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Rana N, Vijayvergiya R, Kasinadhuni G, Khanal S, Panda P. Comparison of radial versus femoral access using hemostatic devices following percutaneous coronary intervention. Indian Heart J 2021; 73:382-4. [PMID: 34154763 DOI: 10.1016/j.ihj.2021.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/10/2021] [Accepted: 04/19/2021] [Indexed: 11/24/2022] Open
Abstract
Arterial access site complications are the important predictor of successful percutaneous coronary interventions (PCI). We prospectively studied 722 consecutive PCI patients for access site complications. A total of 303 trans-femoral access (TFA) patients who had suture based vascular closure devices (VCD) were compared with 419 transradial access (TRA) patients. Incidence of hematoma was more in TFA (2.3% vs 0.23%, p 0.01). Median ambulation time (4 h vs 1 h, p < 0.01) was significantly higher in TFA. In conclusion, TRA had fewer access site complications like haematoma, compared to TFA with VCD. TRA also resulted in earlier ambulation and discharge, compared to TFA with VCD.
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Chugh Y, Bavishi C, Mojadidi MK, Elgendy IY, Faillace RT, Brilakis ES, Tamis‐Holland J, Mamas M, Chugh SK. Safety of transradial access compared to transfemoral access with hemostatic devices (vessel plugs and suture devices) after percutaneous coronary interventions: A systematic review and
meta‐analysis. Catheter Cardiovasc Interv 2020; 96:285-295. [DOI: 10.1002/ccd.29061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/28/2020] [Accepted: 05/24/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Yashasvi Chugh
- Mount Sinai St Luke's Roosevelt Hospital New York New York
| | - Chirag Bavishi
- Rhode Island Hospital Warren Alpert Medical School of Brown University Providence Rhode Island
| | | | - Islam Y. Elgendy
- Massachusetts General Hospital and Harvard Medical School Boston Massachusetts
| | - Robert T. Faillace
- Jacobi Medical Center/Albert Einstein College of Medicine New York New York
| | - Emmanouil S. Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Minneapolis Minnesota
| | | | - Mamas Mamas
- Keele Cardiovascular Research Group Centre for Prognosis Research, Keele University United Kingdom
| | - Sanjay Kumar Chugh
- Jaipur National University Hospital and Medical College Institute for Medical Sciences and Research Center Jaipur India
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Steffenino G, Dutto S, Conte L, Dutto M, Lice G, Tomatis M, Cavallo S, Cavallo S, Dellavalle A, Baralis G, LaScala E. Vascular Access Complications after Cardiac Catheterisation: A Nurse-Led Quality Assurance Program. Eur J Cardiovasc Nurs 2016; 5:31-6. [PMID: 15993648 DOI: 10.1016/j.ejcnurse.2005.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2004] [Revised: 05/17/2005] [Accepted: 06/02/2005] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vascular access complications may be a cause of discomfort, prolonged hospital stay, and impaired outcomes in patients undergoing cardiac catheterisation. AIMS To assess vascular access complication in our patients with/without the use of closure devices as a first local benchmark for subsequent quality improvement. METHODS A nurse-led single-centre prospective survey of all vascular access complications in consecutive patients submitted to cardiac catheterisation during 4 months. RESULTS The radial and femoral access were used in 78 (14%) and 470 (83%), respectively, of 564 procedures, and a closure device was used in 136 of the latter. A haematoma (any size) was isolated and uneventful in 9.6% of cases. More severe complications (haemoglobin loss >2 g, need for blood transfusion or vascular repair) occurred in 1.2% of cases, namely: in none of the procedures with radial access, and in 0.4% and 2.4% of femoral diagnostic and interventional coronary procedures, respectively. During complicated (n=40) vs uncomplicated (n=172) transfemoral interventions, the activated coagulation time was 309+/-83 vs 271+/-71 s (p=0.004), but the use of closure devices was similar. CONCLUSION Severe vascular access complications in our patients were fewer than in most reports, and virtually absent in radial procedures. Vigorous anticoagulation was associated with increased complications in our patients, but closure devices were not. A new policy including both the use of the radial access whenever possible, and a less aggressive anticoagulation regimen during transfemoral interventions will be tested.
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Affiliation(s)
- Giuseppe Steffenino
- Cardiac Catheterisation Unit, Cardiovascular Department, Ospedale S.Croce, Cuneo, Italy.
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Gao F, Lo WJ, Sun X, Ma N, Mo D, Xu X, Miao Z. Selective use of transradial access for endovascular treatment of severe intracranial vertebrobasilar artery stenosis. Clin Neurol Neurosurg 2015; 134:116-21. [DOI: 10.1016/j.clineuro.2015.04.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/24/2015] [Accepted: 04/22/2015] [Indexed: 11/24/2022]
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Jinnouchi H, Sakakura K, Wada H, Kubo N, Sugawara Y, Nakamura T, Funayama H, Ako J, Momomura SI. Transradial percutaneous coronary intervention for acute myocardial infarction reduces CCU stay in patients 80 or older. Int Heart J 2012; 53:79-84. [PMID: 22688310 DOI: 10.1536/ihj.53.79] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Transradial percutaneous coronary intervention (PCI), which is less invasive than transfemoral PCI, may facilitate early rehabilitation of patients with acute myocardial infarction (AMI). The aim of our study was to investigate whether transradial PCI is associated with a shorter coronary care unit (CCU) stay in very elderly AMI patients (≥ 80 years old). We enrolled 116 AMI patients aged ≥ 80 years. There were 39 patients in the transradial group and 77 patients in the non-transradial group. The length of CCU stay, the length of hospital stay, in-hospital mortality, the day of the monitored sitting and standing test, and the occurrence of delirium were compared between the two groups. The duration of CCU stay in the transradial and non-transradial groups was 3.6 ± 1.5 days and 5.0 ± 3.2 days, respectively (P = 0.001). The duration of hospital stay in the transradial and non-transradial groups was 13.3 ± 7.4 days and 19.2 ± 11.1 days, respectively (P = 0.001). In-hospital mortality was not different between the two groups (7.7% versus 2.6%, P = 0.20). The day of the monitored standing test in the transradial and non-transradial groups was 3.2 ± 0.7 and 4.6 ± 2.3, respectively (P < 0.0001). Multivariate logistic regression analysis identified a transradial approach as an independent predictor of short (≤ 3 days) CCU stay (OR: 3.01, 95%CI: 1.16-7.83, P = 0.02). In conclusion, transradial PCI was associated with a shorter CCU stay in AMI patients ≥ 80 years old. Furthermore, transradial PCI facilitated early rehabilitation in this high risk population.
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Affiliation(s)
- Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Department of Integrated Medicine I, Jichi Medical University, Saitama Medical Center, Japan
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Bertrand OF, Bélisle P, Joyal D, Costerousse O, Rao SV, Jolly SS, Meerkin D, Joseph L. Comparison of transradial and femoral approaches for percutaneous coronary interventions: a systematic review and hierarchical Bayesian meta-analysis. Am Heart J 2012; 163:632-48. [PMID: 22520530 DOI: 10.1016/j.ahj.2012.01.015] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 01/18/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite lower risks of access site-related complications with transradial approach (TRA), its clinical benefit for percutaneous coronary intervention (PCI) is uncertain. We conducted a systematic review and meta-analysis of clinical studies comparing TRA and transfemoral approach (TFA) for PCI. METHODS Randomized trials and observational studies (1993-2011) comparing TRA with TFA for PCI with reports of ischemic and bleeding outcomes were included. Crude and adjusted (for age and sex) odds ratios (OR) were estimated by a hierarchical Bayesian random-effects model with prespecified stratification for observational and randomized designs. The primary outcomes were rates of death, combined incidence of death or myocardial infarction, bleeding, and transfusions, early (≤ 30 days) and late after PCI. RESULTS We collected data from 76 studies (15 randomized, 61 observational) involving a total of 761,919 patients. Compared with TFA, TRA was associated with a 78% reduction in bleeding (OR 0.22, 95% credible interval [CrI] 0.16-0.29) and 80% in transfusions (OR 0.20, 95% CrI 0.11-0.32). These findings were consistent in both randomized and observational studies. Early after PCI, there was a 44% reduction of mortality with TRA (OR 0.56, 95% CrI 0.45-0.67), although the effect was mainly due to observational studies (OR 0.52, 95% CrI 0.40-0.63, adjusted OR 0.49 [95% CrI 0.37-0.60]), with an OR of 0.80 (95% CrI 0.49-1.23) in randomized trials. CONCLUSION Our results combining observational and randomized studies show that PCI performed by TRA is associated with substantially less risks of bleeding and transfusions compared with TFA. Benefit on the incidence of death or combined death or myocardial infarction is found in observational studies but remains inconclusive in randomized trials.
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Fech JC, Welsh R, Hegadoren K, Norris CM. Caring for the radial artery post-angiogram: a pilot study on a comparison of three methods of compression. Eur J Cardiovasc Nurs 2012; 11:44-50. [DOI: 10.1177/1474515111429656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Colleen M Norris
- University of Alberta, Canada
- Mazankowski Alberta Heart Institute, Canada
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Achenbach S, Ropers D, Kallert L, Turan N, Krähner R, Wolf T, Garlichs C, Flachskampf F, Daniel WG, Ludwig J. Transradial versus transfemoral approach for coronary angiography and intervention in patients above 75 years of age. Catheter Cardiovasc Interv 2009; 72:629-35. [PMID: 18798237 DOI: 10.1002/ccd.21696] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS The transradial (TR) approach has potentially lower complication rates than transfemoral (TF) approach coronary angiography. However, it may be technically more challenging, especially in elderly patients with alterations in vascular anatomy. We thus determined success rates, procedural data, and complication rates of TR angiography in comparison to the TF approach in elderly patients in a randomized, prospective trial. METHODS AND RESULTS Four hundred consecutive patients >or=75 years with known or suspected coronary artery disease were included in the study. After exclusion of 93 patients with contraindications to the radial approach, 152 patients were randomized to the TR and 155 to TF coronary angiography and intervention. In 13 patients randomized to TR, cross-over to TF was necessary (9%). Total examination time was significantly longer for the TR approach (18.1 vs. 15.0 min, P = 0.009), but no difference was found for fluoroscopy time, number of catheters used, or amount of contrast agent. The rate of major complications (bleeding requiring surgery or transfusion, stroke) was 0% for TR and 3.2% for TF approach (P < 0.001). Minor complications occurred in 1.3% versus 5.8% of patients (P < 0.001). CONCLUSION In elderly patients, TR coronary angiography and intervention has a high technical success rate and lower complication rates than the TF approach.
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Affiliation(s)
- Stephan Achenbach
- Department of Cardiology, University of Erlangen-Nürnberg, Erlangen, Germany
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Jabara R, Gadesam R, Pendyala L, Chronos N, Crisco LV, King SB, Chen JP. Ambulatory discharge after transradial coronary intervention: Preliminary US single-center experience (Same-day TransRadial Intervention and Discharge Evaluation, the STRIDE Study). Am Heart J 2008; 156:1141-6. [PMID: 19033010 DOI: 10.1016/j.ahj.2008.07.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 07/19/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although the safety and cost-effectiveness of same-day discharge after uncomplicated transradial percutaneous coronary intervention (TR-PCI) is well established in Europe and Asia, such data are not available for US patients. METHODS All patients who underwent TR-PCI at our high-volume US medical center between 2004 and 2007 were included in this study. The primary end point was in-hospital adverse clinical outcomes between 6 and 24 hours postprocedure. RESULTS A total of 450 patients were included in this study (aged 59 +/- 11 years). Of these, 13% were female, 27% were diabetic, 6% had peripheral vascular disease, and 5% had chronic kidney disease. Procedural indications included stable angina (49%), unstable angina (31%), non-ST elevation myocardial infarction (NSTEMI) (17%), and ST elevation myocardial infarction (STEMI) (3%). All patients received an intra-arterial cocktail of heparin, verapamil, and nitroglycerin, and 13% of patients received glycoprotein IIb/IIIa inhibitors. Seven percent of patients had 3-vessel disease, 3% had bypass grafts stenoses, and 20% had class B(2)/C lesions. Procedural success rate was 96%. A total of 24 (5.3%) postprocedural complications were observed; however, none occurred between hours 6 to 24, the time differential between same-day and next-day discharge. Thirteen patients (2.9%) experienced significant complications within the first 6 hours (MI, urgent repeat revascularization, and ventricular tachycardia). Eleven (2.4%) spontaneously resolved minor access complications developed. There were 12 same-day discharges according to the operators' discretion; none required readmission. CONCLUSIONS Although a low incidence of complications did occur, none would have been impacted by same-day discharge. Those observed before 6 hours would have prevented early discharge, and those occurring after 24 hours would have been unaffected by routine next-day discharge. This observational study demonstrated the safety and feasibility for a prospective evaluation of ambulatory TR-PCI in an American practice setting.
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Cao Z, Zhou Y, Zhao Y, Liu Y, Shi D, Guo Y, Cheng W, Nie B, Wang J. Transradial approach for coronary angioplasty in Chinese elderly patients: . Chin Med J (Engl) 2008; 121:1126-9. [DOI: 10.1097/00029330-200806020-00017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
The choice of a transradial or transfemoral approach remains a pivotal decision in percutaneous coronary angioplasty. We discuss here the varying criteria leading to a rational choice in the arterial access choice. Since the emergent transradial approach in France has led to a dramatic reduction in local vascular complications, we also discuss the remaining place of femoral approach and the usefulness of femoral percutaneous closure devices.
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Affiliation(s)
- J Monsegu
- Service de cardiologie, hôpital du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris cedex 05, France
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Li AH, Yeih DF, Chen KC, Chu SH, Weng CS. The thicker the skin fold, the less hematoma development: a novel parameter other than body mass index associated with transradial vascular complication. Angiology 2007; 58:597-602. [PMID: 18024944 DOI: 10.1177/0003319707303445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It was reported recently that body mass index (BMI) is a prognostic factor of vascular complications after radial puncture, and that extremely thin patients are at higher risk than obese subjects. However, the underlining mechanism of this phenomenon has rarely been studied. Therefore, we conducted a survey measuring a novel parameter, the skin fold thickness, and other potential risk factors in our patients developing postprocedure hematoma. In 1176 consecutive patients undergoing percutaneous radial catheterization, 18 (1.53%) developed hematoma afterward. When a patient with hematoma had been identified, the next patient having no hematoma after radial puncture was enrolled into the control group, which thus turned out to have 18 patients. In addition, we also compared the BMI, skin fold thickness, and other potential risk factors, including heparin dosage and antiplatelet medication, between these 2 groups. We found hematoma patients to be older (69.5 +/- 10.3 years vs 61.50 +/- 11.7 years, P = .037), to have more cases of coronary intervention (10/18 vs 4/18, P = .04), to have lower BMI (23.63 +/- 4.03 vs 27.25 +/- 4.38, P = .014), and to have thinner skin folds of forearm (5.94 +/- 4.56 vs 9.27 +/- 3.06 mm, P = .015), deltoid area (14.61 +/- 9.00 vs 19.73 +/- 7.15 mm, P = .042), and waist (21.94 +/- 9.90 vs 29.00 +/- 8.46 mm, P = .028) than the nonhematoma group. On the contrary, no statistical difference in heparin dosage or other factors was noted between the 2 groups. We conclude that the vascular complication rate after radial catheterization is higher in elderly patients with lower BMI, body weight, or thinner skin folds.
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Affiliation(s)
- Ai-Hsien Li
- Cardiovascular Center, Far-Eastern Memorial Hospital, Taipei, Taiwan
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Rossi ML, Zavalloni D, Scatturin M, Gasparini GL, Lisignoli V, Presbitero P. Immediate removal of femoral-sheath following protamine administration in patients undergoing intracoronary paclitaxel-eluting-stent implantation. Expert Opin Pharmacother 2007; 8:2017-24. [PMID: 17714056 DOI: 10.1517/14656566.8.13.2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Immediate sheath-removal using post-procedural reversal of heparin with protamine reduces groin complications, shortens bed rest and hospital stay after percutaneous coronary intervention (PCI) with bare-metal stents. No data are available with newer and possibly more thrombogenic paclitaxel-eluting stents (PES). AIM We assessed the safety and efficacy of post-procedural protamine administration after successful coronary PES implantation in elective PCI and in patients with acute coronary syndromes (ACS). METHODS A consecutive series of 291 patients received 0.5 mg of protamine per 100 units of heparin whenever the post-procedural ACT was > 180 seconds, followed by immediate removal of the sheath (protamine group). Outcomes were compared to a historic control group comprising 291 consecutive patients, who also underwent PCI with PES, but without reversal of anticoagulation by protamine (non protamine group). The incidence of post-procedural vascular complications and bleeding complications, as well as hospital stay, were compared; as were the incidence of major cardiac events at 24 h, 30 days and 6 months. RESULTS The post-procedural bleeding complications were significantly higher in the non-protamine group. Vascular complications were also more frequent in patients who were not treated with protamine. Hospitalisation length was significantly lower in the protamine group than in the non-protamine group (13.6 +/- 7 h versus 20.41 +/- 3.9 h; p < 0.001). The protamine-group patients also had a significantly reduced bed rest (10.3 h +/- 5.6 h versus 18 h +/- 3.5 h; p < 0.001). During hospitalisation, after PES implantation, no deaths or acute stent thrombosis were observed in either group. The overall incidence of thrombosis and major adverse cardiac events at follow-up were similar in the two groups. CONCLUSIONS Immediate heparin neutralisation by protamine after successful PES implantation appears to be safe and feasible, also in patients with ACS. Use of protamine and early sheath removal after PCI confers early deambulation and may significantly limit healthcare cost, reduce vascular complications, bedrest, delayed discharge and patient discomfort.
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Affiliation(s)
- Marco L Rossi
- Unitá Operativa di Emodinamica e Cardiologia Invasiva, Istituto Clinico Humanitas, Rozzano, Milano, Italy.
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Ansel G, Yakubov S, Neilsen C, Allie D, Stoler R, Hall P, Fail P, Sanborn T, Caputo RP. Safety and efficacy of staple-mediated femoral arteriotomy closure: Results from a randomized multicenter study. Catheter Cardiovasc Interv 2006; 67:546-53. [PMID: 16538688 DOI: 10.1002/ccd.20628] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Mechanical closure of percutaneous femoral arteriotomies following catheter based procedures remains problematic. METHODS The EVS closure device is the first to utilize a staple to effect arteriotomy closure and was compared to manual compression following sheath removal in a 362 patient randomized (2:1 to device) multicenter trial. As pre-specified, one half of the patients underwent coronary intervention. RESULTS Time to hemostasis was significantly reduced in the EVS group for both diagnostic (3.3 +/- 2.6 vs. 19.3 +/- 5.7 minutes; p < 0.001) and interventional procedures (5.5 +/- 5.1 vs. 22.3 +/- 9.9 minutes; p < 0.0001). Time to ambulation was similarly reduced in the EVS group following diagnostic (2.4 +/- 3.3 vs. 6.0 +/- 5.2 hours; p < 0.001) and interventional procedures (3.4 +/- 4.5 vs. 7.6 +/- 7.0 hours; p < 0.001). The incidence of major complications was similar between the EVS and manual compression groups at discharge (0.4% vs. 1.7%; p = NS) and at 30 day follow-up (0.4% vs. 2.5%; p = NS). CONCLUSION Compared to manual compression, the EVS device provides a safe and effective method of femoral artery closure.
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Affiliation(s)
- Gary Ansel
- Section of Cardiology, Riverside Methodist Hosptial, Columbus, Ohio, USA.
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Aptecar E, Pernes JM, Chabane-Chaouch M, Bussy N, Catarino G, Shahmir A, Bougrini K, Dupouy P. Transulnar versus transradial artery approach for coronary angioplasty: The PCVI-CUBA study. Catheter Cardiovasc Interv 2006; 67:711-20. [PMID: 16557601 DOI: 10.1002/ccd.20679] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To compare in terms of efficacy and safety the transulnar to the transradial approach for coronary angiography and angioplasty. BACKGROUND Opposite to the transradial approach, which is now widely used in catheterization laboratories worldwide, the ulnar artery approach is rarely used for cardiac catheterization. METHODS Diagnostic coronarography, followed or not by angioplasty, was performed by transulnar or transradial approach, chosen at random. A positive (normal) direct or reverse Allen's test was required before tempting the radial or the ulnar approach, respectively. MACE were recorded till 1-month follow-up. Doppler ultrasound assessment of the forearm vessels was scheduled for all the angioplastied patients. RESULTS Successful access was obtained in 93.1% of patients in the ulnar group (n = 216), and in 95.5% of patients in the radial group (n = 215), P = NS. One hundred and three and 105 angioplasty procedures were performed in 94 and 95 patients in ulnar and radial group, with success in 95.2% and 96.2% of procedures in ulnar and radial group, respectively (P = NS). Freedom from MACE at 1-month follow-up was observed in 93 patients in both groups (97.8% for ulnar group and 95.8% for radial group), P = NS. Asymptomatic access site artery occlusion occurred in 5.7% of patients after transulnar and in 4.7% of patients after transradial angioplasty. A big forearm hematoma, and a little A-V fistula were observed, each in one patient, in the ulnar group. CONCLUSION The transulnar approach for diagnostic and therapeutic coronary interventions is a safe and effective alternative to the transradial approach, as both techniques share a high success rate and an extremely low incidence of entry site complications. The transulnar approach has the potential to spare injury to the radial artery in anticipation of its use as a coronary bypass conduit.
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Affiliation(s)
- Eduardo Aptecar
- Pôle Cardio-Vasculaire Interventionnel, Clinique Les Fontaines, Melun, France.
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Bendok BR, Przybylo JH, Parkinson R, Hu Y, Awad IA, Batjer HH. Neuroendovascular Interventions for Intracranial Posterior Circulation Disease via the Transradial Approach: Technical Case Report. Neurosurgery 2005; 56:E626. [DOI: 10.1227/01.neu.0000154820.28342.38] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2004] [Accepted: 08/09/2004] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE AND IMPORTANCE:
To describe our experience with the transradial approach for posterior circulation neurointerventional procedures. To the best of our knowledge, this approach has not been described previously for intracranial neuroendovascular procedures.
CLINICAL PRESENTATION:
The clinical and imaging characteristics as well as periprocedural outcomes of patients treated for intracranial posterior circulation disease via the transradial approach were analyzed retrospectively.
INTERVENTION:
Between January 1 and October 21, 2003, four patients with posterior circulation disease (aneurysm, n = 1, and atherosclerotic stenosis, n = 3) were treated via the transradial approach because of tortuous brachiocephalic anatomy. Procedural success was 100%, and there were no procedural complications. No technical difficulties were encountered.
CONCLUSION:
The transradial approach is an alternative to the femoral approach for posterior circulation neuroendovascular intervention. This approach has several advantages over other approaches, and the vasculature can be less tortuous than that encountered during the femoral approach. These factors can result in increased device trackability and procedural ease.
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Affiliation(s)
- Bernard R. Bendok
- Departments of Neurological Surgery and Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Jason H. Przybylo
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Richard Parkinson
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Yin Hu
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Issam A. Awad
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - H Hunt Batjer
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Criado E, Doblas M, Fontcuberta J, Orgaz A, Flores A, Wall LP, Gasparis A, Lopez P, Strachan J, Ricotta J. Transcervical carotid stenting with internal carotid artery flow reversal: Feasibility and preliminary results. J Vasc Surg 2004; 40:476-83. [PMID: 15337876 DOI: 10.1016/j.jvs.2004.06.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Transfemoral carotid artery stenting (CAS), with or without distal protection, is associated with risk for cerebral and peripheral embolism and access site complications. To establish cerebral protection before crossing the carotid lesion and to avert transfemoral access complications, the present study was undertaken to evaluate a transcervical approach for CAS with carotid flow reversal for cerebral protection. METHODS Fifty patients underwent CAS through a transcervical approach. All patients with symptoms had greater than 60% internal carotid artery (ICA) stenosis, and all patients without symptoms had greater than 80% ICA stenosis. Twenty-one patients (42%) had symptomatic disease or ipsilateral stroke, and 8 patients (16%) had contralateral stroke. Four patients (8%) had recurrent stenosis, 7 patients (14%) had contralateral ICA occlusion, and 1 patient (2%) had undergone previous neck radiation. Twenty-seven procedures (54%) were performed with local anesthesia, and 23 (46%) with general anesthesia. Using a cervical cutdown, flow was reversed in the ICA by occluding the common carotid artery and establishing a carotid-jugular vein fistula. Pre-dilation was selective, and 8-mm to 10-mm self-expanding stents were deployed and post-dilated with 5-mm to 6-mm balloons in all cases. RESULTS The procedure was technically successful in all patients, without significant residual stenoses. No strokes or deaths occurred. There was 1 wound complication (2%). All patients were discharged within 2 days of surgery. Mean flow reversal time was 21.4 minutes (range, 9-50 minutes). Carotid flow reversal was not tolerated in 2 patients (4%). Early in the experience, carotid flow reversal was not possible in 1 patient, and there were 1 major and 3 minor common carotid artery dissections, which resolved after stent placement. One intraoperative transient ischemic attack (2%) occurred in 1 patient in whom carotid flow was not reversed, and 1 patient with a contralateral ICA occlusion had a contralateral transient ischemic attack. At 1 to 12 months of follow-up, all patients remained asymptomatic, and all but 1 stent remained patent. CONCLUSION Transcervical CAS with carotid flow reversal is feasible and safe. It can be done with the patient under local anesthesia, averts the complications of the transfemoral approach, and eliminates the increased complexity and cost of cerebral protection devices. Transcervical CAS is feasible when the transfemoral route is impossible or contraindicated, and may be the procedure of choice in a subset of patients in whom carotid stenting is indicated.
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Affiliation(s)
- Enrique Criado
- Division of Vascular Surgery, Stony Brok University Hospital, NY, USA.
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Agostoni P, Biondi-Zoccai GGL, de Benedictis ML, Rigattieri S, Turri M, Anselmi M, Vassanelli C, Zardini P, Louvard Y, Hamon M. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; Systematic overview and meta-analysis of randomized trials. J Am Coll Cardiol 2004; 44:349-56. [PMID: 15261930 DOI: 10.1016/j.jacc.2004.04.034] [Citation(s) in RCA: 691] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2004] [Revised: 03/17/2004] [Accepted: 04/06/2004] [Indexed: 02/08/2023]
Abstract
OBJECTIVES We sought to compare, through a meta-analytic process, the transradial and transfemoral approaches for coronary procedures in terms of clinical and procedural outcomes. BACKGROUND The radial approach has been increasingly used as an alternative to femoral access. Several trials have compared these two approaches, with inconclusive results. METHODS The MEDLINE, CENTRAL, and conference proceedings from major cardiologic associations were searched. Random-effect odds ratios (ORs) for failure of the procedure (crossover to different entry site or impossibility to perform the planned procedure), entry site complications (major hematoma, vascular surgery, or arteriovenous fistula), and major adverse cardiovascular events (MACE), defined as death, myocardial infarction, emergency revascularization, or stroke, were computed. RESULTS Twelve randomized trials (n = 3,224) were included in the analysis. The risk of MACE was similar for the radial versus femoral approach (OR 0.92, 95% confidence interval [CI] 0.57 to 1.48; p = 0.7). Instead, radial access was associated with a significantly lower rate of entry site complications (OR 0.20, 95% CI 0.09 to 0.42; p < 0.0001), even if at the price of a higher rate of procedural failure (OR 3.30, 95% CI 1.63 to 6.71; p < 0.001). CONCLUSIONS The radial approach for coronary procedures appears as a safe alternative to femoral access. Moreover, radial access virtually eliminates local vascular complications, thanks to a time-sparing hemostasis technique. However, gaining radial access requires higher technical skills, thus yielding an overall lower success rate. Nonetheless, a clear ongoing trend toward equalization of the two procedures, in terms of procedural success, is evident through the years, probably due to technologic progress of materials and increased operator experience.
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Affiliation(s)
- Pierfrancesco Agostoni
- Department of Biomedical and Surgical Sciences, Section of Cardiology, University of Verona, Verona, Italy.
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Abstract
Transcatheter dilatation is considered the elective treatment of residual coarctation. In the presence of native coarctation, dilatation is often effective but in the first months of life, and the risk of aneurysm formation is not low. The use of stents in adolescents and adults provides excellent results and seems to reduce the complication and aneurysm rates. A perfect technique, now well codified, is necessary.
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Alonso M, Tascón J, Hernández F, Andreu J, Albarrán A, Velázquez MT. [Complications with femoral access in cardiac cathetization. Impact of previous systematic femoral angiography and hemostasis with VasoSeal-ES collagen plug]. Rev Esp Cardiol 2003; 56:569-77. [PMID: 12783732 DOI: 10.1016/s0300-8932(03)76918-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Most cardiac catheterizations are performed via femoral artery access, and hemostatic devices are commonly used. We evaluate the relationship between the strategy used for femoral arteriography and the use of VasoSeal-ES, and local vascular complications. PATIENTS AND METHOD Prospective study of 540 consecutive catheterizations with systematic femoral artery and sheath angiography. VasoSeal-ES was used in 427 patients. Predictors of local vascular complications such as patient-related factors, anatomy and hemostasis were analyzed. Variables related to failure of the collagen plug were also studied. RESULTS Punctures of the common femoral artery occurred in 35.9% of all patients (16% in the deep femoral artery and its ostium). Spasm was evident in 18% (ranging from 58.1% in the deep femoral artery to 5.2% in the common femoral artery). Puncture at the site of ramification was seen in 11.3%. Angiographically significant atheroma was seen in 17.8%. The femoral head was a valid landmark for the common femoral artery in only 63.9% of the pateints. Risk factors for local vascular complications were punctures of the common femoral artery, female sex and failure of VasoSeal-ES to achieve hemostasis (15.8% in the first two months of use, 5.2% in the last months of the study). Complications involving superficial and deep femoral arteries occurred in 6.7% and 1.2% of the patients, respectively, in contrast to 0.6% involving the common femoral artery. Variables related to collagen plug failure were patient-related factors, weight less than 55 kg, operator-related factors and the learning curve. CONCLUSIONS Systematic femoral angiography provides data that aids the choice of the best hemostasis procedure to reduce local vascular complications. Punctures of the common femoral artery were more frequent than expected, and were associated with a higher complication rate. VasoSeal-ES is a safe and useful method of hemostasis, and its infrequent failures were associated with high complication rates that were substantially reduced with experience.
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Affiliation(s)
- Manuel Alonso
- Servicio de Cardiología. Hospital Universitario 12 de Octubre. Madrid. España.
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Kozak M, Adams DR, Ioffreda MD, Nickolaus MJ, Seery TJ, Chambers CE, Ettinger SM, McNulty PH, Gilchrist IC. Sterile inflammation associated with transradial catheterization and hydrophilic sheaths. Catheter Cardiovasc Interv 2003; 59:207-13. [PMID: 12772242 DOI: 10.1002/ccd.10522] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In 1999, we noted the development of inflammation and/or abscesses at the site of radial access in a group of patients. Over a 3-year period, we noted this inflammation in 33 patients out of 2,038 (1.6%) who had catheterization via the radial approach. The radial abscesses occurred in 30 patients out of 1,063 (2.8%) in whom we could confirm the use of a hydrophilic-coated sheath, but in no patient for whom we can document that an uncoated sheath was used. No infectious agent could be implicated, and the time course for the development of the abscess, typically 2 to 3 weeks, seemed long for a bacterial infection. Later patients had biopsies, and granulomatous reactions were seen in most. Additionally, a few of the biopsies showed an amorphous extravascular substance consistent with the catheter coating. All patients had good long-term outcomes.
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Affiliation(s)
- Mark Kozak
- Division of Cardiology, Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, Pennsylvania 17033, USA.
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Eggebrecht H, Naber C, Woertgen U, Ringe S, Konorza TFM, Schmermund A, von Birgelen C, Haude M, Kroeger K, Erbel R, Baumgart D. Percutaneous suture-mediated closure of femoral access sites deployed through the procedure sheath: initial clinical experience with a novel vascular closure device. Catheter Cardiovasc Interv 2003; 58:313-21. [PMID: 12594694 DOI: 10.1002/ccd.10472] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The objective of this study was to assess the initial safety and feasibility of a novel suture-mediated device for closure of femoral access sites immediately after diagnostic or interventional cardiac catheterization. In a prospective study, 150 patients (mean age, 61.5 years; 109 male) underwent femoral access closure with a novel suture closure device (Superstitch, Sutura) immediately after diagnostic (n = 106) or interventional (n = 44) catheterization procedures, independently of the coagulation status. All patients were monitored for 24 hr after the procedure. The closure device was successfully deployed in 92% of patients. Immediate hemostasis was achieved in 77% of patients with no differences between patients undergoing diagnostic catheterization or coronary interventions (79% vs. 73%; P = 0.659). After 2 min of additional light manual compression, hemostasis was achieved in 92% of patients. There was one major complication requiring vascular surgery (0.7%). The novel suture closure device is a safe and effective device that allows for immediate closure of femoral puncture sites after both diagnostic and interventional procedures with a low rate of major complications.
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Affiliation(s)
- Holger Eggebrecht
- Department of Cardiology, Center of Internal Medicine, University Hospital Essen, Essen, Germany
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Eggebrecht H, Haude M, Woertgen U, Schmermund A, von Birgelen C, Naber C, Baumgart D, Kaiser C, Oldenburg O, Bartel T, Kroeger K, Erbel R. Systematic use of a collagen-based vascular closure device immediately after cardiac catheterization procedures in 1,317 consecutive patients. Catheter Cardiovasc Interv 2002; 57:486-95. [PMID: 12455083 DOI: 10.1002/ccd.10254] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite recent advances in interventional cardiology, vascular access complications continue to be a significant problem. Conventional manual compression of the femoral access site is associated with prolonged immobilization and significant patient discomfort. We investigated the performance of a collagen-based closure device applied immediately after catheterization and its complication rate in 1,317 consecutive patients undergoing cardiac catheterization or coronary angioplasty. Patients undergoing coronary angioplasty (n = 644) received more heparin than patients with diagnostic cardiac catheterization (n = 673; 9,675 +/- 1,144 IU vs. 6,419 +/- 2,211 IU; P < 0.0001). Deployment success rates of the closure device were comparable for patients undergoing diagnostic vs. interventional procedures (95.8% vs. 96.7%; P = 0.46). Complete hemostasis immediately after deployment of the device was achieved in > 90% of all patients, but was lower in the interventional group (93.7% vs. 90.6%; P = 0.05). Major complications including any vascular surgery, major bleeding requiring transfusion, retroperitoneal hematoma, thrombosis or loss of distal pulses, groin infections, significant groin hematoma, and death were observed in 0.53% of all patients, with no differences between diagnostic or interventional patients (0.62% vs. 0.45%; P = 0.953). Subgroup analysis revealed female gender as a predictor of access site complications. Systematic sealing of femoral access sites after both diagnostic and interventional procedures allows for immediate sheath removal with reliable hemostasis. The use of a collagen-based closure device is associated with a low rate of clinically significant complications.
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Affiliation(s)
- Holger Eggebrecht
- Department of Cardiology, Center of Internal Medicine, University Hospital Essen, Essen, Germany.
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Levy EI, Boulos AS, Fessler RD, Bendok BR, Ringer AJ, Kim SH, Qureshi AI, Guterman LR, Hopkins LN. Transradial Cerebral Angiography: An Alternative Route. Neurosurgery 2002. [DOI: 10.1227/00006123-200208000-00007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Levy EI, Boulos AS, Fessler RD, Bendok BR, Ringer AJ, Kim SH, Qureshi AI, Guterman LR, Hopkins LN. Transradial Cerebral Angiography: An Alternative Route: . Neurosurgery 2002; 51:335-42. [DOI: 10.1097/00006123-200208000-00007] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Saito S, Tanaka S, Hiroe Y, Miyashita Y, Takahashi S, Satake S, Tanaka K, Yamamoto M. Usefulness of hydrophilic coating on arterial sheath introducer in transradial coronary intervention. Catheter Cardiovasc Interv 2002; 56:328-32. [PMID: 12112884 DOI: 10.1002/ccd.10202] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Radial artery spasm is one of the major problems during transradial coronary intervention (TRI). The sheath introducer with hydrophilic coating may reduce the incidence of spasm and reduce the difficulty in removing it from the radial artery under the situation of spasm artery spasm. After we compared the friction resistance between the sheath introducer with hydrophilic coating and that without coating (nine samples each) in vitro, the sheath introducers with and without hydrophilic coating were randomly used in 37 and 36 patients, respectively, who underwent elective TRI with a 6 Fr introducer sheath. Hydrophilic coating of sheath introducer reduced friction resistance by 70% (P < 0.00001) in in vitro model and facilitated sheath removal after finishing TRI (P = 0.0003). Hydrophilic coating of sheath introducer is useful in TRI.
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Affiliation(s)
- Shigeru Saito
- Division of Cardiology and Catheterization Laboratories, Heart Center of Shonan, Kamakura General Hospital, Kamakura, Japan.
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Gilchrist IC, Nickolaus MJ, Momplaisir T. Same-day transradial outpatient stenting with a 6-hr course of glycoprotein IIb/IIIa receptor blockade: a feasibility study. Catheter Cardiovasc Interv 2002; 56:10-3. [PMID: 11979524 DOI: 10.1002/ccd.10093] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The aim of the study was to explore the feasibility of same-day outpatient stent placement using a short course of intravenous antiplatelet therapy. Patients (n = 26) had stent placement and 6 hr of eptifibatide therapy. Demographics, procedural information, CPK data, and length of stay were recorded along with postdischarge outcomes. Twenty-one men and five women with median age of 60 years (49, 69) underwent transradial stenting. Baseline characteristics included diabetes 62%, hyperlipidemia 77%, prior coronary bypass surgery 19%, and unstable angina 35%. There were no CPK elevations (> 2 x normal) or ECG changes. Discharge occurred after 6.5 hr (5.8, 7.0). Neither vascular site complications nor readmission for procedure-related problems occurred. One patient later expressed concerns about discharge education. Outpatient stent placement with 6-hr infusion of GP IIb/IIIa inhibitor appears feasible and efficient in select patients. There may be challenges to meet with regard to patient education. Further studies with larger populations are needed to evaluate and optimize this approach.
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Affiliation(s)
- Ian C Gilchrist
- Department of Medicine, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pennsylvania 17033, USA.
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Hamon M, Sabatier R, Zhao Q, Niculescu R, Valette B, Grollier G. Mini-invasive strategy in acute coronary syndromes: direct coronary stenting using 5 Fr guiding catheters and transradial approach. Catheter Cardiovasc Interv 2002; 55:340-3. [PMID: 11870939 DOI: 10.1002/ccd.10105] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to assess the feasibility and safety of direct coronary stenting in acute coronary syndromes using 5 Fr guiding catheters by transradial approach. A series of 119 patients with an acute coronary syndrome (unstable angina, n = 55; acute myocardial infarction, n = 45; recent acute myocardial infarction, n = 19) explored by transradial approach and eligible for direct stenting were included. A large proportion of patients (52%) was treated during the procedure by platelet IIb/IIIa receptor blockade. Only Medtronic 5 Fr guiding catheters were used in this study. Direct coronary stenting was attempted in all 119 highly selected patients. Failure of direct stenting was observed in only five cases (3.9%) and the stent successfully retrieved in each case in the 5 Fr guiding catheter. In these five cases, balloon predilation was performed and then the stent implanted successfully. Different stents were used: ACS stent (54%), AVE stent (33%), Velocity stent (10%), Nir stent (3%), with diameter ranging from 2.5 to 4 mm. In four cases, the dilation was finally performed using 6 Fr guiding catheters because the backup of the 5 Fr catheter was considered to be too low (3%). No vascular access site complications occurred in this series of patients. We conclude that direct coronary stenting using transradial approach and 5 Fr guiding catheters yields excellent procedural success rate. In the setting of acute coronary syndromes requiring platelet IIb/IIIa receptor blockade or after failure of thrombolysis, this mini-invasive strategy is very attractive because of the low risk of access site complications.
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Affiliation(s)
- Martial Hamon
- Service des Maladies du Coeur et des Vaisseaux, Centre Hospitalier Universitaire de Caen, Caen, France.
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Louvard Y. [Treatment of unstable angina: early invasive strategy]. Ann Cardiol Angeiol (Paris) 2001; 50:385-96. [PMID: 12555631 DOI: 10.1016/s0003-3928(01)00045-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Unstable angina is one of the main reasons for admission to a cardiology department and the risk of myocardial infarction is high. Non-Q wave myocardial infarction used to be assimilated to unstable angina. Myocardial infarction without prolonged ST segment elevation and with troponin increase is now the category used to describe this condition. CPK elevation, EKG and clinical parameters are involved in the acute prognosis of patients with unstable coronary syndrome. The FRISC II trial was the first study to demonstrate the superiority of systematic early angiography followed by a revascularization procedure selected according to the type of lesions to be treated, compared with conventional management. The use of stents combined with GPIIb/IIIa inhibitors has increased the safety of PTCA and seems to have a synergetic effect. The superiority of early invasive management using stents and GPIIb/IIIa inhibitors was confirmed by the TACTICS. The risks of bleeding complications associated with this therapeutic strategy are minimized by the TIMI classification. This classification no longer corresponds to the current norms of patient safety and comfort. Several methods can be used in order to decrease the risk of bleeding complications; the radial approach is undoubtedly the most efficient one.
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Affiliation(s)
- Y Louvard
- ICPS, Institut Jacques Cartier, Massy, hôpital Claude Galien, Quincy, HEP la Roseraie, 120, avenue de la République, 93308 Aubervilliers, France
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