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Saeed Al-Asad K, Martinez Salazar A, Banga S, Yavari M, Al-Abcha A, Saleh Y, Abela G. Meta-analysis Comparing Transradial With Transfemoral Access in the Treatment of Coronary Chronic Total Occlusion. Am J Cardiol 2022; 179:114-116. [PMID: 35851470 DOI: 10.1016/j.amjcard.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/15/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Khalid Saeed Al-Asad
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan
| | | | - Sandeep Banga
- Department of Cardiology, Michigan State University, East Lansing, Michigan
| | - Majid Yavari
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan
| | - Abdullah Al-Abcha
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan
| | - Yehia Saleh
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas; Department of Cardiology, Alexandria University, Alexandria, Egypt
| | - George Abela
- Department of Cardiology, Michigan State University, East Lansing, Michigan
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Meijers TA, Aminian A, van Wely M, Teeuwen K, Schmitz T, Dirksen MT, Rathore S, van der Schaaf RJ, Knaapen P, Dens J, Iglesias JF, Agostoni P, Roolvink V, Lemmert ME, Hermanides RS, van Royen N, van Leeuwen MAH. Extremity Dysfunction After Large-Bore Radial and Femoral Arterial Access. J Am Heart Assoc 2022; 11:e023691. [PMID: 35023343 PMCID: PMC9238521 DOI: 10.1161/jaha.121.023691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The use of large‐bore (LB) arterial access and guiding catheters has been advocated for complex percutaneous coronary intervention. However, the impact of LB transradial access (TRA) and transfemoral access (TFA) on extremity dysfunction is currently unknown. Methods and Results The predefined substudy of the COLOR (Complex Large‐Bore Radial PCI) trial aimed to assess upper and lower‐extremity dysfunction after LB radial and femoral access. Upper‐extremity function was assessed in LB TRA‐treated patients by the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire and lower‐extremity function in LB TFA‐treated patients by the Lower Extremity Functional Scale questionnaire. Extremity pain and effect of access site complications and risk factors on extremity dysfunction was also analyzed. There were 343 patients who completed analyzable questionnaires. Overall, upper and lower‐extremity function did not decrease over time when LB TRA and TFA were used for complex percutaneous coronary intervention, as represented by the median Quick Disabilities of the Arm, Shoulder, and Hand score (6.8 at baseline and 2.1 at follow‐up, higher is worse) and Lower Extremity Functional Scale score (56 at baseline and 58 at follow‐up, lower is worse). Clinically relevant extremity dysfunction occurred in 6% after TRA and 9% after TFA. A trend for more pronounced upper‐limb dysfunction was present in female patients after LB TRA (P=0.05). Lower‐extremity pain at discharge was significantly higher in patients with femoral access site complications (P=0.02). Conclusions Following LB TRA and TFA, self‐reported upper and lower‐limb function did not decrease over time in the majority of patients. Clinically relevant limb dysfunction occurs in a small minority of patients regardless of radial or femoral access. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03846752.
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Affiliation(s)
- Thomas A Meijers
- Department of Cardiology Isala Heart Center Zwolle the Netherlands
| | - Adel Aminian
- Department of Cardiology Centre Hospitalier Universitaire de Charleroi Charleroi Belgium
| | - Marleen van Wely
- Department of Cardiology Radboud University Medical Center Nijmegen the Netherlands
| | - Koen Teeuwen
- Department of Cardiology Catharina Hospital Eindhoven the Netherlands
| | - Thomas Schmitz
- Department of Cardiology Elisabeth Krankenhaus Essen Germany
| | | | - Sudhir Rathore
- Department of Cardiology Frimley Health NHS Foundation Trust Surrey United Kingdom
| | - René J van der Schaaf
- Department of Cardiology Onze Lieve Vrouwe Gasthuis Hospital Amsterdam the Netherlands
| | - Paul Knaapen
- Department of Cardiology VU University Medical Center Amsterdam the Netherlands
| | - Joseph Dens
- Department of Cardiology Hospital Oost-Limburg Genk Belgium
| | - Juan F Iglesias
- Department of Cardiology Geneva University Hospital Geneva Switzerland
| | | | - Vincent Roolvink
- Department of Cardiology Isala Heart Center Zwolle the Netherlands
| | - Miguel E Lemmert
- Department of Cardiology Isala Heart Center Zwolle the Netherlands
| | | | - Niels van Royen
- Department of Cardiology Radboud University Medical Center Nijmegen the Netherlands
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Meijers TA, Aminian A, van Wely M, Teeuwen K, Schmitz T, Dirksen MT, Rathore S, van der Schaaf RJ, Knaapen P, Dens J, Iglesias JF, Agostoni P, Roolvink V, Hermanides RS, van Royen N, van Leeuwen MAH. Randomized Comparison Between Radial and Femoral Large-Bore Access for Complex Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2021; 14:1293-1303. [PMID: 34020929 DOI: 10.1016/j.jcin.2021.03.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aim of this study was to investigate whether transradial (TR) percutaneous coronary intervention (PCI) is superior to transfemoral (TF) PCI in complex coronary lesions with large-bore guiding catheters with respect to clinically relevant access site-related bleeding or vascular complications. BACKGROUND The femoral artery is currently the most applied access site for PCI of complex coronary lesions, especially when large-bore guiding catheters are required. With downsizing of TR equipment, TR PCI may be increasingly applied in these patients and might be a safer alternative compared with the TF approach. METHODS An international prospective multicenter trial was conducted, randomizing 388 patients with planned PCI for complex coronary lesions, including chronic total occlusion, left main, heavy calcification, or complex bifurcation, to either 7-F TR access (TRA) or 7-F TF access (TFA). The primary endpoint was defined as access site-related clinically significant bleeding or vascular complications requiring intervention at discharge. The secondary endpoint was procedural success. RESULTS The primary endpoint event rate was 3.6% for TRA and 19.1% for TFA (p < 0.001). The crossover rate from radial to femoral access was 3.6% and from femoral to radial access was 2.6% (p = 0.558). The procedural success rate was 89.2% for TFA and 86.0% for TRA (p = 0.285). There was no difference between TFA and TRA with regard to procedural duration, contrast volume, or radiation dose. CONCLUSIONS In patients undergoing PCI of complex coronary lesions with large-bore access, radial compared with femoral access is associated with a significant reduction in clinically relevant access-site bleeding or vascular complications, without affecting procedural success. (Complex Large-Bore Radial Percutaneous Coronary Intervention [PCI] Trial [Color]; NCT03846752).
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Affiliation(s)
- Thomas A Meijers
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Marleen van Wely
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Koen Teeuwen
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Thomas Schmitz
- Department of Cardiology, Elisabeth Krankenhaus, Essen, Germany
| | - Maurits T Dirksen
- Department of Cardiology, Northwest Clinics, Alkmaar, the Netherlands
| | - Sudhir Rathore
- Department of Cardiology, Frimley Health NHS Foundation Trust, Surrey, United Kingdom
| | - René J van der Schaaf
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Joseph Dens
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | - Juan F Iglesias
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | | | - Vincent Roolvink
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands
| | | | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
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Wang H, Wang HY, Yin D, Feng L, Song WH, Wang HJ, Zhu CG, Dou KF. Early radial artery occlusion following the use of a transradial 7-French sheath for complex coronary interventions in Chinese patients. Catheter Cardiovasc Interv 2021; 97 Suppl 2:1063-1071. [PMID: 33749972 DOI: 10.1002/ccd.29653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES We aimed to explore the impact of 7-Fr sheaths on the incidence of early radial artery occlusion (RAO) after transradial coronary intervention (TRI) in Chinese patients. BACKGROUND RAO precludes future use of the vessel for vascular access. Transradial catheterization is usually performed via 5-Fr or 6-Fr catheters; 7-Fr sheath insertion enables complex coronary interventions but may increase the RAO risk. METHODS We prospectively enrolled 130 consecutive patients undergoing complex TRI using 7-Fr sheaths. Radial artery ultrasound assessment was performed before and after TRI. Early RAO was defined as the absence of flow on ultrasound within 6-24 hr after TRI. Multivariate logistic regression was used to determine the factors related to early RAO after TRI. RESULTS 7-Fr sheaths were mainly used for chronic total occlusion (44.6%), bifurcation (30.0%), and tortuous calcification (25.4%) lesions. All patients were successfully sheathed. Percutaneous coronary intervention (PCI) procedural success was 96.2%; 119 patients (91.5%) had preserved radial artery patency after TRI. All 11 RAO cases (8.5%) were asymptomatic. The radial artery diameter was significantly larger postoperatively (3.1 ± 0.4 mm) than preoperatively (2.6 ± 0.5 mm) (p < .001). No parameters significantly differed between patients with and without RAO. TRI history was the only independent risk factor of early RAO (odds ratio: 6.047, 95% confidence interval: 1.100-33.253, p = .039). CONCLUSIONS 7-Fr sheath use after transradial access for complex PCI is feasible and safe. Evaluating the radial artery within 24 hr after TRI allows timely RAO recognition, important for taking measures to maintain radial artery patency and preserve access for future TRIs.
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Affiliation(s)
- Hao Wang
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao-Yu Wang
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Yin
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Feng
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei-Hua Song
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-Jian Wang
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cheng-Gang Zhu
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ke-Fei Dou
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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