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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] [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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Hirzallah H, Amro A, Kusmic D, Curtis Z, Leigh EC, Numan Y, Parsons J, Amro M, Akpanudo S, Sayyed R, Elhamdani M. Comparison of Transradial and Transfemoral Approaches for Coronary Angiography and Percutaneous Intervention in Patients with Coronary Bypass Grafts. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:2-5. [PMID: 30885499 DOI: 10.1016/j.carrev.2019.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 02/15/2019] [Accepted: 03/07/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We sought to compare the transradial and transfemoral approaches for coronary angiography and percutaneous intervention in patients with coronary artery bypass grafts in terms of volume of radiographic contrast administered during cardiac catheterization, fluoroscopy time, and total procedure time. BACKGROUND The transradial access has been increasingly used as an alternative to transfemoral. Several studies demonstrated that such access is associated with lower rates of vascular and bleeding complications. Although coronary artery bypass graft patients comprise a significant portion of the coronary artery disease population, this subpopulation was often excluded or underrepresented in transradial access studies. METHODS Single center, retrospective cohort study. In the study period, all patients who had previously undergone coronary artery bypass graft surgery and had received cardiac catheterization at our institution were included in the study population. RESULTS A total of 2153 patients were included in the study. From these, 1937 were performed by femoral artery and 216 by transradial approach. Compared to the transfemoral approach, transradial access was associated with lower contrast use (136.3 ± 74.4 ml vs. 122.8 ± 59.1 ml, p = 0.035) and longer fluoroscopy time (13.9 ± 25.6 min vs. 15.9 ± 14.3 min, p < 0.001). CONCLUSION Diagnostic and interventional catheterization through the transradial approach in patients with previous coronary artery bypass graft surgery was associated with less contrast amount used and longer fluoroscopy time compared to the transfemoral approach. The transradial approach was also associated with lower crossover rates and less vascular complications.
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Affiliation(s)
- Hisham Hirzallah
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America.
| | - Ahmed Amro
- Marshall University Joan C. Edwards School of Medicine, Department of Cardiovascular Disease, United States of America
| | - Damir Kusmic
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America
| | - Zachary Curtis
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America
| | - Emilia C Leigh
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America
| | - Yazan Numan
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America
| | - Julia Parsons
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America
| | | | - Sutoidem Akpanudo
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America
| | - Rameez Sayyed
- Marshall University Joan C. Edwards School of Medicine, Department of Cardiovascular Disease, United States of America
| | - Mehiar Elhamdani
- Marshall University Joan C. Edwards School of Medicine, Department of Cardiovascular Disease, United States of America
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Ruiz-Rodriguez E, Asfour A, Lolay G, Ziada KM, Abdel-Latif AK. Systematic Review and Meta-Analysis of Major Cardiovascular Outcomes for Radial Versus Femoral Access in Patients With Acute Coronary Syndrome. South Med J 2016; 109:61-76. [PMID: 26741877 DOI: 10.14423/smj.0000000000000404] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Radial artery access (RA) for left heart catheterization and percutaneous coronary interventions (PCIs) has been demonstrated to be safe and effective. Despite consistent data showing less bleeding complications compared with femoral artery access (FA), it continues to be underused in the United States, particularly in patients with acute coronary syndrome (ACS) in whom aggressive anticoagulation and platelet inhibition regimens are needed. This systematic review and meta-analysis aims to compare major cardiovascular outcomes and safety endpoints in patients with ACS managed with PCI using radial versus femoral access. METHODS Randomized controlled trials and cohort studies comparing RA versus FA in patients with ACS were analyzed. Our primary outcomes were mortality, major adverse cardiac event, major bleeding, and access-related complications. A fixed-effects model was used for the primary analyses. RESULTS Fifteen randomized controlled trials and 17 cohort studies involving 44,854 patients with ACS were identified. Compared with FA, RA was associated with a reduction in major bleeding (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.33-0.61, P < 0.001), access-related complications (OR 0.27, 95% CI 0.18-0.39, P < 0.001), mortality (OR 0.64, 95% CI 0.54-0.75, P < 0.001), and major adverse cardiac event (OR 0.70, 95% CI 0.57-0.85, P < 0.001). These significant reductions were consistent across different study designs and clinical presentations. CONCLUSIONS Based on this large meta-analysis, RA for primary PCI in the setting of ACS is associated with reduction in cardiac and safety endpoints when compared with FA in both urgent and elective procedures. This should encourage a wider adoption of this technique among centers and interventional cardiologists.
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Affiliation(s)
- Ernesto Ruiz-Rodriguez
- From the Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, Kentucky
| | - Ahmed Asfour
- From the Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, Kentucky
| | - Georges Lolay
- From the Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, Kentucky
| | - Khaled M Ziada
- From the Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, Kentucky
| | - Ahmed K Abdel-Latif
- From the Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, Kentucky
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4
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Procedural sedation during transradial coronary angiography to prevent spasm. Herz 2015; 41:435-8. [PMID: 26598418 DOI: 10.1007/s00059-015-4373-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/17/2015] [Accepted: 10/22/2015] [Indexed: 01/23/2023]
Abstract
AIM Radial artery spasm is common during transradial procedures and is the most common cause of procedural failure. The objectives of this study were to assess whether the routine administration of sedation at the beginning of transradial coronary angiography with the use of hydrophilic-coated and smaller sheaths/catheters would reduce the incidence of radial artery spasm. PATIENTS AND METHODS Patients undergoing transradial coronary angiography were prospectively randomized to receive midazolam during the procedure or no sedative treatment. The primary endpoint was angiographically confirmed radial artery spasm. Stenosis of the radial artery was measured with a computer-assisted quantification method. RESULTS In all, 150 patients were randomized into a treatment group and a control group. Spasm occurred in 15 patients of the treatment group (20 %) versus 16 in the control group (21.3 %). There were no differences between the two groups regarding the incidence of spasm and the distribution of spasm severity (p > 0.05). No significant differences were observed between the two groups in terms of 30-day mortality or repeat hospitalization for any cause (p > 0.05). CONCLUSION Routine use of midazolam could not reduce the occurrence of radial artery spasm during transradial coronary angiography.
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Neto SA, de Freitas JO, Berti SL, Costa JR, Zbeid JAL. Comparison of conventional compressive dressings vs. wristband devices after catheterization by radial approach. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.rbciev.2017.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fu Q, Hu H, Wang D, Chen W, Tan Z, Li Q, Chen B. Randomized comparative study of left versus right radial approach in the setting of primary percutaneous coronary intervention for ST-elevation myocardial infarction. Clin Interv Aging 2015; 10:1003-8. [PMID: 26150704 PMCID: PMC4484656 DOI: 10.2147/cia.s81568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Growing evidence suggests that the left radial approach (LRA) is related to decreased coronary procedure duration and fewer cerebrovascular complications as compared to the right radial approach (RRA) in elective percutaneous coronary intervention (PCI). However, the feasibility of LRA in primary PCI has yet to be studied further. Therefore, the aim of this study was to investigate the efficacy of LRA compared with RRA for primary PCI in ST-elevation myocardial infarction (STEMI) patients. MATERIALS AND METHODS A total of 200 consecutive patients with STEMI who received primary PCI were randomized to LRA (number [n]=100) or RRA (n=100). The study endpoint was needle-to-balloon time, defined as the time from local anesthesia infiltration to the first balloon inflation. Radiation dose by measuring cumulative air kerma (CAK) and CAK dose area product, as well as fluoroscopy time and contrast volume were also investigated. RESULTS There were no significant differences in the baseline characteristics between the two groups. The coronary procedural success rate was similar between both radial approaches (98% for left versus 94% for right; P=0.28). Compared with RRA, LRA had significantly shorter needle-to-balloon time (16.0±4.8 minutes versus 18.0±6.5 minutes, respectively; P=0.02). Additionally, fluoroscopy time (7.4±3.4 minutes versus 8.8±3.5 minutes, respectively; P=0.01) and CAK dose area product (51.9±30.4 Gy cm(2) versus 65.3±49.1 Gy cm(2), respectively; P=0.04) were significantly lower with LRA than with RRA. CONCLUSION Primary PCI can be performed via LRA with earlier blood flow restoration in the infarct-related artery and lower radiation exposure when compared with RRA; therefore, the LRA may become a feasible and attractive alternative to perform primary PCI for STEMI patients.
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Affiliation(s)
- Qiang Fu
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hongyu Hu
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dezhao Wang
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wei Chen
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhixu Tan
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Qun Li
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Buxing Chen
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
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Tumscitz C, Pirani L, Tebaldi M, Campo G, Biscaglia S. Seven french radial artery access for PCI: a prospective single-center experience. Int J Cardiol 2014; 176:1074-5. [PMID: 25127334 DOI: 10.1016/j.ijcard.2014.07.134] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/26/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Carlo Tumscitz
- Cardiovascular Institute, Azienda Ospedaliera Universitaria S. Anna, Ferrara, Italy
| | - Lucia Pirani
- Cardiovascular Institute, Azienda Ospedaliera Universitaria S. Anna, Ferrara, Italy
| | - Matteo Tebaldi
- Cardiovascular Institute, Azienda Ospedaliera Universitaria S. Anna, Ferrara, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliera Universitaria S. Anna, Ferrara, Italy; LTTA Center, Ferrara, Italy
| | - Simone Biscaglia
- Cardiovascular Institute, Azienda Ospedaliera Universitaria S. Anna, Ferrara, Italy.
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Aydin A, Gurol T, Soylu O, Dagdeviren B. Early ambulatory discharge is safe and feasible after transradial coronary interventions. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VESSELS 2014; 3:60-63. [PMID: 29450172 PMCID: PMC5801437 DOI: 10.1016/j.ijchv.2014.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 03/08/2014] [Indexed: 06/08/2023]
Abstract
BACKGROUND At present, there are no definite criteria for selecting patients eligible for same-day discharge after percutaneous coronary interventions (PCI). With rapid ambulation and reduced vascular complication rates, transradial PCI have many features that favorably reduce costs and hospital stay. This study aimed to demonstrate the possibility of early ambulatory discharge following transradial percutaneous coronary interventions. METHODS 254 consecutive patients undergoing transradial PCI (elective, urgent, and emergent) at our center was observed during hospital stay. Patient demographics, angiographic characteristics, post-procedural complications, and timing of these post-procedural events were recorded. RESULTS A total of 336 lesions were treated among 299 vessels with 277 stents. One hundred fifty-two (45.2%) lesions were Type C. There were 26 chronic total occlusions (CTO). One hundred fifty-five (61%) patients were discharged on the same day after the procedure. 24 complications (12.6%) occurred and were divided into three groups according to occurrence time. 13 (54.2%) occurred within the first 2 h and 11 (45.8%) occurred after the 24-hour period. No complications were observed between the 2nd and 24th hours. CONCLUSIONS Same-day discharge with a 2-hour observation period is safe and feasible after successful transradial PCI in appropriate patients. Although a minor number of complications occurred, these did not occur between the 2nd and 24th hours. Same-day discharge after successful transradial PCI could be an alternative for better utilization of resources.
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Affiliation(s)
- Alper Aydin
- Corresponding author at: Bahcesehir University School of Medicine, Department of Cardiology, Goztepe Medical Park Hastanesi, 23 Nisan Sok No 17 Goztepe Istanbul, Turkey. Tel.: + 90 542 5855519Corresponding author at: Bahcesehir University School of MedicineDepartment of CardiologyGoztepe Medical Park Hastanesi23 Nisan Sok No 17, GoztepeTel.: + 90 542 5855519IstanbulTurkey
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Rao SV, Tremmel JA, Gilchrist IC, Shah PB, Gulati R, Shroff AR, Crisco V, Woody W, Zoghbi G, Duffy PL, Sanghvi K, Krucoff MW, Pyne CT, Skelding KA, Patel T, Pancholy SB. Best practices for transradial angiography and intervention: a consensus statement from the society for cardiovascular angiography and intervention's transradial working group. Catheter Cardiovasc Interv 2013; 83:228-36. [PMID: 24123781 DOI: 10.1002/ccd.25209] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 09/12/2013] [Indexed: 01/22/2023]
Affiliation(s)
- Sunil V Rao
- Duke University Medical Center, Durham, North Carolina
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Michael TT, Alomar M, Papayannis A, Mogabgab O, Patel VG, Rangan BV, Luna M, Hastings JL, Grodin J, Abdullah S, Banerjee S, Brilakis ES. A randomized comparison of the transradial and transfemoral approaches for coronary artery bypass graft angiography and intervention: the RADIAL-CABG Trial (RADIAL Versus Femoral Access for Coronary Artery Bypass Graft Angiography and Intervention). JACC Cardiovasc Interv 2013; 6:1138-44. [PMID: 24139930 DOI: 10.1016/j.jcin.2013.08.004] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/19/2013] [Accepted: 08/26/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVES This study sought to compare and contrast use and radiation exposure using radial versus femoral access during cardiac catheterization of patients who had previously undergone coronary artery bypass graft (CABG) surgery. BACKGROUND Limited information is available on the relative merits of radial compared with femoral access for cardiac catheterization in patients who had previously undergone CABG surgery. METHODS Consecutive patients (N = 128) having previously undergone CABG surgery and referred for cardiac catheterization were randomized to radial or femoral access. The primary study endpoint was contrast volume. Secondary endpoints included fluoroscopy time, procedure time, patient and operator radiation exposure, vascular complications, and major adverse cardiac events. Analyses were by intention-to-treat. RESULTS Compared with femoral access, diagnostic coronary angiography via radial access was associated with a higher mean contrast volume (142 ± 39 ml vs. 171 ± 72 ml, p < 0.01), longer procedure time (21.9 ± 6.8 min vs. 34.2 ± 14.7 min, p < 0.01), greater patient air kerma (kinetic energy released per unit mass) radiation exposure (1.08 ± 0.54 Gy vs. 1.29 ± 0.67 Gy, p = 0.06), and higher operator radiation dose (first operator: 1.3 ± 1.0 mrem vs. 2.6 ± 1.7 mrem, p < 0.01; second operator 0.8 ± 1.1 mrem vs. 1.8 ± 2.1 mrem, p = 0.01). Fewer patients underwent ad hoc percutaneous coronary intervention (PCI) in the radial group (37.5% vs. 46.9%, p = 0.28) and radial PCI procedures were less complex. The incidences of the primary and secondary endpoints was similar with femoral and radial access among PCI patients. Access crossover was higher in the radial group (17.2% vs. 0.0%, p < 0.01) and vascular access site complications were similar in both groups (3.1%). CONCLUSIONS In patients who had previously undergone CABG surgery, transradial diagnostic coronary angiography was associated with greater contrast use, longer procedure time, and greater access crossover and operator radiation exposure compared with transfemoral angiography. (RADIAL Versus Femoral Access for Coronary Artery Bypass Graft Angiography and Intervention [RADIAL-CABG] Trial; NCT01446263).
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Affiliation(s)
- Tesfaldet T Michael
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas
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Fujii T, Masuda N, Ijichi T, Kamiyama Y, Tanaka S, Nakazawa G, Shinozaki N, Matsukage T, Ogata N, Ikari Y. Transradial intervention for patients with ST elevation myocardial infarction with or without cardiogenic shock. Catheter Cardiovasc Interv 2013; 83:E1-7. [DOI: 10.1002/ccd.24896] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 01/06/2013] [Accepted: 02/18/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Toshiharu Fujii
- Division of Cardiology; Tokai University School of Medicine; Isehara Japan
| | - Naoki Masuda
- Division of Cardiology; Tokai University School of Medicine; Isehara Japan
| | - Takeshi Ijichi
- Division of Cardiology; Tokai University School of Medicine; Isehara Japan
| | - Yoshinari Kamiyama
- Division of Cardiology; Tokai University School of Medicine; Isehara Japan
| | - Shigemitsu Tanaka
- Division of Cardiology; Tokai University School of Medicine; Isehara Japan
| | - Gaku Nakazawa
- Division of Cardiology; Tokai University School of Medicine; Isehara Japan
| | - Norihiko Shinozaki
- Division of Cardiology; Tokai University School of Medicine; Isehara Japan
| | - Takashi Matsukage
- Division of Cardiology; Tokai University School of Medicine; Isehara Japan
| | - Nobuhiko Ogata
- Division of Cardiology; Tokai University School of Medicine; Isehara Japan
| | - Yuji Ikari
- Division of Cardiology; Tokai University School of Medicine; Isehara Japan
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Gellen B, Lesault PF, Canouï-Poitrine F, Champagne S, Mouillet G, Pongas D, Le Thuaut A, Jakljevic T, Boudiche S, de la Vega M, Maalej A, Veugeois A, Dubois-Randé JL, Teiger E. Feasibility limits of transradial primary percutaneous coronary intervention in acute myocardial infarction in the real life (TRAP-AMI). Int J Cardiol 2013; 168:1056-61. [DOI: 10.1016/j.ijcard.2012.10.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 06/02/2012] [Accepted: 10/28/2012] [Indexed: 11/30/2022]
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Romagnoli E, Mann T, Sciahbasi A, Pendenza G, Biondi-Zoccai GGL, Sangiorgi GM. Transradial approach in the catheterization laboratory: Pros/cons and suggestions for successful implementation. Int J Cardiol 2013; 163:116-24. [PMID: 22137451 DOI: 10.1016/j.ijcard.2011.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 09/07/2011] [Accepted: 11/01/2011] [Indexed: 02/05/2023]
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Malaiapan Y, Leung M, Ahmar W, Hutchison AW, Prasad S, Katticaran T, Cameron JD, Harper RW, Meredith IT. Guideline recommended door-to-balloon time can be achieved in transradial primary PCI--the usefulness of a dedicated radial guide catheter. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2012; 14:27-31. [PMID: 23228445 DOI: 10.1016/j.carrev.2012.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 10/18/2012] [Accepted: 10/30/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Radial access for primary percutaneous coronary intervention (PPCI) is well established in terms of safety and efficacy. However, there are limited data on the impact of the use of a single dedicated radial guide catheter in primary PCI using radial access. AIMS To determine the overall cardiac catheterisation laboratory to balloon time (CCL2BT) and door to balloon (D2BT) time in transradial PPCI. To determine the impact of a single dedicated radial guide catheter on CCLD2BT and D2BT in transradial PPCI compared to conventional transfemoral PPCI. METHODS The procedural and clinical outcomes of consecutive patients who had transradial primary PCI between 2005 and 2009 were included in this study and compared with a matched cohort who underwent transfemoral primary PCI. RESULTS Overall D2BT and inpatient MACE were similar between the radial (n=53) and femoral (n=53) groups (85 and 82 min, P=0.889; 0% and 1.8% P=0.317 respectively). An increase in the CCL2BT and procedural times was noted in the radial compared to the femoral group (34 min versus 29 min P=0.028; 15.8 min versus 11.6 min P=0.001). When a single radial guide catheter was used for the entire procedure, there was no difference in CCL2BT, D2BT and procedural times between the radial and femoral groups (31 min versus 29 min P=0.599; 74 min versus 82 min P=0.418; 50 min versus 47 min P=0.086). CONCLUSION The radial approach is safe and results in guideline recommended D2BT in STEMI. The use of a dedicated radial guide catheter reduces treatment time, demonstrating equivalent times to a femoral approach.
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Affiliation(s)
- Yuvaraj Malaiapan
- Monash Cardiovascular Research Centre, MonashHEART, Southern Health & Department of Medicine (MMC), Monash University, Melbourne, Australia.
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Ibebuogu UN, Cercek B, Makkar R, Dinh H, Kwarteng C, Mirocha J, Hussaini A, Singh S, Dohad S, Shah PK, Khorsandi M, Kar S. Comparison between transradial and transfemoral percutaneous coronary intervention in acute ST-elevation myocardial infarction. Am J Cardiol 2012; 110:1262-5. [PMID: 22840847 DOI: 10.1016/j.amjcard.2012.06.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 06/20/2012] [Accepted: 06/20/2012] [Indexed: 11/30/2022]
Abstract
Transradial (TR) access is increasingly being used in percutaneous coronary intervention (PCI). However, its role in PCI for ST-segment elevation myocardial infarction remains controversial because of concerns of procedural complexity adversely affecting the promptness of reperfusion. In this study, 150 consecutive patients who underwent PCI for acute ST-segment elevation myocardial infarction over a period of 24 months were prospectively evaluated; 46 had TR access (31%) and 104 (69%) had transfemoral (TF) access. All patients received thienopyridines, aspirin, and heparin per routine management. There were no significant differences between the TR access and TF access groups with respect to age (62.2 ± 11.6 vs 64.7 ± 14.1, p = 0.28), gender (76.1% vs 72.1% men, p = 0.69), or incidence of diabetes (23.9% vs 26.9%, p = 0.84). The TR and TF access groups were comparable with respect to door-to-balloon time (79.2 ± 32.3 vs 86.8 ± 51.8 minutes, p = 0.67) and amount of contrast used (190.5 ± 101.5 vs 172.2 ± 81.7 ml, p = 0.24). Total fluoroscopy time was longer in the TR access group compared to the TF access group (21.7 ± 12.7 vs 14.4 ± 10.4 minutes, p <0.0001). Postprocedural Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow was comparable for the 2 groups (87% for the TF group and 96% for the TR group, p = 0.15). There were no vascular complications in the TR access group compared to the TF access group (0% vs 5.8%, p = 0.18). In conclusion, this single-center observational study shows that TR access for PCI in STEMI is feasible and that it has fewer vascular complications and shorter length of hospital stay than the TF approach.
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Affiliation(s)
- Uzoma N Ibebuogu
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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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] [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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CHOW JEREMY, TAN CHONGHIOK, TIN AUNGSOE, ONG SEAHING, TAN VERNHSEN, GOH YEWSEONG, GAN HWAWOOI, TAN KOKSOON, LINGAMANAICKER JAYARAM. Feasibility of Transradial Coronary Angiography and Intervention Using a Single Ikari Left Guiding Catheter for ST Elevation Myocardial Infarction. J Interv Cardiol 2012; 25:235-44. [DOI: 10.1111/j.1540-8183.2011.00710.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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The transradial approach. An increasingly used standard for coronary diagnosis and interventions. Herz 2012; 36:386-95. [PMID: 21750973 DOI: 10.1007/s00059-011-3483-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In the 20 years since its introduction, radial access for diagnostic and interventional coronary procedures has been well validated in countless scientific studies. Nevertheless, the use of this access route varies greatly among--and even within--countries. Fear of the unknown may make some experienced interventionalists hesitant to adopt the transradial approach in spite of its proven advantages. In our review, we describe practical aspects of the transradial access, such as the role of Allen's test in patient selection and considerations on the optimal puncture technique of the radial artery. Catheter selection, anatomic variations which may complicate access, as well as strategies to avoid and/or manage possible complications are outlined. Finally, we review the literature on the reduction of access site complications by adopting the transradial approach. Even in interventions for acute myocardial infarction, transradial access can be used safely and effectively. In addition to a reduced rate of access site complications, a reduction in overall in-hospital major adverse cardiac events has been demonstrated. The advantage regarding access site complications could be seen even when closure devices were utilized for transfemoral procedures.
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Dandekar VK, Vidovich MI, Shroff AR. Complications of transradial catheterization. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2012; 13:39-50. [DOI: 10.1016/j.carrev.2011.08.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 08/19/2011] [Accepted: 08/24/2011] [Indexed: 01/30/2023]
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Généreux P, Mehran R, Palmerini T, Caixeta A, Kirtane AJ, Lansky AJ, Brodie BR, Witzenbichler B, Mockel M, Guagliumi G, Peruga JZ, Dudek D, Fahy MP, Dangas G, Stone GW. Radial access in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty in acute myocardial infarction: the HORIZONS-AMI trial. EUROINTERVENTION 2011; 7:905-16. [DOI: 10.4244/eijv7i8a144] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Benamer H, Tafflet M, Bataille S, Escolano S, Livarek B, Fourchard V, Caussin C, Teiger E, Garot P, Lambert Y, Jouven X, Spaulding C. Female gender is an independent predictor of in-hospital mortality after STEMI in the era of primary PCI: insights from the greater Paris area PCI Registry. EUROINTERVENTION 2011; 6:1073-9. [PMID: 21518679 DOI: 10.4244/eijv6i9a187] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIMS To determine if female gender is an independent predictor of in-hospital mortality after percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI). A higher early mortality rate after STEMI has been reported in women before the widespread use of PCI in STEMI. PCI improves the prognosis of STEMI, however, the effect of PCI in women in this setting is controversial. In a large regional prospective registry, we examined the in-hospital mortality after PCI for STEMI. METHODS AND RESULTS The greater Paris area comprises 11 million inhabitants. Data from all PCIs performed in 41 centres is entered in a mandatory registry. In-hospital mortality is recorded in another hospital-based database. From 2003 to 2007, 16,760 patients were treated by PCI for STEMI <24 hours; 21.9% were women. Female patients were significantly older than men, 69.7 ± 14.3 years versus 59.3 ± 13.0 years (p<0.0001). The rate of diabetes mellitus and cardiogenic shock were significantly higher in women versus men, respectively 19.0% versus 15.6%, p<0.0001 and 6.7% versus 4.0%, p<0.0001. The success rate of PCI was significantly lower in women: 94.7% versus 95.9%, p=0.002. In-hospital mortality was significantly higher in women 9.8 % versus 4.3%, p<0.0001 and the impact of gender on mortality was significant only after the age of 75. By multivariate analysis, female gender is associated with higher in-hospital mortality. CONCLUSIONS After PCI for STEMI, female gender is still an independent predictor of in-hospital mortality.
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Affiliation(s)
- Hakim Benamer
- European Hospital of Paris La Roseraie, Aubervilliers, France.
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Prada-Delgado Ó, Estévez-Loureiro R, Calviño-Santos R, Barge-Caballero E, Salgado-Fernández J, Piñón-Esteban P, Vázquez-Rodríguez JM, Aldama-López G, Flores-Ríos X, Soler-Martín MR, Vázquez-González N, Castro-Beiras A. Safety and efficacy of femoral vascular closure devices in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Am Heart J 2011; 161:1207-13. [PMID: 21641370 DOI: 10.1016/j.ahj.2011.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 03/07/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND The use of vascular closure devices (VCDs) for the reduction of access site complications following percutaneous coronary intervention (PCI) remains controversial. Patients undergoing primary PCI for acute ST-segment elevation myocardial infarction (STEMI) are at high risk of femoral artery complications. A lack of information exists regarding the use of VCDs in this group of patients because they have been routinely excluded from randomized trials. This study sought to evaluate the safety and efficacy of the routine use of VCDs after primary PCI. METHODS A total of 558 consecutive patients undergoing primary PCI for STEMI via femoral route were studied for in-hospital outcomes through a prospective registry from January 2003 to December 2008. The primary end point was the presence of major vascular complication (MVC) defined as a composite of fatal access site bleeding, access site complication requiring interventional or surgical correction, or access site bleeding with ≥3 g/dL drop in hemoglobin or requiring blood transfusion. RESULTS Of the total patients, 464 (83.2%) received a VCD; and manual compression was used in 94 patients (16.8%). Major vascular complication occurred in 5.2% of patients. The risk of MVC was significantly lower with VCDs compared with manual compression (4.3% vs 9.6%, P = .036). Multivariable logistic regression analysis determined that VCD use remained an independent predictor of lower rate of MVC (odds ratio 0.38, 95% CI 0.17-0.91). CONCLUSIONS The use of VCDs in patients undergoing primary PCI for STEMI is safe and is associated with lower rates of MVC compared with manual compression.
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Affiliation(s)
- Óscar Prada-Delgado
- Interventional Cardiology Unit, Department of Cardiology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
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Rathore S, Stables RH, Pauriah M, Hakeem A, Mills JD, Palmer ND, Perry RA, Morris JL. A randomized comparison of TR band and radistop hemostatic compression devices after transradial coronary intervention. Catheter Cardiovasc Interv 2011; 76:660-7. [PMID: 20506228 DOI: 10.1002/ccd.22615] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The transradial route for coronary intervention has proven to be safe, effective, and widely applicable in different clinical situations. Several compressive hemostatic devices have been introduced that have shown to be safe and are effective in achieving hemostasis. METHODS Seven hundred ninety patients were randomly assigned to receive either TR band or Radistop hemostatic compression devices after transradial coronary procedure. The outcome measures were patient tolerance of the device, local vascular complications, and the time taken to achieve hemostasis. RESULTS The mean age was 62.88 years, and 74.2% of the patients were men. Patient age, height, weight, wrist circumference, body mass index, male sex, hypertension, diabetes, hypercholesterolemia, and smoking incidences were similar in both groups. There were significantly more patients reporting no discomfort in the TR band group compared to the Radistop group (77% vs. 61%; P = 0.0001). Patients in the Radistop group reported significantly more pain across all categories of severity and three patients in the Radistop group were crossed over to TR band because of severe discomfort. Oozing and ecchymosis were seen in about 16% of the patients. Local small hematoma and large hematoma were seen in 5.4% and 2.2% patients respectively, and similar in both groups. Radial artery occlusion at the time of discharge was seen in 9.2% of the patients though only 6.8% showed persistent occlusion at the time of follow-up. The time taken to achieve hemostasis was significantly longer in the TR Band group (5.32 ± 2.29 vs. 4.83 ± 2.23 hr; P = 0.004). There was significantly higher incidence of radial artery occlusion in patients with smaller wrist circumference, the patients who experienced radial artery spasm during the procedure, and patients with no heparin administration during the procedure. CONCLUSIONS We have shown in a randomized comparison of Radistop and TR band that both devices are safe and effective as hemostatic compression devices following transradial procedures. However, more patients felt discomfort with the Radistop device and the time taken to achieve hemostasis was longer with TR band. © 2010 Wiley-Liss, Inc.
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Affiliation(s)
- Sudhir Rathore
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK.
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Larsen P, Shah S, Waxman S, Freilich M, Riskalla N, Piemonte T, Jeon C, Pyne C. Comparison of procedural times, success rates, and safety between left versus right radial arterial access in primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction. Catheter Cardiovasc Interv 2010; 78:38-44. [DOI: 10.1002/ccd.22843] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 09/20/2010] [Indexed: 01/28/2023]
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Cooper L, Banerjee S, Brilakis ES. Crossover from radial to femoral access during a challenging percutaneous coronary intervention can make the difference between success and failure. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2010; 11:266.e5-8. [DOI: 10.1016/j.carrev.2010.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 04/16/2010] [Accepted: 04/22/2010] [Indexed: 10/19/2022]
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Rathore S, Stables RH, Pauriah M, Hakeem A, Mills JD, Palmer ND, Perry RA, Morris JL. Impact of length and hydrophilic coating of the introducer sheath on radial artery spasm during transradial coronary intervention: a randomized study. JACC Cardiovasc Interv 2010; 3:475-83. [PMID: 20488402 DOI: 10.1016/j.jcin.2010.03.009] [Citation(s) in RCA: 163] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 02/18/2010] [Accepted: 03/04/2010] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of this study was to assess the impact of length and hydrophilic coating of the introducer sheath on radial artery spasm, radial artery occlusion, and local vascular complications in patients undergoing transradial coronary procedures. BACKGROUND Radial artery spasm is common during transradial procedures and the most common cause for procedural failure. METHODS We randomly assigned, in a factorial design, 790 patients scheduled for a transradial coronary procedure to long (23-cm) or short (13-cm) and hydrophilic-coated or uncoated introducer sheaths. The primary outcome measure was clinical evidence of radial artery spasm, and secondary outcome measures were patient discomfort and local vascular complications. RESULTS Procedural success was achieved in 96% of the cases, and radial artery spasm accounted for 17 of 33 failed cases. There was significantly less radial artery spasm (19.0% vs. 39.9%, odds ratio [OR]: 2.87; 95% confidence interval [CI]: 2.07 to 3.97, p < 0.001) and patient reported discomfort (15.1% vs. 28.5%, OR: 2.27; 95% CI: 1.59 to 3.23, p < 0.001) in patients receiving a hydrophilic-coated sheath. No difference was observed between long and short sheaths. Radial artery occlusion was observed in 9.5% of the patients and was not influenced by sheath length or coating. A local large hematoma or arterial dissection was seen in 2.6% of the patients with no difference in groups allocated at randomization. Younger age, female sex, diabetes, and lower body mass index were identified as independent predictors of radial artery spasm. CONCLUSIONS Hydrophilic sheath coating, but not sheath length, reduces the incidence of radial artery spasm during transradial coronary procedures.
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Affiliation(s)
- Sudhir Rathore
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
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Arzamendi D, Ly HQ, Tanguay JF, Chan MYY, Chevallereau P, Gallo R, Ibrahim R, L'Allier P, Levesque S, Gosselin G, DeGuise P, Joyal M, Gregoire J, Bonan R, Crepeau J, Doucet S. Effect on bleeding, time to revascularization, and one-year clinical outcomes of the radial approach during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. Am J Cardiol 2010; 106:148-54. [PMID: 20598995 DOI: 10.1016/j.amjcard.2010.02.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 02/21/2010] [Accepted: 02/21/2010] [Indexed: 11/26/2022]
Abstract
The radial approach during percutaneous coronary intervention (PCI) has been reported to reduce the incidence of bleeding complications. However, the radial approach still accounts for <10% of procedures worldwide and only 1% in the United States. Our objective was to compare the effect of radial versus femoral vascular access on the time to reperfusion, incidence of bleeding complications, and overall clinical outcomes in the setting of primary PCI. We prospectively collected data on all patients undergoing primary PCI at the Montreal Heart Institute from April 1, 2007 to March 30, 2008. The time to revascularization and major bleeding were prespecified as a co-primary end point, and major adverse cardiac events, including death, myocardial infarction, and target vessel revascularization within 12 months, were considered a secondary end point. A total of 489 patients were included in the present longitudinal cohort study, 234 in the femoral group and 254 in the radial group. In the propensity-adjusted model, the use of the femoral approach was a strong independent predictor of bleeding (odds ratio 4.22, 95% confidence interval 3.17 to 10.60). No significant difference between the radial and femoral groups was observed relative to the time to revascularization (21.4 +/- 11.8 minutes vs 22.8 +/- 10.3 minutes, respectively; p = 0.68). Moreover, the radial approach was associated with a decreased risk of major adverse cardiac events (odds ratio 0.31, 95% confidence interval 0.10 to 0.94). In conclusion, primary PCI using the radial approach was associated with a fourfold reduction in major bleeding, without compromising the time to revascularization. Moreover, the radial approach was associated with a significant reduction in major adverse cardiac events at 12 months.
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Transradial and slender percutaneous coronary intervention: less invasive strategy in PCI. Cardiovasc Interv Ther 2010; 25:60-4. [DOI: 10.1007/s12928-010-0023-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Indexed: 11/25/2022]
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Komócsi A, Vorobcsuk A, Aradi D. Transradial percutaneous coronary intervention in acute myocardial infarction. Interv Med Appl Sci 2010. [DOI: 10.1556/imas.2.2010.2.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Although transradial coronary intervention is widely applied for percutaneous procedures, its safety in the setting of ST-segment elevation myocardial infarction (STEMI) is controversial. The benefit of transradial approach in terms of reducing access site complications is well documented. However, higher rate of procedural failure and longer procedural times reported by some authors raise concerns regarding its applicability in STEMI. Our aim was to review the safety and efficacy of transradial coronary intervention versus transfemoral intervention in acute ST-elevation myocardial infarction. This review focuses on key aspects of safety and efficacy: adverse ischemic and bleeding events, reperfusion times and radiation exposure.
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Affiliation(s)
- András Komócsi
- 1 Heart Institute, Faculty of Medicine, University of Pécs, Pécs, Hungary
- 2 University of Pécs, Heart Institute, H-7624, Pécs, Ifjúság u. 13, Hungary
| | - A. Vorobcsuk
- 1 Heart Institute, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - D. Aradi
- 1 Heart Institute, Faculty of Medicine, University of Pécs, Pécs, Hungary
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Brueck M, Bandorski D, Kramer W, Wieczorek M, Höltgen R, Tillmanns H. A Randomized Comparison of Transradial Versus Transfemoral Approach for Coronary Angiography and Angioplasty. JACC Cardiovasc Interv 2009; 2:1047-54. [DOI: 10.1016/j.jcin.2009.07.016] [Citation(s) in RCA: 288] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 07/25/2009] [Indexed: 11/26/2022]
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Transradial access compared with femoral puncture closure devices in percutaneous coronary procedures. Int J Cardiol 2009; 137:199-205. [DOI: 10.1016/j.ijcard.2008.06.045] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 05/02/2008] [Accepted: 06/01/2008] [Indexed: 11/21/2022]
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Ikari Y. Transradial coronary intervention as the primary approach for acute myocardial infarction. Circ J 2009; 73:2011-2. [PMID: 19851027 DOI: 10.1253/circj.cj-09-0685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Candemir B, Kumbasar D, Turhan S, Kilickap M, Ozdol C, Akyurek O, Atmaca Y, Altin T. Facilitation of Radial Artery Cannulation by Periradial Subcutaneous Administration of Nitroglycerin. J Vasc Interv Radiol 2009; 20:1151-6. [DOI: 10.1016/j.jvir.2009.05.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Revised: 05/26/2009] [Accepted: 05/28/2009] [Indexed: 10/20/2022] Open
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Ziakas A, Klinke P, Mildenberger R, Fretz E, Williams M, Della Siega A, Kinloch D, Hilton D. A comparison of the radial and the femoral approach in vein graft PCI. A retrospective study. ACTA ACUST UNITED AC 2009; 7:93-6. [PMID: 16093218 DOI: 10.1080/14628840510011270] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Transradial PCI is a safe and effective method of percutaneous revascularization. However, there is limited data on the efficacy of the transradial approach for saphenous vein graft (SVG) PCI. METHODS We studied 334 patients who underwent SVG PCI between January 2000 and December 2003, and compared the radial (132 patients) and the femoral (202 patients) approach. RESULTS Mean EF (55.6+/-18.6% radial versus 58.1+/-16.8% femoral), lesion location (proximal, mid, distal: 22.6/50.6/26.7% versus 22.6/44.5/32.9% respectively) and lesion type (B1/B2/C: 3.4/4.1/92.5% versus 0.4/3.1/96.5%) were similar in both groups (P>0.05). Five patients had a failed radial attempt (3.8%) and were switched to the femoral approach. Mean fluoroscopy time (20.4+/-12.2 versus 18.4+/-10.2 min), procedural time (60.0+/-27.2 versus 61.6+/-24.9 min) and the use of contrast (223+/-91 versus 234+/-91 ml) IIB/IIIA inhibitors (27.2 versus 33.2%), and stenting (81.5 versus 81.3%) were similar in both groups, whereas 5 or 6 French sheaths were used more often in the radial group (83.4 versus 64.9%, P<0.01). Angiographic success (93.9 versus 92.9%), in hospital MACE (radial:5 MI (3.8%) versus femoral: 1 death (0.5%) and 7 MI (3.5%) and major vascular complications (0.7 versus 0.5%) were also similar. CONCLUSIONS The radial approach in SVG PCI is as fast and successful as the femoral.
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Ziakas A, Gomma A, McDonald J, Klinke P, Hilton D. A comparison of the radial and the femoral approaches in primary or rescue percutaneous coronary intervention for acute myocardial infarction in the elderly. ACTA ACUST UNITED AC 2009; 9:93-6. [PMID: 17573583 DOI: 10.1080/17482940701227736] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Access site complications are reduced using radial percutaneous coronary intervention (PCI). There is concern that technical difficulties using this approach can delay achievement of reperfusion during primary or rescue PCI for acute myocardial infarction (AMI) especially in elderly patients. METHODS AND RESULTS We studied 155 patients (pts) > or = 70 years who underwent primary or rescue PCI for AMI; radial (Group1; 87 pts) or femoral (Group2; 68 pts). Baseline characteristics, the amount of IIB/IIIA inhibitor, contrast and heparin used, and TIMI flow pre and post PCI were similar in both groups (P>0.05). Time from arrival in the catheterization laboratory to the first balloon inflation (Group 1: 44.0+/-21.5 versus Group 2 38.8+/-18.7 min) was also similar, but was significantly longer (61.2+/-11.1 min) compared to both groups in patients with a failed radial approach (7 pts, 8%). Angiographic success, and in-hospital MACE were also similar in the two groups, but vascular access site complications were significantly higher in Group 2 (0 versus 2.9%, P<0.05). CONCLUSION The use of the radial approach in elderly patients undergoing primary and rescue PCI, when successful, is safe and effective as the femoral approach, and leads to fewer vascular complications.
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Five-year experience with transradial coronary angioplasty in ST-segment-elevation myocardial infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2009; 10:73-9. [PMID: 19327668 DOI: 10.1016/j.carrev.2008.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 06/26/2008] [Accepted: 07/24/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE Percutaneous coronary intervention (PCI) via radial approach has been shown to be an alternative to femoral approach in emergency cases; however, its feasibility has been questioned. This single-center study was performed to compare the outcomes and complication rates between transradial (TR) and transfemoral (TF) PCI in ST-segment-elevation myocardial infarction (STEMI). METHODS AND MATERIALS The clinical and angiographic data of 582 consecutive STEMI patients treated with PCI between 2001 and 2006 were evaluated in a retrospective study. Forty-three patients were excluded from the present study due to cardiogenic shock or rescue PCI. Patients (n=539) were categorized into the TR group (n=167) or the TF group (n=372), and several parameters were evaluated to assess the advantages and drawbacks of TR access: access-site crossover, rate of access-site complications, procedure time, fluoroscopy time, X-ray area dose, major adverse cardiac events (MACE) at 1 month, and consumption of angioplasty equipment. RESULTS In the TR group, the crossover rate to femoral access was 5%, while in the TF group, it was 0.8% (P<.05). There was a significant difference, in both major and minor access-site complications, between the TR group and the TF group (0% vs. 5%, P<.05, and 4% vs. 9%, P<.05, respectively). Consumption of angioplasty equipment proved to be the same for the two groups. The MACE rate was 4% in the TR group and 11% in the TF group (P<.05). CONCLUSIONS Our results suggest that the TR approach is a safe and effective way to treat STEMI; furthermore, site-related complications are less common with this approach.
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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] [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] [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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Safety and feasibility of transradial approach for primary percutaneous coronary intervention in elderly patients with acute myocardial infarction. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200805010-00004] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Brasselet C, Tassan S, Nazeyrollas P, Hamon M, Metz D. Randomised comparison of femoral versus radial approach for percutaneous coronary intervention using abciximab in acute myocardial infarction: results of the FARMI trial. Heart 2007; 93:1556-61. [PMID: 17639099 PMCID: PMC2095748 DOI: 10.1136/hrt.2007.117309] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To compare bleeding complications and results of percutaneous coronary intervention (PCI) between patients treated by radial and femoral approaches for acute myocardial infarction (AMI,) and using abciximab and 5 French guiding-catheters. PATIENTS 114 consecutive patients with AMI were prospectively randomised. Exclusion criteria were a history of coronary artery bypass graft, cardiogenic shock, atrioventricular block, and contraindication to abciximab or a negative Allen test. Local haemostasis was achieved by manual compression. RESULTS Baseline characteristics were similar between the two groups. Peripheral arterial complication rates and delays to patient ambulation were significantly lower in the radial group than in the femoral group, whereas in-hospital stay was similar between the two groups. A cross over was more often necessary in the radial group than in the femoral group. Coronary angiography duration and fluoroscopy time were significantly longer in the radial group than in the femoral group, whereas PCI duration was similar in both groups. CONCLUSIONS The FARMI trial showed that the radial route lowered peripheral arterial complication rates and allowed earlier ambulation, despite no significant benefit on the duration of hospitalisation.
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Affiliation(s)
- Camille Brasselet
- Department of Cardiology, CHU Robert Debré, Avenue du général Koenig, 51092 Reims Cedex, France.
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Safety and feasibility of emergent percutaneous coronary intervention with the transradial access in patients with acute myocardial infarction. Chin Med J (Engl) 2007. [DOI: 10.1097/00029330-200704010-00014] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Amoroso G, Laarman GJ, Kiemeneij F. Overview of the transradial approach in percutaneous coronary intervention. J Cardiovasc Med (Hagerstown) 2007; 8:230-7. [PMID: 17413298 DOI: 10.2459/01.jcm.0000263494.10865.0f] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Thirteen years have passed since the first percutaneous coronary intervention was performed at Onze Lieve Vrouwe Gasthuis in Amsterdam using the transradial approach (TRA). Since then TRA has spread through the interventional community and many centres have now adopted TRA as the arterial access of choice. This review is focused on the hot issues and the latest developments in this field. The following subjects will be addressed and discussed: drawbacks and learning curve, procedural technique, indications (with particular attention to acute coronary patients), complications, contraindications, nurse workload, patient management, and economics.
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MESH Headings
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/economics
- Angioplasty, Balloon, Coronary/education
- Angioplasty, Balloon, Coronary/methods
- Angioplasty, Balloon, Coronary/nursing
- Cardiac Catheterization/adverse effects
- Cardiac Catheterization/economics
- Cardiac Catheterization/methods
- Cardiac Catheterization/nursing
- Clinical Competence
- Contraindications
- Curriculum
- Education, Medical, Graduate
- Health Care Costs
- Humans
- Internship and Residency
- Myocardial Infarction/therapy
- Nurse's Role
- Patient Selection
- Radial Artery
- Risk Assessment
- Treatment Outcome
- Workload
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Affiliation(s)
- Giovanni Amoroso
- Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
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Park SJ, Park JH, Lee JH, No SP, Park HS, Park YK, Lee MS, Choi SW, Jeong JO, Seong IW. The Clinical Feasibility of Transradial Primary Percutaneous Coronary Intervention with an ST Elevation Acute Myocardial Infarction. Korean Circ J 2007. [DOI: 10.4070/kcj.2007.37.2.72] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Soo Jin Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jae-Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Sang-Pil No
- Division of Cardiology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Hyeong Seo Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Yong Kyu Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Min Soo Lee
- Division of Cardiology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Si Wan Choi
- Division of Cardiology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - In-Whan Seong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea
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Cantor WJ, Mahaffey KW, Huang Z, Das P, Gulba DC, Glezer S, Gallo R, Ducas J, Cohen M, Antman EM, Langer A, Kleiman NS, White HD, Chisholm RJ, Harrington RA, Ferguson JJ, Califf RM, Goodman SG. Bleeding complications in patients with acute coronary syndrome undergoing early invasive management can be reduced with radial access, smaller sheath sizes, and timely sheath removal. Catheter Cardiovasc Interv 2006; 69:73-83. [PMID: 17139670 DOI: 10.1002/ccd.20897] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Our objective was to analyze the impact of arterial access site, sheath size, timing of sheath removal, and use of access site closure devices on high-risk patients with acute coronary syndromes (ACS). BACKGROUND In the SYNERGY trial, 9,978 patients with ACS were randomly assigned to receive enoxaparin or unfractionated heparin. METHODS This analysis includes 9,404 patients for whom sheath access information was obtained for the first PCI procedure or diagnostic catheterization. Comparisons of baseline, angiographic, and procedural characteristics were carried out according to access site and sheath size. RESULTS Overall, 9,404 (94%) patients underwent angiography at a median of 21 hr (25th and 75th percentiles: 5, 42) and 4,687 (50%) underwent PCI at a median of 23 hr (6,49) of enrollment. The access site was femoral for 94.9% of cases, radial for 4.4%, and brachial for 0.7%. Radial access was associated with fewer transfusions than femoral access (0.9% vs. 4.8%, P=0.007). For femoral access, the rates of noncoronary artery bypass grafting (CABG)-related TIMI major bleeding by sheath size was 1.5% for 4 or 5 French (Fr), 1.6% for 6 Fr, 3.3% for 7 Fr, and 3.8% for >or=8 Fr (P<0.0001). After adjustment for baseline characteristics, femoral access site, larger sheath size, and delayed sheath removal were independent predictors of need for transfusion. CONCLUSIONS Smaller sheaths, radial access, and timely sheath removal may mitigate the bleeding risk associated with potent antithrombotic/platelet therapy and early catheterization.
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Affiliation(s)
- Warren J Cantor
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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Valsecchi O, Vassileva A, Musumeci G, Rossini R, Tespili M, Guagliumi G, Mihalcsik L, Gavazzi A, Ferrazzi P. Failure of transradial approach during coronary interventions: Anatomic considerations. Catheter Cardiovasc Interv 2006; 67:870-8. [PMID: 16649233 DOI: 10.1002/ccd.20732] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The anatomy of the radial artery has yet to be systematically studied from the perspective of using it as a route for catheter access. We prospectively performed angiography of the arteries of the upper limb to delineate the anatomic features of the radial artery as a way to determine the feasibility of using it as a route for coronary intervention. We studied 2,211 consecutive patients submitted to transradial cardiac catheterization. In all patients, an angiography of the upper limb arteries was performed before and after procedure. Radial puncture was successful in 98.9% of patients. At angiography, anatomic variations of upper limb arteries were noted in 505 patients (22.8%) and included tortuous configurations (3.8%), stenosis (1.7%), hypoplasias (7.7%), radioulnar loop (0.8%), abnormal origin of the radial artery (8.3%), and lusoria subclavian artery (0.45%). Overall procedural success by transradial approach was 97.5%. Patients with anatomic variations of radial artery had a significantly lower puncture (96.2% vs 99.7%, P < 0.0001) and procedural (93.1% vs 98.8%, P < 0.0001) success. The procedure was successfully performed by radial approach in 98.8% of patients with tortuous configurations, 91.9% of radial stenosis, 93.9% of hypoplastic radial artery, 83.3% of radioulnar loop, 96.7% of radial axillary origin, and 60% of lusoria subclavian artery setting. Anatomic variations of the radial artery are not rare. However, they do not represent an important limitation in transradial approach if they are well documented previously.
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Affiliation(s)
- Orazio Valsecchi
- Interventional Cath Lab, Cardiovascular Department, Ospedali Riuniti of Bergamo, Italia.
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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] [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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Cantor WJ, Puley G, Natarajan MK, Dzavik V, Madan M, Fry A, Kim HH, Velianou JL, Pirani N, Strauss BH, Chisholm RJ. Radial versus femoral access for emergent percutaneous coronary intervention with adjunct glycoprotein IIb/IIIa inhibition in acute myocardial infarction--the RADIAL-AMI pilot randomized trial. Am Heart J 2005; 150:543-9. [PMID: 16169338 DOI: 10.1016/j.ahj.2004.10.043] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Accepted: 10/18/2004] [Indexed: 02/07/2023]
Abstract
BACKGROUND Transradial percutaneous coronary intervention (PCI) results in fewer vascular complications, earlier ambulation, and improved patient comfort. Limited data exist for radial access in acute myocardial infarction, where reperfusion must occur quickly. METHODS In a multicenter pilot trial, 50 patients with myocardial infarction requiring either primary or rescue PCI were randomized to radial or femoral access. All operators had previously performed at least 100 transradial cases. Procedure times were prospectively recorded. RESULTS Thrombolysis was used in 66% of the cases and glycoprotein IIb/IIIa inhibitors in 94%. Crossover from radial to femoral access was required in one case. Percutaneous coronary intervention was performed in 47 patients, with stenting in 45. One procedural failure occurred with radial access because of inability to cross the occlusion. The time from local anesthesia to first balloon inflation was 32 (25th percentile 26, 75th percentile 38) minutes for radial access and 26 (22, 33) minutes for femoral access (P = .04). There were no significant differences in contrast use or fluoroscopy time. No patient experienced major bleeding or required transfusion. Doppler studies demonstrated 2 asymptomatic radial occlusions and 2 pseudoaneurysms (1 from each group). One patient in the femoral group died 2 days after PCI. At 30 days, there were no strokes or reinfarctions and no patient required bypass surgery or repeat PCI. CONCLUSIONS Primary and rescue PCI can be performed with high success rates using either radial or femoral access. Although radial access was associated with a longer time to first balloon inflation, the difference was small and likely not clinically significant. In patients without shock, major bleeding and vascular complications are infrequent with either access site despite the high use of thrombolysis and glycoprotein IIb/IIIa inhibitors.
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Affiliation(s)
- Warren J Cantor
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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