Distal versus conventional transradial access for coronary angiography and intervention: a systematic review and meta-analysis

Introduction

Distal transradial artery access (DTRA) has recently gained attention due to potential benefits in terms of local complications and risk of superficial palmar arch ischemia in case of radial artery occlusion.

Purpose

In this meta-analysis, we aimed to evaluate the utility of DTRA compared to conventional transradial artery access (CTRA) for coronary angiography and intervention.

Method

We performed a comprehensive literature search using multiple databases from inception through February 2021 for all the studies that evaluated the efficacy and safety of DTRA for coronary angiography and intervention. The primary outcome of interest was access success rate. The secondary outcomes were periprocedural local complications (site hematoma, radial artery occlusion or spasm) and procedural characteristics (cannulation, fluoroscopy, and radial artery compression times). All meta-analyses were conducted using a random-effect model.

Results

A total of 8 studies including 1630 patients (805 underwent DTRA vs. 825 with CTRA), were included in the final analysis. Three of the included studies were randomized controlled trials (RCTs), and the remainder were observational studies. The access success rate was similar in the two groups (odds ratio (OR): 0.61; 95% confidence interval (CI): 0.18–2.09; P=0.43; I2=72%). Similarly, no difference was observed in the overall periprocedural local complications rate (OR 0.63, 95% CI 0.38–1.04, P=0.07, I2=25%). On subgroup analysis, the rate of radial artery occlusion was significantly lower in DRTA group (OR 0.33, 95% CI 0.13–0.82, P=0.02, I2=0%). Regarding the procedural characteristics, the two approaches were different only in the cannulation time favoring the CTRA group (mean difference in minutes [MD] 0.96, 95% CI 0.16–1.76; P=0.02).

Conclusions

The DTRA represents an alternative site for radial artery access for coronary angiography and interventions, with a high success rate accompanied by a low risk of complications. Although the cannulation time was longer for the DTRA, this can potentially improve with training, practice, and utilization of ultrasound-guided punctures. The major advantage provided by the DTRA is the trend toward a lower risk of radial artery occlusion, which is frequently observed with the conventional approach. Further adequately powered RCTs are needed to confirm the safety and efficacy of this approach.

Funding Acknowledgement

Type of funding sources: None. Central illustration

[Quality of care of acute ischemic stroke in Germany 2018]

In this overview the current quality of acute in-hospital care of stroke patients in Germany in 2018 is described based on standardized and evidence-based quality indicators. For this purpose the reports of the regional quality assurance projects for stroke care, which collaborated within the German-speaking Stroke Registers Study Group (ADSR) were analyzed. Overall, more than 280,000 acute admissions of stroke patients were documented in the included quality assurance projects. The results regarding the defined 16 quality indicators comprising diagnostics, acute treatment, rehabilitation and secondary prevention showed a high level of acute inpatient treatment of stroke in Germany. Only a few quality indicators, such as early transfer for thrombectomy indicated a great necessity for process optimization.

[Reasons for proximal femoral fracture surgery delays : Analysis of the structured dialog in Rheinland-Pfalz]

BACKGROUND

For the "preoperative stay" quality indicator , which is part of the external quality assurance for proximal femoral fractures (module 17/1), a tolerance range for surgery within 48 h after admission of ≤15 % is given.

MATERIALS AND METHODS

The structured dialog (2014) in Rheinland-Pfalz was analyzed with respect to reasons for delaying surgery for more than 48 h after admission.

RESULTS

A total of 331 cases were analyzed. In 60.7 % patient-related reasons and in 13.3 % administrative reasons were found. In 9.1 % the statements were not feasible. Due to a lack of software-related specifications in 7.3 % a wrong preoperative length of stay was generated. Wrong coding or a computer-related problem was found in 6.6 %. The most common reason for delay was the intake of an anticoagulant (25.7 %).

CONCLUSION

The significance of the quality indicator "Preoperative stay" without division into whether this was administrative or patient-related must be considered critically.

Identification and first characterization of SmEps8, a potential interaction partner of SmTK3 and SER transcribed in the gonads of Schistosoma mansoni

In eukaryotes the roles of protein kinases (PKs) regulating important biological processes such as growth and differentiation are well known. Molecular, biochemical, and physiological analyses trying to unravel principles of schistosome development have substantiated the importance for PKs also in this parasite. Amongst others the role of SmTK3 was studied, one of the first cellular PKs characterized from Schistosoma mansoni. Its function was demonstrated in mitogenic and differentiation processes in the gonads. Furthermore, first insights were obtained for the downstream part of a signal transduction cascade SmTK3 is involved in, which includes the diaphanous homolog SmDia. Here we attempted to further unravel the SmTK3 signaling cascade by searching for upstream interaction partners. Using yeast three-hybrid (Y3H) analyses we detected the epidermal growth factor receptor (EGFR) pathway substrate 8 of S. mansoni (SmEps8) as the most interesting candidate. By detailed interaction analyses we showed a contribution of the Src homology (SH) domains SH2 and SH3 of SmTK3 to binding, with a clear bias towards SH2. Compared to full-length SmEps8, binding was enhanced when only its 5' part including the phosphotyrosine binding domain (PTB) was used for interaction analyses including the SH2 domain of SmTK3, although phosphorylation seemed not to play a decisive role for binding. RT-PCR analyses and in situ hybridization experiments demonstrated similar transcription patterns of SmTK3 and SmEPS8, which co-localize in the reproductive organs. Furthermore, first evidence was obtained for SmEps8 interaction and colocalization with SER, one of the epidermal growth factor receptor (EGFR) homologs detected in S. mansoni. The results of this study provide first evidence for a SER-SmEps8-SmTK3-SmDia signal transduction pathway controlling differentiation processes in the gonads of S. mansoni.

Crystallization and preliminary X-ray diffraction studies of the glutathione S-transferase from Plasmodium falciparum

Glutathione S-transferases (GSTs) belong to a family of detoxification enzymes that conjugate glutathione to various xenobiotics, thus facilitating their expulsion from the cells. For high-resolution crystallographic investigations, GST from the human malarial parasite Plasmodium falciparum was overexpressed in bacterial cells and crystallized using hanging-drop vapour diffusion. X-ray intensity data to 2.8 A resolution were collected from an orthorhombic crystal form with unit-cell parameters a = 62.2, b = 88.3, c = 75.3 A. A search for heavy-atom derivatives has been initiated, along with phase-determination efforts by molecular replacement.

[Diameter of coronary arteries before and after bypass grafting (author's transl)]

Patients with patent coronary bypass grafts showed the followings: 1. a decrease in prestenotic coronary diameter due to a reduction in flow. 2. An increase of the poststenotic segment of the bypassed vessel due to an increase in flow via the venous graft. 3. An increase of the bypassed stenosis, mainly due to a general decrease of vessel diameter proximal to the stenosis. 4. No change in diameter in non bypassed arteries. The postoperative changes in diameter were not dependent on the time elapsed since surgery and were independent from the severity of coronary sclerosis and the number of risk factors. A correlation was found between the amount of the diameter changes and the amount of reduction in exercise induced ST-segment depression. The decrease in coronary diameter proximal to the stenosis is not due to progression of coronary sclerosis but to a functional change. A narrow poststenotic vessel does not constitute a contraindication for bypass grafting because its true diameter is flow dependent and cannot be judged with certainty from the preoperative angiogram.