goran Rimac
- Quebec Heart-Lung Institute, 2725, Chemin Sainte Foy, Quebec City, Quebec G1V 4G5, Canada
| | - Guillaume Plourde
- Quebec Heart-Lung Institute, 2725, Chemin Sainte Foy, Quebec City, Quebec G1V 4G5, Canada
| | - Yann Poirier
- Quebec Heart-Lung Institute, 2725, Chemin Sainte Foy, Quebec City, Quebec G1V 4G5, Canada
| | - Olivier Costerousse
- Quebec Heart-Lung Institute, 2725, Chemin Sainte Foy, Quebec City, Quebec G1V 4G5, Canada
| | - Olivier F Bertrand
- Quebec Heart-Lung Institute, 2725, Chemin Sainte Foy, Quebec City, Quebec G1V 4G5, Canada.
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Patel TM, Shah S, Pancholy SB. Strategies to Traverse the Arm and Chest Vasculature. Interv Cardiol Clin 2015; 4:127-144. [PMID: 28582045 DOI: 10.1016/j.iccl.2015.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article discusses different methods of working through arm and chest vasculature to increase the success rate of the transradial approach (TRA). Despite lower rates of bleeding and vascular complications as compared with the transfemoral approach, adoption of the TRA has been slow, particularly because of higher failure rates. Anatomic complexities of arm and chest vasculature play an important role in cases of TRA failure. Using a simple framework to classify the anatomic or functional problem and approaching these challenges in a logical sequence should facilitate management and increase the success rate for TRA.
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Affiliation(s)
- Tejas M Patel
- Apex Heart Institute, S. G. Road, Ahmedabad 380 054, India; Department of Cardiology, Sheth V.S. General Hospital, Smt. N.H.L. Municipal Medical College, Ellisbridge, Ahmedabad 380 006, India.
| | - Sanjay Shah
- Apex Heart Institute, S. G. Road, Ahmedabad 380 054, India; Department of Cardiology, Sheth V.S. General Hospital, Smt. N.H.L. Municipal Medical College, Ellisbridge, Ahmedabad 380 006, India
| | - Samir B Pancholy
- Department of Cardiology, The Wright Center for Graduate Medical Education, The Commonwealth Medical College, 501 Madison Avenue, Scranton, PA 18510, USA
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Abstract
Despite advances in antithrombotic and antiplatelet therapy, bleeding complications remain an important cause of morbidity and mortality in patients with acute ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Many bleeding events are related to the access site. Transradial access (TRA) PPCI is associated with significant reduction in bleeding and vascular complications and reduced cardiac mortality compared with the transfemoral approach (TFA). High-risk patients might particularly benefit from TRA. Radial skills providing procedural times and success rates comparable with those of the TFA are strongly recommended before using this technique in the STEMI PPCI setting.
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Affiliation(s)
- Sasko Kedev
- Medical Faculty, University Clinic of Cardiology, University of St. Cyril & Methodius, Vodnjanska 17, Skopje 1000, Macedonia.
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Chen HC, Lee WC, Hsueh SK, Cheng CI, Chen CJ, Yang CH, Fang CY, Hang CL, Yip HK, Wu CJ, Fang HY. Transradial percutaneous coronary intervention for chronic total occlusion of coronary artery disease using sheathless standard guiding catheters. Int J Cardiol Heart Vasc 2014; 6:35-41. [PMID: 28785624 PMCID: PMC5497147 DOI: 10.1016/j.ijcha.2014.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/02/2014] [Accepted: 12/20/2014] [Indexed: 11/30/2022]
Abstract
Objectives Our aim was to evaluate the feasibility and safety of routine transradial approach (TRA) percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions using the sheathless technique with standard guiding catheters. Background Transradial approach PCI was applied for CTO lesions. A major limitation of TRA CTO PCI is the inability to use large guiding catheters because of the relatively small size of the radial artery. Therefore, the sheathless technique for TRA PCI has been recently developed. However, reports on TRA CTO PCI using the sheathless technique are still lacking. Methods Sixty-eight patients with CTO lesions were enrolled for TRA PCI using the sheathless technique with standard guiding catheters. The baseline characteristics, coronary angiographic characteristics and major procedure or access site related complications were compared between procedure success and procedure failure group to determine the predictors of success in sheathless CTO PCI. In-hospital and 30-day clinical outcomes were also evaluated in this study. Routine assessments of radial artery occlusion via Doppler ultrasound and pulse oximeter were recorded during one-year clinical follow-up. Results The mean duration of CTO by history was 31.8 ± 42.3 months. The 7 Fr standard guiding catheter was used with the sheathless technique in 91.2%, and bilateral sheathless approach in 42.6% of the study patients. The procedure-related complications included coronary perforation needing covered stent deployment (2.9%), cardiac tamponade (2.9%), collateral perforation needing coil deployment (4.4%), and contrast induced nephropathy (2.9%). Only 2 patients (2.9%) experienced forearm ecchymosis at the radial artery access sites. In-hospital mortality and 30-day all-cause mortality were 2.9%, and 30-day MACEs were 1.5%. The rate of radial artery occlusion during one-year clinical follow-up was only 3.0%. Conclusions It is feasible and safe to routinely use the sheathless technique with standard guiding catheters for TRA CTO PCI, with a low incidence of procedure-related complications and long-term radial artery occlusion.
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Affiliation(s)
- Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Shu-Kai Hsueh
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Cheng-I Cheng
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chien-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chi-Ling Hang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan, Republic of China
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Hernández-Pérez FJ, Blasco-Lobo A, Goicolea L, Muñiz-Lozano A, Fernandez-Díaz JA, Domínguez JR, Goicolea-Ruigómez J. Use of the radial approach in primary angioplasty: results in 1029 consecutive patients and analyses in unfavorable subgroups. ACTA ACUST UNITED AC 2014; 67:45-51. [PMID: 24774263 DOI: 10.1016/j.rec.2013.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 06/19/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES The transradial approach is associated with a reduction in vascular access-related complications after primary percutaneous coronary interventions. The purpose of this study was to examine the feasibility of the routine use of transradial access in primary angioplasty and to evaluate how it affects subgroups with less favorable characteristics. METHODS We analyzed 1029 consecutive patients with an ST-segment elevation acute coronary syndrome treated with primary angioplasty. RESULTS Transradial access was the primary approach in 93.1% of the patients. The success rate of primary angioplasty was 95.9%, and 87.6% of the patients were event-free 30 days after the procedure. Crossover was required in 3.0% of the patients with primary transradial access, and this rate remained stable over the years. Predictors of the need for crossover were age older than 75 years (odds ratio=2.50, 95% confidence interval, 1.09-5.71; P=.03) and a history of ischemic heart disease (odds ratio=2.65; 95% confidence interval, 1.12-6.24; P=.02). Primary transfemoral access use was higher in women older than 75 years. Use of the transradial approach in this subgroup did not affect reperfusion time or the success of angioplasty, although there was a greater need for crossover (10.9% vs 2.6%; P=.006). Among patients in cardiogenic shock, the transradial approach was used in 51.5%; reperfusion times and angioplasty success rates were similar to those obtained with transfemoral access, but there was a greater need for crossover. CONCLUSIONS Transradial access can be used safely and effectively in most primary angioplasty procedures. In older women and in patients in cardiogenic shock, there is a higher crossover requirement, with no detriment to reperfusion time.
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Affiliation(s)
- Francisco J Hernández-Pérez
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Ana Blasco-Lobo
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Leire Goicolea
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Ana Muñiz-Lozano
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - José A Fernandez-Díaz
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - José R Domínguez
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Javier Goicolea-Ruigómez
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Komócsi A, Tornyos A, Kehl D, Aradi D, Vorobcsuk A. Mortality after transradial approach in ST-segment elevation myocardial infarction. Do we see the forest for the trees? Int J Cardiol 2013; 168:3050-3. [PMID: 23664700 DOI: 10.1016/j.ijcard.2013.04.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 04/06/2013] [Indexed: 11/23/2022]
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49
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Abstract
Despite advances in antithrombotic and antiplatelet therapy, bleeding complications remain an important cause of morbidity and mortality in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). A significant proportion of such bleedings are related to the access site, and adoption of transradial access (TRA) may reduce these complications. In patients with ST-segment elevation myocardial infarction (STEMI), TRA reduced cardiac mortality in comparison with the femoral approach (TFA). High-risk patients such as women, obese patients and elderly subjects who are at increased risk for vascular complications and bleeding, might particularly benefit from the TRA. However, specific radial expertise providing procedural time and a success rate comparable to those with the TFA are strongly recommended before using this technique in the emergency setting.
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Affiliation(s)
- Sasko Kedev
- Professor of Medicine, University Clinic of Cardiology, Medical Faculty, University of St Cyril and Methodius, Skopje, Macedonia
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Tuncez A, Kaya Z, Aras D, Yıldız A, Gül EE, Tekinalp M, Karakaş MF, Kısacık HL. Incidence and predictors of radial artery occlusion associated transradial catheterization. Int J Med Sci 2013; 10:1715-9. [PMID: 24151442 PMCID: PMC3804796 DOI: 10.7150/ijms.7087] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 08/21/2013] [Indexed: 11/16/2022] Open
Abstract
In this study, we sought to assess the incidence and predictors of radial artery occlusion (RAO), which is a significant complication of transradial cardiac catheterization. We prospectively evaluated the results of 106 patients who underwent coronary angiography and percutaneous coronary intervention (PCI) via the transradial approach (TRA). At the 3(rd) h of intervention, the radial artery was checked by palpation; color doppler ultrasonography was performed at the 24(th) h. Fluoroscopy duration, procedure success, and complications of the radial artery were recorded. The procedure was successfully completed in all patients. RAO was detected in eight female and two male patients. In terms of RAO, there was a statistically significant difference between males and females (p=0.019). Other parameters did not show a significant correlation with RAO. Altough did not have any effect on procedural success, eight patients developed transient radial artery spasm. Gender was not associated with radial arterial spasms (p=0.19). TRA in the diagnosis and treatment of coronary artery disease has shown high procedural success and low complication rates; it addition, it presents a low economic burden. It should be used widely and be involved in the routine cardiology residency program.
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Affiliation(s)
- Abdullah Tuncez
- 1. Division of Cardiology, Konya Numune State Hospital, Konya
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