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Mufarrih SH, Haider S, Qureshi NQ, Khan MS, Kazimuddin M, Akbar MS, Saleem S, Mufarrih SA, Tripathi A, Singh A, Waheed MA. Distal Versus Proximal Radial Arterial Access for Percutaneous Coronary Angiography and Intervention: Updated Meta-Analysis of Randomized Controlled Trials. Am J Cardiol 2024; 218:34-42. [PMID: 38432336 DOI: 10.1016/j.amjcard.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/23/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
Radial artery occlusion (RAO) is a major impediment to reintervention in patients who underwent proximal transradial access (p-TRA) for coronary catheterization. Distal transradial access (d-TRA) at the level of snuffbox distal to the radial artery bifurcation is a novel alternative to p-TRA. We conducted an updated meta-analysis of all available randomized controlled trials (RCTs) to compare the incidence of RAO between p-TRA and d-TRA, along with access site-related complications. PubMed, Web of Science, and Google Scholar were searched for RCTs published since 2017 to October 2023 comparing d-TRA and p-TRA for coronary angiography and/or intervention. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals were calculated using the random-effects model for procedural and clinical outcomes for the 2 approaches. A total of 18 RCTs with 8,205 patients (d-TRA n = 4,096, p-TRA n = 4,109) were included. The risk of RAO (RR 0.31, 0.21 to 0.46, p ≤0.001) and time to hemostasis (minutes) (MD -51.18, -70.62 to -31.73, p <0.001) was significantly lower in the d-TRA group. Crossover rates (RR 2.39, 1.71 to 3.32, p <0.001), access time (minutes) (MD 0.93, 0.50 to 1.37, p <0.001), procedural pain (MD 0.46, 0.13 to 0.79, p = 0.006), and multiple puncture attempts (RR 2.13, 1.10 to 4.11, p = 0.03) were significantly higher in the d-TRA group. The use of d-TRA for coronary angiography and/or intervention is associated with a lower risk of RAO at the forearm and may preserve p-TRA site for reintervention in selective patients by reducing the incidence of RAO.
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Affiliation(s)
| | - Sajjad Haider
- Department of Medicine, University of Kentucky, Bowling Green, Kentucky; Department of Cardiology, Western Kentucky Heart and Lung, Bowling Green, Kentucky
| | | | - Mohammad Saud Khan
- Department of Medicine, University of Kentucky, Bowling Green, Kentucky; Department of Cardiology, Western Kentucky Heart and Lung, Bowling Green, Kentucky
| | - Mohammed Kazimuddin
- Department of Medicine, University of Kentucky, Bowling Green, Kentucky; Department of Cardiology, Western Kentucky Heart and Lung, Bowling Green, Kentucky
| | - Muhammad Shoaib Akbar
- Department of Medicine, University of Kentucky, Bowling Green, Kentucky; Department of Cardiology, Western Kentucky Heart and Lung, Bowling Green, Kentucky
| | - Sameer Saleem
- Department of Medicine, University of Kentucky, Bowling Green, Kentucky; Department of Cardiology, Western Kentucky Heart and Lung, Bowling Green, Kentucky
| | | | - Avnish Tripathi
- Department of Cardiology, CHI St. Vincent, Heart Clinic Arkansas, Little Rock, Arizona
| | - Aniruddha Singh
- Department of Medicine, University of Kentucky, Bowling Green, Kentucky; Department of Cardiology, Reading Hospital, West Reading, Pennsylvania
| | - Mohammad Abdul Waheed
- Department of Medicine, University of Kentucky, Bowling Green, Kentucky; Department of Cardiology, Western Kentucky Heart and Lung, Bowling Green, Kentucky
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Chen T, Li L, Li F, Lu W, Shi G, Li W, Yang A, Huang H, Xiao J, Zhang Q, Gu J, Xue S, Zhang L, Li L, Xu L, Ji R, Wang H, Cai G. Comparison of long-term radial artery occlusion via distal vs. conventional transradial access (CONDITION): a randomized controlled trial. BMC Med 2024; 22:62. [PMID: 38331793 PMCID: PMC10854098 DOI: 10.1186/s12916-024-03281-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/01/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The distal transradial access (dTRA) has become an attractive and alternative access to the conventional transradial access (TRA) for cardiovascular interventional diagnosis and/or treatment. There was a lack of randomized clinical trials to evaluate the effect of the dTRA on the long-term radial artery occlusion (RAO). METHODS This was a prospective, randomized controlled study. The primary endpoint was the incidence of long-term RAO at 3 months after discharge. The secondary endpoints included the successful puncture rate, puncture time, and other access-related complications. RESULTS The incidence of long-term RAO was 0.8% (3/361) for dTRA and 3.3% (12/365) for TRA (risk ratio = 0.25, 95% confidence interval = 0.07-0.88, P = 0.02). The incidence of RAO at 24 h was significantly lower in the dTRA group than in the TRA group (2.5% vs. 6.7%, P < 0.01). The puncture success rate (96.0% vs. 98.5%, P = 0.03) and single puncture attempt (70.9% vs. 83.9%, P < 0.01) were significantly lower in the dTRA group than in the TRA group. However, the number of puncture attempts and puncture time were higher in the dTRA group. The dTRA group had a lower incidence of bleeding than the TRA group (1.5% vs. 6.0%, P < 0.01). There was no difference in the success rate of the procedure, total fluoroscopy time, or incidence of other access-related complications between the two groups. In the per-protocol analysis, the incidence of mEASY type ≥ II haematoma was significantly lower in the dTRA group, which was consistent with that in the as-treated analysis. CONCLUSIONS The dTRA significantly reduced the incidence of long-term RAO, bleeding or haematoma. TRIAL REGISTRATION ClinicalTrials.gov identifer: NCT05253820.
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Affiliation(s)
- Tao Chen
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Lamei Li
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Feng Li
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Wei Lu
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Ganwei Shi
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Wenhua Li
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Anni Yang
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Hui Huang
- Department of Cardiology, Jiangyin Hospital of Traditional Chinese Medicine, Wuxi, 214400, Jiangsu Province, China
| | - Jianqiang Xiao
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Qiuwei Zhang
- Department of Catheter Room, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Jun Gu
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Sheliang Xue
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Liuyan Zhang
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Li Li
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Lingxia Xu
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Rongrong Ji
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Haibo Wang
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, 100191, China.
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, 38 Xueyuan St, Haidian District, Beijing, 100191, China.
| | - Gaojun Cai
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China.
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Mohammed MK, Andraska EA, Mohapatra A, Avgerinos ED, Madigan MC, Salem KM. Incidence and Outcomes of Visceral Ischemia in Acute Aortic Occlusion. Ann Vasc Surg 2024; 98:164-172. [PMID: 37516427 DOI: 10.1016/j.avsg.2023.07.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Acute aortic occlusion (AAO) is a morbid diagnosis in which mortality correlates with severity of ischemia on presentation. Visceral ischemia (VI) is challenging to diagnose and its presentation as a consequence of AAO is not well-studied. We aim to identify characteristics associated with VI in AAO to facilitate diagnosis. METHODS Patients diagnosed with AAO who underwent revascularization were identified retrospectively from institutional records (2006-2020). The primary outcome was the development of VI (intra-abdominal ischemia). Univariate analysis was used to compare demographic, exam, imaging, and intraoperative variables between patients with and without VI in the setting of AAO. RESULTS Ninety-one patients were included. The prevalence of VI was 20.9%. Preoperative comorbidities, time to revascularization, and operative approach did not differ between patients with and without VI. Patients with VI more frequently were transferred from outside institutions (100% vs. 53%, P = 0.02), presented with advanced acute limb ischemia (Rutherford III 36.9% vs. 7.5%, P < 0.01), and had elevated preoperative serum lactate (4.31 vs. 2.41 mmol/L, P < 0.01). VI patients had an increased occurrence of bilateral internal iliac artery (IIA) occlusion (47.4% vs. 18.1%, P = 0.01). Unilateral IIA occlusion, level of aortic occlusion, and patency of inferior mesenteric arteries were not associated with VI. Patients with VI had worse postoperative outcomes. In particular, VI conferred significant risk of mortality (odds ratio 5.45, P < 0.01). CONCLUSIONS Visceral ischemia is a common consequence of AAO. Elevated lactate, bilateral IIA occlusion, and advanced acute limb ischemia (ALI) should increase clinical suspicion for concomitant VI with AAO and may facilitate earlier diagnosis to improve outcomes.
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Affiliation(s)
- Maryam K Mohammed
- Division of Vascular Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Elizabeth A Andraska
- Division of Vascular Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Efthymios D Avgerinos
- Division of Vascular Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Michael C Madigan
- Division of Vascular Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Karim M Salem
- Division of Vascular Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA; Division of Vascular Surgery, VA Pittsburgh Healthcare System, Pittsburgh, PA.
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Gokdemir M, Cindik N. Risk factors and frequency of acute and permanent femoral arterial occlusion in neonates with CHD who undergo ultrasound-guided femoral arterial access. Cardiol Young 2023; 33:1574-1580. [PMID: 36062562 DOI: 10.1017/s1047951122002608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We investigated frequency and risk factors of acute loss of the arterial pulse and permanent femoral arterial occlusion in neonates with CHD who underwent ultrasound-guided femoral arterial access. METHODS We divided the patients into groups according to the presence of acute loss of the arterial pulse and permanent femoral arterial occlusion. We obtained data related to patient characteristics and access variables of ultrasound-guided femoral arterial access from our database of cardiac catheterisation between August, 2017 and May, 2021. We used an echocardiography-S6, 12-MHz linear probe, 21-gauge needle, 0.018"guidewire, and a 4F sheath for arterial access. RESULTS Ultrasound-guided femoral arterial access was obtained in 323 (98.8%) of the 327 neonates. We identified acute loss of the arterial pulse in 130 (40.2%) patients and permanent femoral arterial occlusion in 19 (5.9%) patients. Median weight was 3.05 (Interquartile range (IQR): 2.80-3.40) kg, first attempt success rate was 88.2%, and median access time was 46 sec (IQR: 23-94). Logistic regression analysis identified coarctation of the aorta (odds ratio: 2.46; 95% CI: 1.30-4.66; p = 0.006) as independent risk factor for acute loss of the arterial pulse, but did not identify any independent risk factors for permanent femoral arterial occlusion. CONCLUSIONS This study showed coarctation of the aorta as an independent risk factor for acute loss of the arterial pulse, but did not identify any independent factors for permanent femoral arterial occlusion in neonates with CHD. Although most cases of acute loss of the arterial pulse resolve in the early period, the frequency of permanent femoral arterial occlusion remains high despite effective treatment.
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Affiliation(s)
- Mahmut Gokdemir
- Division of Pediatric Cardiology, Baskent University Faculty of Medicine, Konya, Turkey
| | - Nimet Cindik
- Division of Pediatric Cardiology, Baskent University Faculty of Medicine, Konya, Turkey
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Schlosser J, Herrmann L, Böhme T, Bürgelin K, Löffelhardt N, Nührenberg T, Mashayekhi K, Valina CM, Neumann FJ, Hochholzer W. Incidence and predictors of radial artery occlusion following transradial coronary angiography: the proRadial trial. Clin Res Cardiol 2023; 112:1175-1185. [PMID: 36074269 PMCID: PMC10449957 DOI: 10.1007/s00392-022-02094-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This study investigated the contemporary incidence and predictors of radial artery occlusion as well as the effectiveness of antithrombotic treatment for radial artery occlusion following transradial coronary angiography. BACKGROUND The radial artery is the standard access for coronary angiography and even complex interventions. Postprocedural radial artery occlusion is still a common and significant complication. METHODS This prospective study enrolled 2004 patients following transradial coronary angiography. After sheath removal, hemostasis was obtained in a standardized fashion. Radial artery patency was evaluated by duplex ultrasonography in all patients. In case of occlusion, oral anticoagulation was recommended and patients were scheduled for a 30-day follow-up including Doppler ultrasonography. RESULTS A new-diagnosed radial occlusion was found in 4.6% of patients. The strongest independent predictors of radial occlusion were female sex and active smoking status. In the subgroup of patients with percutaneous coronary interventions, female sex followed by sheath size > 6 French were the strongest predictors of radial occlusion. 76 of 93 patients with radial occlusion received an oral anticoagulation for 30 days. However, reperfusion at 30 days was found in 32% of patients on oral anticoagulation. CONCLUSION The incidence of radial artery occlusion following coronary angiography in contemporary practice appears with 4.6% to be lower as compared to previous cohorts. Female sex and smoking status are the strongest independent predictors of radial occlusion followed by procedural variables. The limited effectiveness of oral anticoagulation for treatment of radial artery occlusion suggests a primarily traumatic than thrombotic mechanism of this complication.
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Affiliation(s)
- Julia Schlosser
- Department of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
| | - Laura Herrmann
- Department of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Tanja Böhme
- Department of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Karlheinz Bürgelin
- Department of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Nikolaus Löffelhardt
- Department of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Thomas Nührenberg
- Department of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Christian M Valina
- Department of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Willibald Hochholzer
- Department of Internal Medicine and Cardiology, Klinikum Wuerzburg Mitte, Würzburg, Germany
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Pacchioni A, Pesarini G, Sanz-Sanchez J, Sgueglia GA, Bellamoli M, Ferro J, Mugnolo A, Morandin R, Penzo C, Turri R, Guiducci V, Benfari G, Giovannini D, Saccà S, Ribichini FL, Versaci F, Biondi-Zoccai G, Reimers B. Radial artery occlusion after transradial procedures: impact on 1-year adverse events. Minerva Cardiol Angiol 2023; 71:414-420. [PMID: 36468762 DOI: 10.23736/s2724-5683.22.06112-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Radial artery occlusion after transradial procedures is a frequent iatrogenic thrombotic process. The impact on prognosis has not been investigated. This study sought to investigate whether radial artery occlusion is related to increased risk of major adverse cardiac and cerebrovascular events, defined as death, myocardial infarction, stroke and coronary revascularization. METHODS Eight hundred thirty-seven consecutive patients who underwent a transradial coronary procedure had patency of radial artery checked at 24 hours. Radial artery occlusion occurred in 41 over 837 patients (4.8%); 764 (91.2%) were available for planned follow-up at 1 year and were included in the analysis. Event-free survival rate between patients with and without radial artery occlusion was calculated using Kaplan-Meier estimates, and Cox proportional-hazards models were used to identify independent risk factors. RESULTS At a median 370-day follow-up (IQR: 366-375 days), adverse events occurred in 37 patients (4.8%), 2 in patients with radial artery occlusion and 35 in patients without. One-year survival rate was 94.9% vs. 95% (unadjusted HR=1.026, 95% CI: 0.24 to 4.6, P=0.9). After multivariable modeling, age and coronary artery disease extension was associated with increased risk of adverse events. CONCLUSIONS Age and coronary artery disease extension were independent predictors of adverse events at follow-up. RAO had no prognostic impact.
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Affiliation(s)
- Andrea Pacchioni
- Division of Cardiology, Ospedale Civile, Mirano, Venice, Italy -
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Jorge Sanz-Sanchez
- Division of Cardiology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
- Division of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain
- Centro de Investigation Biomedica en Red (CIBERCV), Madrid, Spain
| | | | - Michele Bellamoli
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Jayme Ferro
- Arcispedale Santa Maria, Reggio Emilia, Italy
| | - Antonio Mugnolo
- Division of Cardiology, Ospedale Civile, Mirano, Venice, Italy
| | - Riccardo Morandin
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Carlo Penzo
- Division of Cardiology, Ospedale Civile, Mirano, Venice, Italy
| | - Riccardo Turri
- Division of Cardiology, Ospedale Civile, Mirano, Venice, Italy
| | | | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Davide Giovannini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Salvatore Saccà
- Division of Cardiology, Ospedale Civile, Mirano, Venice, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Versaci
- UOC of Hemodynamics and Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Bernhard Reimers
- Division of Cardiology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
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Rahman A, Uddin MJ, Hussain KS, Dutta B, Rahaman MA, Ahmed S, Huda SN, Mondal B, Chowdhury MF, Jahan F. Effect of Duration of Hemostatic Compression on Radial Artery Occlusion after Transradial Percutaneous Coronary Intervention. Mymensingh Med J 2023; 32:386-392. [PMID: 37002749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Radial artery occlusion (RAO) is now a major concern in transradial approach (TRA). RAO limits future radial artery use for further TRA, for as a conduit during CABG, for invasive hemodynamic monitoring and for creation of arteriovenous fistula for hemodialysis in Chronic Kidney Disease (CKD) patients through same vascular approach. The effect of duration of hemostatic compression of RAO is unknown in Bangladesh. This prospective observational study was conducted in the department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh (NICVD) from September 2018 to August 2019, to evaluate the effect of duration of hemostatic compression on the incidence of radial artery occlusion (RAO) after transradial percutaneous coronary intervention. A total of 140 patients underwent percutaneous coronary intervention (PCI) through TRA. RAO was defined as an absence of antegrade flow or monophasic flow or invert flow on Duplex study. In this study 70 patients (Group I) received 2 hours hemostatic compression after transradial PCI. Another 70 patients (Group II) received 6 hours hemostatic compression after transradial PCI. Radial arterial blood flow assessed at early (24 hours) and late (30 days) by color duplex study after the procedure in both groups. Early radial artery occlusion occurred in 4.3% of patients in Group I and 12.8% of patients in Group II, (p=0.04). Late radial artery occlusion occurred in 2.8% of patients in Group I and 11.4% of patients in Group II, the difference was statistically significant (p=0.04). From multivariate logistic regression analysis duration of hemostatic compression time 6 hours (p=0.01), post-procedural nitroglycerine use (p=0.03) and procedure time (p=0.03) were predictors of RAO. Shorter duration of hemostatic compression is associated with a lower incidence of early and late radial artery occlusion after transradial intervention.
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Affiliation(s)
- A Rahman
- Dr Atikur Rahman, Assistant Registrar, Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh; E-mail:
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Korotkikh A, Babunashvili A, Kaledin A, Akhramovich R, Derkach V, Portnov R, Kartashov D, Kazantsev A. Distal Radiation Access as an Alternative to Conventional Radial Access for Coronary Angiography and Percutaneous Coronary Interventions (According to TENDERA Trial). Curr Probl Cardiol 2023; 48:101546. [PMID: 36535496 DOI: 10.1016/j.cpcardiol.2022.101546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
The aim of this study was to assess the immediate and medium-term (3 months) results of the safety and efficacy of distal radial access (DRA) in coronary interventions compared with conventional transradial radial access (TRA). TRA is the recommended access for coronary procedures because of increased safety: fewer local complications, large and small bleeding. Recently, DRA has emerged as a promising alternative access to minimize radial artery occlusion (RAO) risk, as well as other complications. A large-scale, international, randomized trial comparing medium-term results with TRA and DRA is lacking. An analysis of 776 patients of the prospective randomized TENDERA trial was carried out: the distal artery access group (DRA) - 391, the transradial access group (TRA) - 385. Statistically more often the crossover access was in the DRA group (5.1% and 0.8%, P < 0.001). The primary endpoint was early or late thrombosis/occlusion of the radial artery (RA). Secondary endpoints: (1) composite complications from access vessels; (2) access parameters. Statistically significant differences were obtained for the primary endpoint: DRA 2.7% (n = 10), TRA 6.8% (n = 26), P = 0.008. Occlusion of the distal radial artery (DRAt), with patent RA: DRA 1.3% (n = 5), TRA 0 (0), P = 0.023. At the secondary composite endpoint, statistically significant differences were obtained for the following groups of complications: BARC type I bleeding (DRA: 3.8% (n = 14), TRA: 21.7% (n = 83), P < 0.001); hematoma larger than 5 cm on day 1 (DRA: 10% [n = 37], TRA: 25.9% [n = 98], P < 0.001); hematoma larger than 5 cm on day 7 (DRA: 12.4% [n = 45], TRA: 34.6% [n = 132], P < 0.001). Of the access parameters, the following statistically significantly differed: puncture time DRA 19.0 (8.0; 50), TRA 13.5 (5.0; 29), P < 0.001; insertion of introducer DRA 42.0 (26.0; 84.0), TRA 35.0 (23.0; 55.0), P < 0.001, access artery hemostasis duration (min.) DRA 180.0 (120.0; 480.0), TRA 155.0 (115.0; 195.0), P < 0.001. The duration of the procedure and fluoroscopy, radiation dose, RA spasm in both groups had no statistically significant differences. In the TENDERA trail, DRA demonstrated efficacy and safety in interventional coronary interventions compared with TRA in the medium-term follow-up period: a statistically significant lower incidence of RA occlusion and local complications.
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Affiliation(s)
- A Korotkikh
- Cardiac Surgery Department, Cardiac Surgery Clinic, Amur State Medical Academy, Blagoveshchensk, Russia.
| | - A Babunashvili
- Endovascular Surgery Department, Center for Endosurgery and Lithotripsy, Moscow, Russia; Department of Interventional Cardioangiology, Sechenov University, Moscow, Russia
| | - A Kaledin
- Endovascular Surgery Department, Northwestern State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia
| | - R Akhramovich
- Endovascular Surgery Department, Mytishchi City Clinical Hospital, Mytishchi, Russia
| | - V Derkach
- Endovascular Surgery Department, Clinic of Innovative Surgery, Klin, Russia
| | - R Portnov
- Endovascular Surgery Department, Clinic of Innovative Surgery, Klin, Russia
| | - D Kartashov
- Endovascular Surgery Department, Center for Endosurgery and Lithotripsy, Moscow, Russia; End ovascular Surgery Department, Center for Endosurgery and Lithotripsy, Moscow Regional Research Clinical Institute named after M. F. Vladimirsky, Moscow, Russia
| | - A Kazantsev
- Vascular Surgery Department, Kostroma Regional Clinical Hospital named after E. I. Korolev, Kostroma, Russia
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Abdelazeem B, Abuelazm MT, Swed S, Gamal M, Atef M, Al-Zeftawy MA, Noori MA, Lutz A, Volgman AS. The efficacy of nitroglycerin to prevent radial artery spasm and occlusion during and after transradial catheterization: A systematic review and meta-analysis of randomized controlled trials. Clin Cardiol 2022; 45:1171-1183. [PMID: 36335609 DOI: 10.1002/clc.23906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/07/2022] Open
Abstract
Radial artery spasm (RAS) is the most common cause of transradial access site crossover and is a common intra-procedural complication. RAS incidence can lead to radial artery occlusion (RAO) postprocedure, preventing the radial artery as a future access site. We evaluated the efficacy of nitroglycerin preventing RAS and RAO during transradial catheterization discussing the different routes of administration, including topical, subcutaneous, and intra-arterial. A systematic review and meta-analysis included all relevant articles until April 23, 2022. We searched six databases Google Scholar, Web of Science, SCOPUS, EMBASE, PubMed (MEDLINE), and CENTRAL. We registered our review protocol in PROSPERO with ID: CRD42022330356. We included 11 trials with 5814 patients. Compared to placebo, the pooled analysis favored subcutaneous nitroglycerin in preventing RAS (risk ratio [RR]: 0.57 with 95% confidence interval [CI] [0.43-0.77], p = .0003) and RAO (RR: 0.39 with 95% CI [0.16-0.98], p = .05). In contrast to the intra-arterial nitroglycerin that showed nonstatistically significant results in preventing RAS and RAO (RR: 0.8 with 95% CI [0.63-1.02], p = .07)- (RR: 0.78 with 95% CI [0.6-1.01], p = .06)), respectively. Also, topical nitroglycerin did not prevent RAS (RR: 0.73 with 95% CI [0.42-1.24], p = .24). Compared with placebo, subcutaneous nitroglycerin during transradial catheterization reduced the incidence of RAS and RAO. Meanwhile, Intra-arterial and topical nitroglycerin did not show statistically significant outcomes. Subcutaneous nitroglycerin may be a practical and cost-effective technique to facilitate transradial catheterization; however, more RCTs are needed to evaluate the subcutaneous versus intra-arterial nitroglycerin administration.
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Affiliation(s)
- Basel Abdelazeem
- McLaren Health Care, Flint, Michigan, USA
- Michigan State University, East Lansing, Michigan, USA
| | | | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | | | - Mostafa Atef
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Anthony Lutz
- Michigan State University, East Lansing, Michigan, USA
- Division of Cardiology, Beaumont Hospital, Farmington Hills, Michigan, USA
| | - Annabelle S Volgman
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
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10
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Shih PK, Chen JX, Lin MC, Wu SC. Risk of peripheral artery occlusive disease in patients with lower leg fracture who received fixation and non-fixation treatments: A population cohort study. PLoS One 2022; 17:e0272068. [PMID: 35925984 PMCID: PMC9352030 DOI: 10.1371/journal.pone.0272068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Abstract
Background The risk of peripheral artery occlusive disease (PAOD) in patients with lower leg fracture who underwent fixation procedures is not yet completely understood. Therefore, the current study aimed to examine the risk of subsequent PAOD in patients with lower leg fracture who received fixation and non-fixation treatments. Methods We included 6538 patients with lower leg fracture who received non-fixation treatment and a matched cohort comprising 26152 patients who received fixation treatment from the National Health Insurance Database. Patients were frequency matched according to age, sex, and index year. The incidence and risk of PAOD in patients with lower leg fracture who received fixation and non-fixation treatments were evaluated via the stratification of different characteristics and comorbidities. Results Non-fixation treatment, male sex, older age (≥ 50 years old), diabetes mellitus, and gout were associated with a significantly higher risk of lower extremity PAOD compare to each comparison group, respectively. Moreover, there was a significant correlation between fixation treatment and a lower risk of lower extremity PAOD in women (adjusted hazard ratio [aHR] = 0.58, 95% confidence interval [CI] = 0.38–0.90), women aged > 50 years (aHR = 0.61, 95% CI = 0.38–0.96), and patients with coronary artery disease (aHR = 0.43, 95% CI = (0.23–0.81). Further, patients with fixation treatment had a significantly lower risk of lower extremity PAOD within 2 years after trauma (aHR = 0.57, 95% CI = 0.34–0.97). The Kaplan–Meier analysis showed that the cumulative incidence of PAOD was significantly higher in the non-fixation treatment group than in the fixation treatment group at the end of the 10-year follow-up period (log-rank test: P = 0.022). Conclusion Patients with lower leg fracture who received non-fixation treatment had a significantly higher risk of PAOD than those who received fixation treatment. Moreover, the risk of PAOD was higher in women aged > 50 years, as well as in coronary artery disease patients who received non-fixation treatment than in those who received fixation treatment. Therefore, regular assessment of vessel patency are recommended for these patients. Nevertheless, further studies must be conducted to validate the results of our study.
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Affiliation(s)
- Pin-Keng Shih
- School of medicine, China Medical University, Taichung, Taiwan
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Jian-Xun Chen
- School of medicine, China Medical University, Taichung, Taiwan
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Mei-Chen Lin
- School of medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University and Hospital, Taichung, Taiwan
| | - Shih-Chi Wu
- School of medicine, China Medical University, Taichung, Taiwan
- Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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11
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Bigler MR, Buffle E, Rappo MV, Grossenbacher R, Tschannen C, Seiler C. Association of Palmar Arch Collateral Function and Radial Artery Occlusion After Transradial Access. Am J Cardiol 2022; 168:151-158. [PMID: 35065801 DOI: 10.1016/j.amjcard.2021.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/19/2022]
Abstract
The prevalence and implications of radial artery occlusion (RAO) after transradial catheterization are an intensely discussed topic, resulting in numerous preventive strategies such as adjusted anticoagulation, residual-patency hemostasis, or distal puncture site. The present study aimed at assessing an association of palmar arch, in particular radial artery collateral function and RAO after transradial access (TRA) catheterization. Radial artery collateral function was determined using radial artery pressure signals in the nonobstructed vessel and during brief manual occlusion of the more proximal radial artery. Collateral flow index, the ratio of mean occlusive divided by mean nonocclusive arterial blood pressure, both subtracted by central venous pressure, was determined during manual RAO (radial artery collateral flow index [CFIrad]). The presence or absence of RAO was determined by Doppler ultrasound at least 3 months after TRA. A total of 630 patients with TRA coronary angiography underwent palmar arch, that is, radial and radial plus ulnar artery collateral function assessment. CFIrad was equal to 0.808 ± 0.144 (95% confidence interval 0.797 to 0.819). A total of 200 patients underwent Doppler ultrasound examination of their forearm arterial circulation 301 ± 140 days after TRA. Eight (4%) patients showed signs of RAO, 4 of whom (2%) had a complete RAO and 4 (2%) a stenosis above 30%. Patients with RAO showed a higher CFIrad than those without RAO: 0.900 ± 0.074 versus 0.801 ± 0.154 (p = 0.006). In conclusion, complete RAO as determined by Doppler ultrasound later than 3 months after TRA is rare (2%). In the long run, RAO appears to be related to a very well-developed radial artery collateral function.
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Affiliation(s)
- Marius R Bigler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eric Buffle
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michèle V Rappo
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raphael Grossenbacher
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christine Tschannen
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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12
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Dwivedi SK, Sharma AK, Nayak GR, Chaudhary GK, Chandra S, Pradhan A, Vishwakarma P, Bhandari M, Sethi R. Factors influencing radial artery occlusion after transradial coronary intervention in the Indian population. Anatol J Cardiol 2022; 26:105-111. [PMID: 35190358 DOI: 10.5152/anatoljcardiol.2021.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
| | - Akhil Kumar Sharma
- Department of Cardiology, King George's Medical University; Lucknow-India
| | - Gyan Ranjan Nayak
- Department of Cardiology, King George's Medical University; Lucknow-India
| | | | - Sharad Chandra
- Department of Cardiology, King George's Medical University; Lucknow-India
| | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University; Lucknow-India
| | | | - Monika Bhandari
- Department of Cardiology, King George's Medical University; Lucknow-India
| | - Rishi Sethi
- Department of Cardiology, King George's Medical University; Lucknow-India
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13
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Hsu KF, Chiu YL, Chiao HY, Chen CY, Chang CK, Wu CJ, Peng YJ, Wang CH, Dai NT, Chen SG, Tzeng YS. Negative-pressure wound therapy combined with artificial dermis (Terudermis) followed by split-thickness skin graft might be an effective treatment option for wounds exposing tendon and bone: A retrospective observation study. Medicine (Baltimore) 2021; 100:e25395. [PMID: 33832132 PMCID: PMC8036026 DOI: 10.1097/md.0000000000025395] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/14/2021] [Indexed: 01/05/2023] Open
Abstract
Skin grafts are not suitable for closing tendon- or bone-exposing wounds, which require flap surgery. Dermal regeneration templates have value for closing such wounds, but the disadvantages of the technique include implantation failures because of infection, hematoma formation, or inappropriate immobilization. Negative-pressure wound therapy was reported to increase graft acceptance in difficult wounds.This retrospective case series of 65 patients evaluated negative-pressure therapy combined with artificial dermis for the treatment of acute or chronic tendon- or bone-exposing wounds. The artificial dermis was placed after adequate wound-bed preparation, with simultaneous application of a vacuum-assisted closure system. Split-thickness skin grafting was performed after the implanted artificial dermis had become established.The overall success rate was 88.1% (59/67): 88.6% (39/44) in the chronic wounds group and 87% (20/23) in the acute-trauma group separately. The overall mean survival time of artificial dermis in success cases was 13.24 ± 7.14 days. In separately, the survival time of artificial dermis had no statistically difference in chronic wound group (13.64 ± 7.53 vs 12.60 ± 5.86. P = .943), but had significant statistical difference in acute trauma group (12.45 ± 6.44 days vs 23.33 ± 4.04 days, P = .018). Also, comorbidity of PAOD was found a strong risk factor of failure in chronic wound group (100% vs 23.1%, P < 0.001).We concluded that artificial dermis combined with negative-pressure therapy followed by split-thickness skin grafting might be a reliable and effective option for surgical reconstruction of tendon- or bone-exposing wounds, and could decreasing waiting periods of autologous skin graft.
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Affiliation(s)
- Kuo-Feng Hsu
- Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Yu-Lung Chiu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
| | - Hao Yu Chiao
- Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Chun-Yu Chen
- Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Chun-Kai Chang
- Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Chien-Ju Wu
- Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Yi-Jen Peng
- Department of Pathology, Tri-Service General Hospital
| | - Chih-Hsin Wang
- Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Niann-Tzyy Dai
- Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Shyi-gen Chen
- Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Yuan-Sheng Tzeng
- Department of Surgery, Division of Plastic and Reconstructive Surgery
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14
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Fujimura N, Hosokawa K, Obara H, Igari K, Akamatsu D, Matsumoto H, Asami A, Shibutani S, Akiyoshi T, Nunokawa M, Harada H, Inoue K, Koya A, Furuyama T, Sagara D, Shintani T, Yamaoka T, Akiyama Y, Inoue Y, Hoshina K. Incidence, diagnosis and treatment of popliteal artery entrapment syndrome in current vascular practice in Japan. Cardiovasc Interv Ther 2020; 36:506-513. [PMID: 32989708 DOI: 10.1007/s12928-020-00710-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 09/16/2020] [Indexed: 11/30/2022]
Abstract
Few data regarding popliteal artery entrapment syndrome (PAES) is available in Japan. In this study, we investigated incidence, diagnosis and treatment of PAES in current vascular practice. A retrospective analysis of all patients with PAES visiting 31 participating institutes between 2003 and 2015 was conducted. Thirty-five limbs (28 patients) were identified during the 13-year study period, and the incidence of PAES was 0.12% of all peripheral artery disease cases revascularized. Mean age was 32.0 ± 16.9 years old, and 60 and more years old was 10.7%. Also, 92.9% were male and 39.3% were athletes. Most frequent initial symptoms were intermittent claudication in 23 limbs (65.7%); 4 limbs (11.4%) had chronic limb-threatening ischemia. CT scan was most frequently (94.3%) used for the diagnostic imaging followed by MRI (45.7%) and duplex ultrasound (45.7%). Stress test such as dorsal flexion during duplex ultrasound was used only in 28.6%. Thirty-two limbs (91.4%) received surgical treatment, including 23 arterial reconstructions (71.9%); there were no major perioperative complications. All patients achieved improvement of their symptoms, and the average ankle brachial index increased from 0.69 ± 0.22 to 1.00 ± 0.14 post-surgery. The average postoperative follow-up period was 26.0 months with only one reintervention during the follow-up. In conclusion, PAES was a rare condition and traditional surgical treatment was solid. However, given a broad spectrum of clinical feature of PAES and less usage of diagnostic duplex ultrasound with stress test, there might be a miss- or delayed diagnosis of PAES even in the current vascular practice.
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Affiliation(s)
- Naoki Fujimura
- Division of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Kyousuke Hosokawa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Kimihiro Igari
- Division of Vascular and Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Daijirou Akamatsu
- Division of Vascular Surgery, Tohoku University Hospital, Miyagi, Japan
| | | | - Atsunori Asami
- Department of Surgery, Saitama Municipal Hospital, Saitama, Japan
| | - Shintaro Shibutani
- Department of Vascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | | | - Masao Nunokawa
- Department of Cardiovascular Surgery, Kyorin University Hospital, Tokyo, Japan
| | - Hirohisa Harada
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Kyozo Inoue
- Department of Cardiovascular Surgery, Kobe Rosai Hospital, Hyogo, Japan
| | - Atsuhiro Koya
- Department of Vascular Surgery, Asahikawa Medical University, Hokkaido, Japan
| | - Tadashi Furuyama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisuke Sagara
- Department of Surgery, Hamamatsu Red Cross Hospital, Shizuoka, Japan
| | - Tsunehiro Shintani
- Department of Vascular Surgery, Shizuoka Red Cross Hospital, Shizuoka, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Ehime, Japan
| | | | | | - Katsuyuki Hoshina
- Department of Surgery, Division of Vascular Surgery, The University of Tokyo, Tokyo, Japan
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15
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Majidi S, Fifi JT, Ladner TR, Lara-Reyna J, Yaeger KA, Yim B, Dangayach N, Oxley TJ, Shigematsu T, Kummer BR, Stein LK, Weinberger J, Fara MG, De Leacy R, Dhamoon MS, Tuhrim S, Mocco J. Emergent Large Vessel Occlusion Stroke During New York City's COVID-19 Outbreak: Clinical Characteristics and Paraclinical Findings. Stroke 2020; 51:2656-2663. [PMID: 32755349 PMCID: PMC7434004 DOI: 10.1161/strokeaha.120.030397] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/02/2020] [Accepted: 07/10/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE The 2019 novel coronavirus outbreak and its associated disease (coronavirus disease 2019 [COVID-19]) have created a worldwide pandemic. Early data suggest higher rate of ischemic stroke in severe COVID-19 infection. We evaluated whether a relationship exists between emergent large vessel occlusion (ELVO) and the ongoing COVID-19 outbreak. METHODS This is a retrospective, observational case series. Data were collected from all patients who presented with ELVO to the Mount Sinai Health System Hospitals across New York City during the peak 3 weeks of hospitalization and death from COVID-19. Patients' demographic, comorbid conditions, cardiovascular risk factors, COVID-19 disease status, and clinical presentation were extracted from the electronic medical record. Comparison was made between COVID-19 positive and negative cohorts. The incidence of ELVO stroke was compared with the pre-COVID period. RESULTS Forty-five consecutive ELVO patients presented during the observation period. Fifty-three percent of patients tested positive for COVID-19. Total patients' mean (±SD) age was 66 (±17). Patients with COVID-19 were significantly younger than patients without COVID-19, 59±13 versus 74±17 (odds ratio [95% CI], 0.94 [0.81-0.98]; P=0.004). Seventy-five percent of patients with COVID-19 were male compared with 43% of patients without COVID-19 (odds ratio [95% CI], 3.99 [1.12-14.17]; P=0.032). Patients with COVID-19 were less likely to be White (8% versus 38% [odds ratio (95% CI), 0.15 (0.04-0.81); P=0.027]). In comparison to a similar time duration before the COVID-19 outbreak, a 2-fold increase in the total number of ELVO was observed (estimate: 0.78 [95% CI, 0.47-1.08], P≤0.0001). CONCLUSIONS More than half of the ELVO stroke patients during the peak time of the New York City's COVID-19 outbreak were COVID-19 positive, and those patients with COVID-19 were younger, more likely to be male, and less likely to be White. Our findings also suggest an increase in the incidence of ELVO stroke during the peak of the COVID-19 outbreak.
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Affiliation(s)
- Shahram Majidi
- Department of Neurosurgery (S.M., J.T.F., T.R.L., J.L.-R., K.A.Y., B.Y., N.D., T.J.O., T.S., R.D.L., J.M.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Johanna T. Fifi
- Department of Neurosurgery (S.M., J.T.F., T.R.L., J.L.-R., K.A.Y., B.Y., N.D., T.J.O., T.S., R.D.L., J.M.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Travis R. Ladner
- Department of Neurosurgery (S.M., J.T.F., T.R.L., J.L.-R., K.A.Y., B.Y., N.D., T.J.O., T.S., R.D.L., J.M.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jacques Lara-Reyna
- Department of Neurosurgery (S.M., J.T.F., T.R.L., J.L.-R., K.A.Y., B.Y., N.D., T.J.O., T.S., R.D.L., J.M.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kurt A. Yaeger
- Department of Neurosurgery (S.M., J.T.F., T.R.L., J.L.-R., K.A.Y., B.Y., N.D., T.J.O., T.S., R.D.L., J.M.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Benjamin Yim
- Department of Neurosurgery (S.M., J.T.F., T.R.L., J.L.-R., K.A.Y., B.Y., N.D., T.J.O., T.S., R.D.L., J.M.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Neha Dangayach
- Department of Neurosurgery (S.M., J.T.F., T.R.L., J.L.-R., K.A.Y., B.Y., N.D., T.J.O., T.S., R.D.L., J.M.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Thomas J. Oxley
- Department of Neurosurgery (S.M., J.T.F., T.R.L., J.L.-R., K.A.Y., B.Y., N.D., T.J.O., T.S., R.D.L., J.M.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Tomoyoshi Shigematsu
- Department of Neurosurgery (S.M., J.T.F., T.R.L., J.L.-R., K.A.Y., B.Y., N.D., T.J.O., T.S., R.D.L., J.M.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Benjamin R. Kummer
- Department of Neurology (B.R.K., L.K.S., J.W., M.G.F., M.S.D., S.T.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Laura K. Stein
- Department of Neurology (B.R.K., L.K.S., J.W., M.G.F., M.S.D., S.T.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jesse Weinberger
- Department of Neurology (B.R.K., L.K.S., J.W., M.G.F., M.S.D., S.T.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael G. Fara
- Department of Neurology (B.R.K., L.K.S., J.W., M.G.F., M.S.D., S.T.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Reade De Leacy
- Department of Neurosurgery (S.M., J.T.F., T.R.L., J.L.-R., K.A.Y., B.Y., N.D., T.J.O., T.S., R.D.L., J.M.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mandip S. Dhamoon
- Department of Neurology (B.R.K., L.K.S., J.W., M.G.F., M.S.D., S.T.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stanley Tuhrim
- Department of Neurology (B.R.K., L.K.S., J.W., M.G.F., M.S.D., S.T.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - J Mocco
- Department of Neurosurgery (S.M., J.T.F., T.R.L., J.L.-R., K.A.Y., B.Y., N.D., T.J.O., T.S., R.D.L., J.M.), Icahn School of Medicine at Mount Sinai, New York, NY
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16
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Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, Kaptein FHJ, van Paassen J, Stals MAM, Huisman MV, Endeman H. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020; 191:145-147. [PMID: 32291094 PMCID: PMC7146714 DOI: 10.1016/j.thromres.2020.04.013] [Citation(s) in RCA: 3225] [Impact Index Per Article: 806.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION COVID-19 may predispose to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilisation and diffuse intravascular coagulation. Reports on the incidence of thrombotic complications are however not available. METHODS We evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction or systemic arterial embolism in all COVID-19 patients admitted to the ICU of 2 Dutch university hospitals and 1 Dutch teaching hospital. RESULTS We studied 184 ICU patients with proven COVID-19 pneumonia of whom 23 died (13%), 22 were discharged alive (12%) and 139 (76%) were still on the ICU on April 5th 2020. All patients received at least standard doses thromboprophylaxis. The cumulative incidence of the composite outcome was 31% (95%CI 20-41), of which CTPA and/or ultrasonography confirmed VTE in 27% (95%CI 17-37%) and arterial thrombotic events in 3.7% (95%CI 0-8.2%). PE was the most frequent thrombotic complication (n = 25, 81%). Age (adjusted hazard ratio (aHR) 1.05/per year, 95%CI 1.004-1.01) and coagulopathy, defined as spontaneous prolongation of the prothrombin time > 3 s or activated partial thromboplastin time > 5 s (aHR 4.1, 95%CI 1.9-9.1), were independent predictors of thrombotic complications. CONCLUSION The 31% incidence of thrombotic complications in ICU patients with COVID-19 infections is remarkably high. Our findings reinforce the recommendation to strictly apply pharmacological thrombosis prophylaxis in all COVID-19 patients admitted to the ICU, and are strongly suggestive of increasing the prophylaxis towards high-prophylactic doses, even in the absence of randomized evidence.
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Affiliation(s)
- F A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
| | - M J H A Kruip
- Department of Haematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - N J M van der Meer
- Department of Anesthesiology and Critical Care, Amphia Hospital Breda and Oosterhout the Netherlands and TIAS/Tilburg University, Tilburg, the Netherlands
| | - M S Arbous
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - D A M P J Gommers
- Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands
| | - K M Kant
- Department of Intensive Care, Amphia Hospital, Breda, the Netherlands
| | - F H J Kaptein
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - J van Paassen
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - M A M Stals
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - M V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - H Endeman
- Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands
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Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers D, Kant KM, Kaptein FHJ, van Paassen J, Stals MAM, Huisman MV, Endeman H. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. Thromb Res 2020; 191:148-150. [PMID: 32381264 PMCID: PMC7192101 DOI: 10.1016/j.thromres.2020.04.041] [Citation(s) in RCA: 1132] [Impact Index Per Article: 283.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION We recently reported a high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 admitted to the intensive care units (ICUs) of three Dutch hospitals. In answering questions raised regarding our study, we updated our database and repeated all analyses. METHODS We re-evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction and/or systemic arterial embolism in all COVID-19 patients admitted to the ICUs of 2 Dutch university hospitals and 1 Dutch teaching hospital from ICU admission to death, ICU discharge or April 22nd 2020, whichever came first. RESULTS We studied the same 184 ICU patients as reported on previously, of whom a total of 41 died (22%) and 78 were discharged alive (43%). The median follow-up duration increased from 7 to 14 days. All patients received pharmacological thromboprophylaxis. The cumulative incidence of the composite outcome, adjusted for competing risk of death, was 49% (95% confidence interval [CI] 41-57%). The majority of thrombotic events were PE (65/75; 87%). In the competing risk model, chronic anticoagulation therapy at admission was associated with a lower risk of the composite outcome (Hazard Ratio [HR] 0.29, 95%CI 0.091-0.92). Patients diagnosed with thrombotic complications were at higher risk of all-cause death (HR 5.4; 95%CI 2.4-12). Use of therapeutic anticoagulation was not associated with all-cause death (HR 0.79, 95%CI 0.35-1.8). CONCLUSION In this updated analysis, we confirm the very high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 pneumonia.
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Affiliation(s)
- F A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
| | - M J H A Kruip
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - N J M van der Meer
- Department of Anesthesiology and Critical Care, Amphia Hospital Breda, Oosterhout, the Netherlands; TIAS/Tilburg University Tilburg, the Netherlands
| | - M S Arbous
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - D Gommers
- Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands
| | - K M Kant
- Department of Intensive Care, Amphia Hospital, Breda, the Netherlands
| | - F H J Kaptein
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - J van Paassen
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - M A M Stals
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - M V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - H Endeman
- Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands
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18
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Fischer U, Hsieh-Meister K, Kellner-Weldon F, Galimanis A, Yan X, Kaesmacher J, El-Koussy M, Jung S, Arnold M, Michel P, Wiest R, Mattle HP, Gralla J, Heldner MR. Symptomatic and asymptomatic intracranial atherosclerotic stenosis: 3 years' prospective study. J Neurol 2020; 267:1687-1698. [PMID: 32100122 DOI: 10.1007/s00415-020-09750-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intracranial stenoses can cause TIA/ischaemic stroke. The purpose of this study was to assess vascular risk factors, clinical and imaging findings and outcome in Caucasians with intracranial stenosis under best prevention management. METHODS In this prospective observational study (from 05/2012, to last follow-up 06/2017) we compared vascular risk factors, imaging findings and long-term outcome in Swiss patients with symptomatic versus asymptomatic intracranial atherosclerotic stenoses on best prevention management. RESULTS 62 patients were included [35.5% women, median age 68.3 years], 33 (53.2%) with symptomatic intracranial stenoses. Vascular risk factors (p = 0.635) and frequency of anterior circulation stenoses (66.7% vs. 55.2%; p = 0.354) did not differ between symptomatic and asymptomatic patients, but CT/MR-perfusion deficits in the territory of the stenosis (81.8% vs. 51.7%; p = 0.011) were more common in symptomatic patients. Outcome in symptomatic and asymptomatic patients at last follow-up was similar (mRS 0-1:66.7% vs. 75%;adjp = 0.937, mRS adjp-shift = 0.354, survival:100% vs. 96.4%;adjp = 0.979). However, during 59,417 patient follow-up days, symptomatic patients experienced more cerebrovascular events (ischaemic stroke or TIA) [37.5% vs. 7.1%;adjHR 7.58;adjp = 0.012], mainly in the territory of the stenosis [31.3% vs. 3.6%;adjHR 12.69;adjp = 0.019], more vascular events (i.e. ischaemic stroke/TIA/TNA and acute coronary/peripheral vascular events) [62.5% vs. 14.3%;adjHR 6.37;adjp = 0.001]) and more multiple vascular events (p-trend = 0.006; ≥ 2:37.5% vs. 10.7%;adj OR 5.37;adjp = 0.022) than asymptomatic patients. CONCLUSIONS Despite best prevention management, one in three patients with a symptomatic intracranial stenosis suffered a cerebrovascular event, three in five a vascular event and two in five ≥ 2 vascular events. There is an unmet need for more rigorous and effective preventive strategies in patients with symptomatic intracranial stenoses.
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Affiliation(s)
- Urs Fischer
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Kety Hsieh-Meister
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Frauke Kellner-Weldon
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Aikaterini Galimanis
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Xin Yan
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Marwan El-Koussy
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Patrik Michel
- Stroke Centre, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Roland Wiest
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Heinrich P Mattle
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
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Miesbach W, Makris M. COVID-19: Coagulopathy, Risk of Thrombosis, and the Rationale for Anticoagulation. Clin Appl Thromb Hemost 2020; 26:1076029620938149. [PMID: 32677459 PMCID: PMC7370334 DOI: 10.1177/1076029620938149] [Citation(s) in RCA: 248] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/17/2020] [Accepted: 06/08/2020] [Indexed: 01/08/2023] Open
Abstract
The novel coronavirus infection (COVID-19) is caused by the new coronavirus SARS-CoV-2 and is characterized by an exaggerated inflammatory response that can lead to severe manifestations such as adult respiratory syndrome, sepsis, coagulopathy, and death in a proportion of patients. Among other factors and direct viral effects, the increase in the vasoconstrictor angiotensin II, the decrease in the vasodilator angiotensin, and the sepsis-induced release of cytokines can trigger a coagulopathy in COVID-19. A coagulopathy has been reported in up to 50% of patients with severe COVID-19 manifestations. An increase in d-dimer is the most significant change in coagulation parameters in severe COVID-19 patients, and progressively increasing values can be used as a prognostic parameter indicating a worse outcome. Limited data suggest a high incidence of deep vein thrombosis and pulmonary embolism in up to 40% of patients, despite the use of a standard dose of low-molecular-weight heparin (LMWH) in most cases. In addition, pulmonary microvascular thrombosis has been reported and may play a role in progressive lung failure. Prophylactic LMWH has been recommended by the International Society on Thrombosis and Haemostasis (ISTH) and the American Society of Hematology (ASH), but the best effective dosage is uncertain. Adapted to the individual risk of thrombosis and the d-dimer value, higher doses can be considered, especially since bleeding events in COVID-19 are rare. Besides the anticoagulant effect of LMWH, nonanticoagulant properties such as the reduction in interleukin 6 release have been shown to improve the complex picture of coagulopathy in patients with COVID-19.
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Affiliation(s)
- Wolfgang Miesbach
- Department of Haemostaseology and Hemophilia Center, Medical Clinic 2, Institute of Transfusion Medicine, University Hospital Frankfurt, Germany
| | - Michael Makris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, United Kingdom
- Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, United Kingdom
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20
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Warny M, Helby J, Birgens HS, Bojesen SE, Nordestgaard BG. Arterial and venous thrombosis by high platelet count and high hematocrit: 108 521 individuals from the Copenhagen General Population Study. J Thromb Haemost 2019; 17:1898-1911. [PMID: 31309714 DOI: 10.1111/jth.14574] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/11/2019] [Indexed: 08/31/2023]
Abstract
BACKGROUND It is unclear whether high platelet count or high hematocrit predict risk of thrombosis in individuals from the general population. OBJECTIVES We tested the hypothesis that individuals from the general population with high platelet count or high hematocrit have high risk of arterial and venous thrombosis. METHODS We prospectively followed 108 521 individuals from The Copenhagen General Population Study for a median of 8 years. Platelet count and blood hematocrit were measured at study entry. RESULTS AND CONCLUSION Multivariable adjusted hazard ratios for individuals with platelet counts in the top 5 percentiles (>398 × 109 /L) vs in the 25th-75th percentiles (231-316 × 109 /L) were 1.77 (95% confidence interval [CI], 1.38-2.24) for arterial thrombosis in the brain (38 and 26 events/10 000 person-years) and 0.82 (95%, 0.61-1.11) for arterial thrombosis in the heart (23 and 28 events/10 000 person-years). For individuals with hematocrit values in the top 5 percentiles (women/men: >45/>48%) vs the 25th-75th percentiles (women/men: 38.1-42/41.1-45%), hazard ratios were 1.27 (95% CI, 0.91-1.75) for arterial thrombosis in the brain (40 and 26 events/10 000 person-years) and 1.46 (95% CI, 1.06-2.00) for arterial thrombosis in the heart (43 and 25 events/10 000 person-years). Neither high platelet count nor high hematocrit was associated with risk of venous thromboembolism. When excluding individuals with myeloproliferative neoplasia from the main analyses, results on risk of thrombosis were similar. In this prospective study, high platelet counts were associated with 1.8-fold risk of arterial thrombosis in the brain, whereas high hematocrit was associated with 1.5-fold risk of arterial thrombosis in the heart.
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Affiliation(s)
- Marie Warny
- Department of Hematology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Jens Helby
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Department of Internal Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Henrik S Birgens
- Department of Hematology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stig E Bojesen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Børge G Nordestgaard
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
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21
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Grilz E, Marosi C, Königsbrügge O, Riedl J, Posch F, Lamm W, Lang IM, Pabinger I, Ay C. Association of complete blood count parameters, d-dimer, and soluble P-selectin with risk of arterial thromboembolism in patients with cancer. J Thromb Haemost 2019; 17:1335-1344. [PMID: 31099477 PMCID: PMC6771479 DOI: 10.1111/jth.14484] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/03/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with cancer are at risk of developing arterial thromboembolism (ATE). With the prevalence of cancer and cardiovascular diseases on the rise, the identification of risk factors for ATE in patients with cancer is of emerging importance. OBJECTIVES As data on the association of potential biomarkers with risk of ATE in patients with cancer are scarce, we conducted a cohort study with the aim to identify blood-based biomarkers for ATE risk prediction in patients with cancer. PATIENTS/METHODS Overall, 1883 patients with newly diagnosed cancer or progressive disease after complete or partial remission were included and followed for 2 years. Venous blood was drawn at study inclusion for measurement of complete blood count parameters, total cholesterol, d-dimer, and soluble P-selectin (sP-selectin) levels. RESULTS The 2-year cumulative incidence of ATE was 2.5%. In univariable analysis, red cell distribution width (subdistribution hazard ratio (SHR) per doubling: 4.4, 95% CI: 1.4-14.1), leukocyte count (1.2, 1.1-1.5), neutrophil count (1.6, 1.1-2.3), and sP-selectin levels (1.9, 1.3-2.7) were associated with risk of ATE in patients with cancer; d-dimer was not associated with the risk of ATE (1.1, 0.9-1.4). After adjustment for age, sex, and smoking status the association prevailed for the neutrophil count (adjusted [adj.] SHR per doubling: 1.6, 1.1-2.4), and sP-selectin levels (1.8, 1.2-2.8). CONCLUSIONS An elevated absolute neutrophil count and higher sP-selectin levels were associated with an increased risk of ATE in patients with cancer. Their role for predicting cancer-related ATE needs to be validated in further studies.
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Affiliation(s)
- Ella Grilz
- Clinical Division of Hematology and HemostaseologyDepartment of Medicine IComprehensive Cancer Center ViennaMedical University of ViennaViennaAustria
| | - Christine Marosi
- Clinical Division of OncologyDepartment of Medicine IComprehensive Cancer Center ViennaMedical University of ViennaViennaAustria
| | - Oliver Königsbrügge
- Clinical Division of Hematology and HemostaseologyDepartment of Medicine IComprehensive Cancer Center ViennaMedical University of ViennaViennaAustria
| | - Julia Riedl
- Clinical Division of Hematology and HemostaseologyDepartment of Medicine IComprehensive Cancer Center ViennaMedical University of ViennaViennaAustria
| | - Florian Posch
- Division of OncologyDepartment of Internal MedicineMedical University of GrazGrazAustria
| | - Wolfgang Lamm
- Clinical Division of OncologyDepartment of Medicine IComprehensive Cancer Center ViennaMedical University of ViennaViennaAustria
| | - Irene M. Lang
- Clinical Division of CardiologyDepartment of Medicine IIMedical University of ViennaViennaAustria
| | - Ingrid Pabinger
- Clinical Division of Hematology and HemostaseologyDepartment of Medicine IComprehensive Cancer Center ViennaMedical University of ViennaViennaAustria
| | - Cihan Ay
- Clinical Division of Hematology and HemostaseologyDepartment of Medicine IComprehensive Cancer Center ViennaMedical University of ViennaViennaAustria
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22
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Abstract
Chronic ulcers of the lower extremities are one of the most common medical problems encountered in western societies. The prevalence of leg ulcers is estimated to be 0.5-1.0% of the German population and is clearly associated with age. Therefore, in an aging society chronic leg ulcers are an important health issue with respect to increased morbidity and healthcare costs. The most frequent causes of leg ulcers are chronic venous insufficiency, peripheral arterial occlusive disease and diabetes mellitus. Efficient treatment necessitates an exact diagnosis and a close interdisciplinary collaboration. Affected patients often require instructions regarding self-help and support for competent nursing and prophylaxis. Therapeutic strategies, especially in the geriatric setting, aim to maintain the quality of life through preservation of patient mobility and autonomy.
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Affiliation(s)
- N Duschek
- Klinische Abteilung für Haut- und Geschlechtskrankheiten, Universitätsklinikum St. Pölten, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dunant-Platz 1, 3100, St. Pölten, Österreich.
| | - F Trautinger
- Klinische Abteilung für Haut- und Geschlechtskrankheiten, Universitätsklinikum St. Pölten, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dunant-Platz 1, 3100, St. Pölten, Österreich
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23
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Moser N, Mior S, Noseworthy M, Côté P, Wells G, Behr M, Triano J. Effect of cervical manipulation on vertebral artery and cerebral haemodynamics in patients with chronic neck pain: a crossover randomised controlled trial. BMJ Open 2019; 9:e025219. [PMID: 31142519 PMCID: PMC6549698 DOI: 10.1136/bmjopen-2018-025219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE It is hypothesised that cervical manipulation may increase the risk of cerebrovascular accidents. We aimed to determine whether cervical spine manipulation is associated with changes in vertebral artery and cerebrovascular haemodynamics measured with MRI compared with neutral neck position and maximum neck rotation in patients with chronic neck pain. SETTING The Imaging Research Centre at St. Joseph's Hospital in Hamilton, Ontario, Canada. PARTICIPANTS Twenty patients were included. The mean age was 32 years (SD ±12.5), mean neck pain duration was 5.3 years (SD ±5.7) and mean neck disability index score was 13/50 (SD ±6.4). INTERVENTIONS Following baseline measurement of cerebrovascular haemodynamics, we randomised participants to: (1) maximal neck rotation followed by cervical manipulation or (2) cervical manipulation followed by maximal neck rotation. The primary outcome, vertebral arteries and cerebral haemodynamics, was measured after each intervention and was obtained by measuring three-dimensional T1-weighted high-resolution anatomical images, arterial spin labelling and phase-contrast flow encoded MRI. Our secondary outcome was functional connectivity within the default mode network measured with resting state functional MRI. RESULTS Compared with neutral neck position, we found a significant change in contralateral blood flow following maximal neck rotation. There was also a significant change in contralateral vertebral artery blood velocity following maximal neck rotation and cervical manipulation. We found no significant changes within the cerebral haemodynamics following cervical manipulation or maximal neck rotation. However, we observed significant increases in functional connectivity in the posterior cerebrum and cerebellum (resting state MRI) after manipulation and maximum rotation. CONCLUSION Our results are in accordance with previous work, which has shown a decrease in blood flow and velocity in the contralateral vertebral artery with head rotation. This may explain why we also observed a decrease in blood velocity with manipulation because it involves neck rotation. Our work is the first to show that cervical manipulation does not result in brain perfusion changes compared with a neutral neck position or maximal neck rotation. The changes observed were found to not be clinically meaningful and suggests that cervical manipulation may not increase the risk of cerebrovascular events through a haemodynamic mechanism. TRIAL REGISTRATION NUMBER NCT02667821.
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Affiliation(s)
- Nicholas Moser
- Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Silvano Mior
- Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Michael Noseworthy
- Radiology, McMaster University Faculty of Engineering, Hamilton, Ontario, Canada
| | - Pierre Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Greg Wells
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Michael Behr
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - John Triano
- Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
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Dharma S, Kedev S, Patel T, Rao SV, Gilchrist IC. Different Spasmolytic Regimens (Nitroglycerin vs Verapamil) and the Incidence of Radial Artery Occlusion After Transradial Catheterization. J Invasive Cardiol 2018; 30:461-464. [PMID: 30504515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study evaluated whether use of different spasmolytic regimens (nitroglycerin or verapamil) administered soon after sheath insertion affects postprocedure radial artery occlusion (RAO) in patients who underwent transradial catheterization. METHODS AND RESULTS We performed a post hoc analysis of a randomized trial evaluating the use of 500 μg intra-arterial nitroglycerin just before sheath removal in 1706 patients undergoing transradial catheterization. Patients who received 200 μg or 300 μg nitroglycerin after sheath placement (group A; n = 688) were compared with patients who received 5 mg verapamil after sheath placement (group B; n = 1018). The primary endpoint was RAO diagnosed by Doppler ultrasound examination at 1 calendar day after the procedure. Logistic regression was used to determine predictors of RAO. RAO occurred in 16.0% of group A and 5.4% of group B. After adjustment for potential confounders, neither the use of verapamil nor nitroglycerin was associated with RAO (odds ratio [OR], 1.24; 95% confidence interval [CI], 0.51-3.02; P=.62). Radial artery compression >4 hours was the strongest predictor of RAO (OR, 5.41; 95% CI, 2.31-12.65; P<.001). CONCLUSIONS In this study, the use of verapamil or nitroglycerin as a spasmolytic regimen was not associated with RAO. Given the strong association between duration of radial compression and RAO, further studies are needed to determine the interaction between vasodilator agents and compression protocols on RAO.
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Affiliation(s)
- Surya Dharma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jl S Parman Kav 87, Slipi, Jakarta Barat, 11420, Jakarta, Indonesia.
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25
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Abstract
Radial artery occlusion (RAO) occurs in 2% to 18% of patients after transradial access (TRA) cardiac catheterization. Using a kaolin-filled pad (QuikClot) reduces compression time during TRA and might reduce RAO. We examined the RAO risk with the kaolin-filled pad after TRA cardiac catheterization.This was a prospective cross-sectional study of 260 patients who underwent TRA cardiac catheterization in a cardiac ward of a Medical Center from 2012 to 2016. Patients were randomly assigned to 1 of 2 groups: the case group (n = 130) was postoperatively treated with a kaolin-filled pad, and the control group (n = 130) was treated with conventional hemostasis. Color duplex ultrasound was used to evaluate the 24-hour and 1-month postoperative radial artery flow velocity, diameter, patency, and RAO risk.RAO risk was not significantly different between the case and control groups after 24 hours (4.6% vs 5.4%, P = .776) or after 1 month (5.4% vs 6.1%, P = .789), regardless of whether it was a first TRA cardiac catheterization (after 24 hours [P = .153] or after 1month [P = .617], respectively) or a repeated TRA cardiac catheterization (after 24 hours [P = .754] or after 1month [P = .753], respectively).Using a kaolin-filled pad after TRA cardiac catheterization did not significantly reduce RAO risk compared with conventional hemostasis.
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Affiliation(s)
- Chun-Yen Chiang
- Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Yong-Kang District
- Department of Optometry, Chung Hwa University of Medical Technology, Rende District
| | - Weng-Ting Chang
- Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Yong-Kang District
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Yong-Kang District
- Department of Hospital and Health Care Administration
| | - Chon-Seng Hong
- Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Yong-Kang District
| | - Jhih-Yuan Shih
- Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Yong-Kang District
| | - Wen-Shiann Wu
- Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Yong-Kang District
| | - Zhih-Cherng Chen
- Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Yong-Kang District
| | - Ming-Ting Chou
- Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Yong-Kang District
- Department of Recreation and Healthcare Management, Chia Nan University of Pharmacy and Science, Rende District, Tainan City, Taiwan
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Burnell AL, Ranta A, Wu T, Fink J, McGuinness B, Caldwell J, Collecutt W, Brew S, Barber PA. Endovascular clot retrieval for acute ischaemic stroke in New Zealand. N Z Med J 2018; 131:13-18. [PMID: 30359351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIMS Stroke endovascular clot retrieval (ECR) in patients with large proximal vessel occlusion improves clinical outcomes. We present the New Zealand ECR experience. METHODS All New Zealand patients treated with ECR since 2011 were included. Patients were considered eligible if they were independent prior to stroke and had proximal intracranial arterial occlusion. RESULTS Three hundred and twelve patients [136 women, mean (SD) age of 64 (17) years] from 11 district health boards have been treated between March 2011 and April 2018. There were 260 (83%) patients with anterior and 52 (17%) with posterior circulation arterial occlusion. One hundred and ninety-three (62%) patients were pre-treated with intravenous alteplase. The median time from symptom onset to groin puncture was 210 (range 65-985) minutes. Complete or near-complete recanalisation (Thrombolysis in Cerebral Infarction scores of 3 or 2b) was achieved in 260 of 300 (87%) and the National Institutes of Health Stroke Scale score improved from a median of 18 at baseline to 7 at 24 hours. By day 90, 55% of the anterior circulation patients and 40% of the posterior circulation patients were living independently at home. Mortality rates were 20% for anterior circulation patients and 30% for the posterior circulation patients. CONCLUSIONS This study has shown that stroke endovascular clot retrieval is being provided safely and effectively in New Zealand. However, there remain discrepancies in service provision, and ongoing regional, inter-regional and inter-sector collaboration is essential to implement comprehensive and equitable ECR services across the country.
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Affiliation(s)
| | - Anna Ranta
- Departments of Neurology and Medicine, Capital & Coast DHB and University of Otago, Wellington
| | - Teddy Wu
- Neurology, Christchurch Hospital, Christchurch
| | - John Fink
- Neurology, Christchurch Hospital, Christchurch
| | | | | | | | | | - P Alan Barber
- Neurology, Auckland City Hospital and University of Auckland, Auckland
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Wafa HA, Wolfe CDA, Rudd A, Wang Y. Long-term trends in incidence and risk factors for ischaemic stroke subtypes: Prospective population study of the South London Stroke Register. PLoS Med 2018; 15:e1002669. [PMID: 30289919 PMCID: PMC6173399 DOI: 10.1371/journal.pmed.1002669] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/07/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND As the average life expectancy increases, more people are predicted to have strokes. Recent studies have shown an increasing incidence in certain types of cerebral infarction. We aimed to estimate time trends in incidence, prior risk factors, and use of preventive treatments for ischaemic stroke (IS) aetiological subtypes and to ascertain any demographic disparities. METHODS AND FINDINGS Population-based data from the South London Stroke Register (SLSR) between 2000 and 2015 were studied. IS was classified, based on the underlying mechanism, into large-artery atherosclerosis (LAA), cardio-embolism (CE), small-vessel occlusion (SVO), other determined aetiologies (OTH), and undetermined aetiologies (UND). After calculation of age-, sex-, and ethnicity-specific incidence rates by subtype for the 16-year period, we analysed trends using Cochran-Armitage tests, Poisson regression models, and locally estimated scatterplot smoothers (loess). A total of 3,088 patients with first IS were registered. Between 2000-2003 and 2012-2015, the age-adjusted incidence of IS decreased by 43% from 137.3 to 78.4/100,000/year (incidence rate ratio [IRR] 0.57, 95% CI 0.5-0.64). Significant declines were observed in all subtypes, particularly in SVO (37.4-18; p < 0.0001) and less in CE (39.3-25; p < 0.0001). Reductions were recorded in males and females, younger (<55 years old) and older (≥55 years old) individuals, and white and black ethnic groups, though not significantly in the latter (144.6-116.2; p = 0.31 for IS). A 4-fold increase in prior-to-stroke use of statins was found (adjusted odds ratio [OR] 4.39, 95% CI 3.29-5.86), and despite the increasing prevalence of hypertension (OR 1.54, 95% CI 1.21-1.96) and atrial fibrillation (OR 1.7, 95% CI 1.22-2.36), preventive use of antihypertensive and antiplatelet drugs was declining. A smaller number of participants in certain subgroup-specific analyses (e.g., black ethnicity and LAA subtype) could have limited the power to identify significant trends. CONCLUSIONS The incidence of ISs has been declining since 2000 in all age groups but to a lesser extent in the black population. The reported changes in medication use are unlikely to fully explain the reduction in stroke incidence; however, innovative prevention strategies and better management of risk factors may contribute further reduction.
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Affiliation(s)
- Hatem A. Wafa
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
- * E-mail:
| | - Charles D. A. Wolfe
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, United Kingdom
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, London, United Kingdom
| | - Anthony Rudd
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, United Kingdom
| | - Yanzhong Wang
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, United Kingdom
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, London, United Kingdom
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Lorbeer R, Grotz A, Dörr M, Völzke H, Lieb W, Kühn JP, Mensel B. Reference values of vessel diameters, stenosis prevalence, and arterial variations of the lower limb arteries in a male population sample using contrast-enhanced MR angiography. PLoS One 2018; 13:e0197559. [PMID: 29924802 PMCID: PMC6010244 DOI: 10.1371/journal.pone.0197559] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 05/06/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Morphological characterization of leg arteries is of significant importance to detect vascular remodeling triggered by atherosclerotic changes. We determined reference values of vessel diameters and assessed prevalence of stenosis and arterial variations of the lower limb arteries in a healthy male population sample. Methods Gadolinium-enhanced magnetic resonance angiography at 1.5 Tesla was performed in 756 male participants (median age = 52 years, range = 21–82 years) of the population-based Study of Health in Pomerania. Vessel diameters were measured in 9 predefined segments of the pelvic and leg arteries and 95th percentiles were used for upper reference values of means of left and right side arteries. Results Reference values of vascular diameters decreased from proximal to distal arteries: common iliac = 1.18cm; internal iliac = 0.75cm; external iliac = 1.03cm; proximal femoral = 1.02cm; distal femoral = 0.77cm; popliteal = 0.69cm; anterior tibial = 0.42cm; posterior tibial = 0.38cm; fibular = 0.40cm. Body-surface area indexed reference values increased with age in all segments. A number of 53 subjects (7.0%) had at least one stenosis, mainly in the lower leg arteries anterior tibial (n = 28, 3.7%), posterior tibial (n = 18, 2.4%) and fibular (n = 20, 2.6%). The risk of stenosis increased considerably with age (odds ratio = 1.08; p<0.001). The most common arterial variant was type I-A in both legs (n = 620, 82%). Conclusion We present reference values for different pelvic and leg artery segment diameters in men that decrease from proximal to distal and increase with age. Stenoses were most prevalent in lower leg arteries and type I-A was the most common variant in the lower leg.
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Affiliation(s)
- Roberto Lorbeer
- Department of Radiology, Ludwig Maximilian University Hospital, Munich, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Andreas Grotz
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
- DZD (German Centre for Diabetes Research), Greifswald, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Christian Albrecht University, Kiel, Germany
| | - Jens-Peter Kühn
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Birger Mensel
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
- * E-mail:
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Heinrichs A, Nikoubashman O, Schürmann K, Tauber SC, Wiesmann M, Schulz JB, Reich A. Relevance of standard intravenous thrombolysis in endovascular stroke therapy of a tertiary stroke center. Acta Neurol Belg 2018; 118:105-111. [PMID: 29435828 DOI: 10.1007/s13760-018-0892-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/01/2018] [Indexed: 11/26/2022]
Abstract
The majority of patients undergoing endovascular stroke treatment (EST) in randomized controlled trials received additional systemic thrombolysis ("combination or bridging therapy (C/BT)"). Nevertheless, its usefulness in this subtype of acute ischemic stroke (AIS) is discussed controversially. Of all consecutive AIS patients, who received any kind of reperfusion therapy in a tertiary university stroke center between January 2015 and March 2016, those with large vessel occlusions (LVO) and EST with or without additional C/BT, were compared primarily regarding procedural aspects. Data were extracted from an investigator-initiated, single-center, prospective and blinded end-point study. 70 AIS patients with EST alone and 118 with C/BT were identified. Significant baseline differences existed in pre-existing cardiovascular disease (52.9% (EST alone) vs. 35.6% (C/BT), p = 0.023), use of anticoagulation (30.6% vs. 5.9%, p < 0.001), and frequency of unknown time of symptom onset (65.7% vs. 32.2%, p < 0.001), in-hospital stroke (18.6% vs. 1.7%, p < 0.001), pre-treatment ASPECT scores (7.9 vs. 8.9, p = 0.004), and frequency of occlusion in the posterior circulation (18.6% vs. 5.1%, p = 0.003). Pre-interventional procedural time intervals tended to be shorter in the C/BT group, reaching statistical significance in door-to-image time (30.3 (EST alone) vs. 22.2 min (C/BT), p < 0.001). Good clinical outcome (mRS d90) was reached more often in the C/BT group (24.5% vs. 11.8%, p = 0.064). Rates of symptomatic intracranial hemorrhages (sICH) were comparable (4.3% (EST alone) vs. 6.8% (C/BT), p = 0.481). Additional systemic thrombolysis did not delay EST. On the contrary, application of IVRTPA seemed to be a positive indicator for faster EST without increased side effects.
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Affiliation(s)
- Annette Heinrichs
- Department of Neurology, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, 52074, Aachen, Germany
| | - Kolja Schürmann
- Department of Neurology, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Simone C Tauber
- Department of Neurology, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, 52074, Aachen, Germany
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Arno Reich
- Department of Neurology, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
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Sánchez AM, Tortorelli AP, Caprino P, Rosa F, Menghi R, Quero G, Doglietto GB, Alfieri S. Incidence and Impact of Variant Celiacomesenteric Vascularization and Vascular Stenosis on Pancreatic Surgery Outcomes: Personal Experience. Am Surg 2018; 84:181-187. [PMID: 29580343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Ischemic complications after pancreatic surgery can raise postoperative mortality from 4 to 83 per cent. Variants in vascular anatomy play a major role in determining such complications, but they have been only occasionally reported in the literature. We retrospectively analyzed 100 records of patients consecutively treated between January 2011 and December 2013 for resectable malignant diseases who underwent pancreaticoduodenectomy (PD) or total pancreatectomy to state the statistical impact of anatomical vascular variations in surgical outcomes (mean surgical timing, mean blood loss during surgery, and postoperative major complications onset) and to state whether preoperatively undetected vascular anomalies (VA) can raise the risk of postoperative ischemic complications. PD was performed in 89 patients, requiring multiorgan resections in three cases and total pancreatectomy was performed in 11 cases, which was associated to splenectomy in four patients. Incidence of VA was 25/100 (25%), whereas in 18/25 cases (72%) they were detected by preoperative radiologic setting. Their presence in patients undergoing PD significantly raised mean surgical timing (P = 0.003) and increased mean blood loss (P < 0.0001). Preoperatively undetected VA resulted in a major risk of postoperative acute liver ischemia (P = 0.008). Celiacomesenteric aberrant anatomy was proven to be related to an increased risk of intraoperative complications. If undetected preoperatively, they can be associated with anastomotic complications and liver failure. Maximal efforts must be done to detect and to preserve vascular anatomy of celiacomesenteric district.
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Affiliation(s)
- Alejandro M Sánchez
- Digestive Surgery Unit, Department of Surgical Sciences, Catholic University School of Medicine, Rome, Italy
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Casais P, Meschengieser SS, Gennari LC, Alberto MF, Sanchez-Luceros A, Blanco AN, Lazzari MA. Antiphospholipid antibodies and hyperhomocysteinaemia in patients with vascular occlusive disease. Thromb Haemost 2017; 96:19-23. [PMID: 16807646 DOI: 10.1160/th05-11-0737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryHyperhomocysteinemia (HHcy), lupus anticoagulant (LA) and anticardiolipin antibodies (ACA) are independent risk factors for thrombosis. Even though risks are cumulative, the clinical impact of the association is unknown. Preliminary data suggested that HHcy might be associated with transient LA and ACA, disappearing after lowering HHcy. We prospectively evaluated the association of HHcy and LA/ACA, the effect of lowering HHcy with folic acid in LA behavior, and the correlation of the initial dRVVT with LA behavior after folic acid in 210 patients with thrombosis and adverse pregnancy outcomes. Prevalence of HHcy among patients with LA/ACA was 40%. Thirty-one patients exhibited only HHcy (15%; Group 1), 106 (50%; Group 2) had only LA/ACA, while 73 (35%; Group 3) had both. After therapy, 63% and 64% of LA/ACA remained positive in Group 3 and 2, respectively. We observed a trend towards a more positive dRVVT in persistent LA after lowering HHcy. No differences in clinical presentation or in outcomes after two years of followup were observed among the groups. Even though the association of HHcy and LA/ACA is common in patients with thrombosis, it might have no prognostic implications if Hcy levels are lowered. Currently, no laboratory findings correlate with LA behavior, which is independent of homocysteine levels and vitamin treatment.
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Affiliation(s)
- Patricia Casais
- Departamento de Hemostasia y Trombosis, Instituto de Investigaciones Hematologicas 'Mariano R. Castex', Academia Nacional de Medicina de Buenos Aires, Buenos Aires, Argentina.
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Muraoka M, Nagata H, Hirata Y, Uike K, Terashi E, Morihana E, Ochiai M, Fujita Y, Kato K, Yamamura K, Ohga S. High incidence of progressive stenosis in aberrant left subclavian artery with right aortic arch. Heart Vessels 2017; 33:309-315. [PMID: 28965152 DOI: 10.1007/s00380-017-1056-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/22/2017] [Indexed: 11/30/2022]
Abstract
Right aortic arch with aberrant left subclavian artery (RAA/aLSCA) is a rare aortic arch anomaly. The clinical association of aLSCA stenosis with RAA/aLSCA has not yet been fully elucidated. The aim of this study was to investigate the diagnosis, incidence, management and outcome of aLSCA stenosis in infants with prenatally diagnosed RAA/aLSCA. Ten fetuses who were diagnosed as having RAA/aLSCA in Kyushu University Hospital between January 2011 and December 2014 were enrolled. The maternal and child medical records were reviewed to investigate sex, gestational age at the fetal diagnosis, gestational age and body weight at birth, the findings of computed tomography (CT), Doppler ultrasonography of the vertebral artery and angiography, and the complications and outcomes of aLSCA stenosis. In 8 of 10 patients, aLSCA stenosis was identified on the first CT examination after birth. No patients had dysphagia or respiratory distress. The stenosis spontaneously resolved in 3 patients. In 4 of the 5 remaining patients, aLSCA stenosis progressed, including one case in which complete occlusion occurred-the case was associated with retrograde flow from the left vertebral artery supplying the distal LSCA. Balloon angioplasty was successfully used to treat stenosis in two cases. The subclavian steal phenomenon and developmental problems were not observed in any patients. aLSCA stenosis was identified in 80% of patients with RAA/aLSCA after birth. The early detection and elective treatment of stenotic lesions may be required to prevent complete occlusion during the development of the cardiovascular and cerebrovascular systems.
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Affiliation(s)
- Mamoru Muraoka
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hazumu Nagata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Yuichiro Hirata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kiyoshi Uike
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Eiko Terashi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Eiji Morihana
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masayuki Ochiai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuyuki Fujita
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichiro Yamamura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Dangoisse V, Guédès A, Chenu P, Hanet C, Albert C, Robin V, Tavier L, Dury C, Piraux O, Domange J, Jourdan K, Bihin B, Schroeder E. Usefulness of a Gentle and Short Hemostasis Using the Transradial Band Device after Transradial Access for Percutaneous Coronary Angiography and Interventions to Reduce the Radial Artery Occlusion Rate (from the Prospective and Randomized CRASOC I, II, and III Studies). Am J Cardiol 2017; 120:374-379. [PMID: 28577752 DOI: 10.1016/j.amjcard.2017.04.037] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 04/25/2017] [Accepted: 04/25/2017] [Indexed: 01/28/2023]
Abstract
The study sought to evaluate the benefit of the reduction in intensity and duration of the hemostasis obtained with the transradial (TR) Band compression device on the radial artery occlusion (RAO) rate. RAO is the most frequent complication of TR access for cardiac catheterization and limits future use of this safe route. Its occurrence must be minimized. Between 2009 and 2016, 3,616 TR accesses were randomized to TR Band hemostasis during 3 consecutive protocols: CRASOC I (Compression of Radial ArterieS without Occlusion): 13 versus 10 cc of air into the TR Band and for 4 hours of continuous compression; CRASOC II: 10 cc of air for 3 hours versus 2 hours of compression; and CRASOC III: 10 cc of air for 2 hours versus 1.5 hours of compression and virtual 4F introducer as default sheath (both arms). Radial artery patency was assessed by plethysmography at 24 hours, using Doppler for doubtful or negative plethysmography. The primary end point, 24 hours of RAO, was markedly reduced when hemostasis was soft (10 cc of air) and short (1.5 hours) and resulted in a 2.3% rate of RAO versus 9.4% for 13 cc, 4 hours. Hemostasis was obtained in 89% of patients with only 10 cc of air and in 97% of patients with less than the recommended 13 cc. About 8% of patients required more than the 1.5 hours of hemostasis time. In conclusion, short and soft hemostasis with the TR Band device leads to a low RAO rate.
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Affiliation(s)
- Vincent Dangoisse
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium.
| | - Antoine Guédès
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium
| | - Patrick Chenu
- Université catholique de Louvain, Clinique St LUC UCL, Service de Cardiologie, Bruxelles, Belgium
| | - Claude Hanet
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium
| | - Clara Albert
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium
| | - Valérie Robin
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium
| | - Laurence Tavier
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium
| | - Christine Dury
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium
| | - Olivier Piraux
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium
| | - Juliette Domange
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium
| | - Karine Jourdan
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium
| | - Benoit Bihin
- Scientific Support Unit, CHU UCL Namur, Namur, Belgium
| | - Erwin Schroeder
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium
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Zuo FT, Liu H, Wu HJ, Su N, Liu JQ, Dong AQ. The effectiveness and safety of dual antiplatelet therapy in ischemic cerebrovascular disease with intracranial and extracranial arteriostenosis in Chinese patients: A randomized and controlled trail. Medicine (Baltimore) 2017; 96:e5497. [PMID: 28072691 PMCID: PMC5228651 DOI: 10.1097/md.0000000000005497] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/26/2016] [Accepted: 11/08/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There are limited data on the effect of dual antiplatelet treatment with clopidogrel plus aspirin in patients with ischemic cerebrovascular disease and intracranial and extracranial arteriostenosis. The aim of our study was to evaluate the efficacy and safety of aspirin plus clopidogrel in the treatment of ischemic cerebrovascular disease with intracranial and extracranial arteriostenosis. METHODS Patients with clinically evident acute cerebral infarction or transient ischemic attack combined with intracranial and extracranial arteriostenosis (greater than 50%) who were unsuitable or reluctance to perform stent implantation were enrolled in this study. We randomly assigned these patients to receive clopidogrel (75 or 50 mg) plus aspirin (100 mg) or aspirin (100 mg) once daily through 90 days, and followed them for 90 days. We examined the main endpoints including the recurrence of stroke, death from cardiovascular causes, and bleeding events. RESULTS In all, 200 patients were recruited and followed for 90 days. Ischemic stroke occurred in 6 patients (9.1%) treated with 50 mg clopidogrel and aspirin, 6 patients (9.1%) receiving 75 mg clopidogrel and aspirin, whereas 19 patients (27.9%) in the aspirin group (aspirin alone vs copidogrel 50 mg plus aspirin; 95% confidence intervals 1.704-23.779, P < 0.05; aspirin alone vs copidogrel 75 mg plus aspirin; 95% confidence intervals 1.190-13.240, P < 0.05). There were more hemorrhagic events among recipients (3 patients [2.3%]) in the copidogrel plus aspirin group than aspirin recipients (0 patient [0%]), including 1 subcutaneous hemorrhage in the group of 50 mg clopidogrel and aspirin, doubling the number of nasal and gum bleeding in the group of 75 mg clopidogrel and aspirin (P > 0.05). No intracranial hemorrhage and gastro-intestinal hemorrhage occurred in these 3 groups. CONCLUSION Accordingly, 50 mg clopidogrel plus aspirin, and 75 mg clopidogrel plus aspirin were all superior to aspirin alone as stroke prevention in patients with cerebral infarction or transient ischemic attack combined with intracranial and extracranial arteriostenosis. The effect of secondary stroke prevention was similar between 50 mg clopidogrel plus aspirin and 75 mg clopidogrel plus aspirin. The therapy of 75 mg clopidogrel plus aspirin resulted in a worrisome tread in bleeding events.
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Affiliation(s)
| | - Hui Liu
- Department of Neurology, Cangzhou Central Hospital
| | - Hui-Jun Wu
- Department of Neurology, Cangzhou Central Hospital
| | - Na Su
- Department of Internal Medicine, Cangzhou Peace Hospital, Cangzhou, Hebei, China
| | | | - Ai-Qin Dong
- Department of Neurology, Cangzhou Central Hospital
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Yacyshyn VJ, Thatipelli MR, Lennon RJ, Bailey KR, Stanson AW, Holmes DR, Gloviczki P. Predictors of Failure of Endovascular Therapy for Peripheral Arterial Disease. Angiology 2016; 57:403-17. [PMID: 17022375 DOI: 10.1177/0003319706290732] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to assess the usefulness of a comparison of clinical failure and restenosis rates of endovascular procedures at 1 year in patients with peripheral arterial disease. The resulting comparison is presented as “clinical failure/restenosis coordinate.” The authors screened 171 papers describing the outcome of lower extremity angioplasty or stent placement. In 20 of them, authors reported detailed outcomes of interest, including baseline demographic measurements, location of arterial occlusive lesions, a measure of restenosis (measured by ankle-brachial indices, ultrasonography, or angiography), and clinical outcomes (mortality, repeat percutaneous transluminal angioplasty, or amputation). An overview of these 20 angioplasty papers was performed. Besides the usual meta-analyses of each end point separately, data were also plotted as coordinates of clinical failure versus restenosis. The clinical failure-to-restenosis coordinate was calculated and reported for percutaneous transluminal angioplasty of the aortoiliac and femoropopliteal distributions. Clinically reported outcomes in the literature were used to calculate the clinical failure/restenosis coordinate. This value was significantly different for various locations of the angioplasty and various baseline angiographic characteristics. A numeric coordinate pair of clinical failure and restenosis is identifiable in patients undergoing endovascular treatment of peripheral arterial disease. The varying coordinates may be important in elucidating the incidence and mechanisms of clinical failure after endovascular treatment. The coordinate reported in this article is hypothesis-generating about mechanisms of endovascular treatment failure. This coordinate is important in determining the role of restenosis in the clinical failure of endovascular therapy of peripheral arterial disease.
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Affiliation(s)
- Vincent J Yacyshyn
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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Nehler MR, McDermott MM, Treat-Jacobson D, Chetter I, Regensteiner JG. Functional outcomes and quality of life in peripheral arterial disease: current status. Vasc Med 2016; 8:115-26. [PMID: 14518614 DOI: 10.1191/1358863x03vm483ra] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This review examines current evidence for baseline functional impairment and changes with therapy in patients with peripheral arterial disease (PAD) - ranging from patients without claudication or critical limb ischemia (CLI) but other exertional leg symptoms (erroneously referred to as asymptomatic in the Fontaine classifi cation system), to patients with claudication and those with CLI. The review points out that the status of functional outcomes research is markedly different in focus and development in the different levels of disease severity - paradoxically less studied in the more severe CLI population than in patients with claudication, for example.
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Affiliation(s)
- Mark R Nehler
- Section of Vascular Surgery, Department of Surgery, University of Colorado Health Sciences Center, Denver, CO 80262-0312, USA.
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Abstract
Harvest of the internal thoracic artery (ITA) in patients with aortoocclusive disease carries a risk of leg ischemia. Staged revascularization of the lower extremities and coronary artery in patients with aortoiliac occlusive disease with collateral vessels to the lower extremities via the ITA is reported. Revascularization of the aortoiliac occlusion prior to coronary artery bypass grafting can be performed in stable patients with appropriate perioperative coronary precautions. In patients with unstable angina and aortoiliac occlusion with collateral vessels to the leg via the ITA, coronary artery bypass grafting should be performed without using the ITA.
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Affiliation(s)
- Hitoshi Hirose
- Department of Cardiovascular Surgery, Kobari General Hospital, Chiba, Japan.
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English WP, Pearce JD, Craven TE, Edwards MS, Geary RL, Plonk GW, Hansen KJ. Chronic Visceral Ischemia: Symptom-Free Survival After Open Surgical Repair. Vasc Endovascular Surg 2016; 38:493-503. [PMID: 15592629 DOI: 10.1177/153857440403800602] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A retrospective review of patients treated with a history of chronic visceral ischemia (CVI) was made to determine primary patency of open surgical repair and estimated symptom-free survival. Patients with CVI between 1990 and 2003 were reviewed. Included were those with chronic symptoms alone (C-CVI) and acute-on-chronic symptoms (A-CVI). Data were obtained from a vascular database. Symptom-free survival and graft patency were estimated by using product limit estimates. Fifty-eight patients (13 men, 45 women; mean age: 63 years) were treated surgically for C-CVI (34 patients) and A-CVI (24 patients). All patients had postprandial abdominal pain and weight loss (mean: 17 kg). One fourth reported food fear. Preoperative imaging demonstrated disease of the superior mesenteric artery (SMA) (100%; 64% occluded), celiac axis (89%; 37% occluded), and inferior mesenteric artery (IMA) (54%; 60% occluded). Multiple vessels were involved in 95% of patients (mean: 2.3 vessels/patient). Operative management included antegrade revascularization of 80 vessels. Combined aortic and/or renal procedures were performed in 7 patients. Patient demographics and visceral disease did not differ for C-CVI and A-CVI; however, perioperative mortality differed significantly (10% for C-CVI vs 54% for A-CVI [p<0.001]). Intestinal gangrene at presentation was associated with perioperative (hazard ratio [HR]: 7.6; 95% CI: 2.7–21.6; p=0.0002) and follow-up death (HR: 7.8; CI 2.8–21.9; p< 0.0001). Follow-up (mean: 34 months) was complete for 54/68 vessels (79%). Estimated primary and primary assisted patency at 5 years were 81% and 89% respectively. Estimated symptom-free survival for hospital survivors was 57% at 70 months. Open antegrade methods of visceral artery repair for CVI were durable and associated with 57% symptom-free survival at 70 months. Patient demographics and distribution of visceral artery anatomy were similar; however, perioperative mortality for C-CVI and A-CVI differed dramatically. Improved outcomes for A-CVI require recognition and treatment of CVI before onset of intestinal gangrene.
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Affiliation(s)
- William P English
- Division of Surgical Sciences, Section on Vascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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Bui TD, Gelfand D, Whipple S, Wilson SE, Fujitani RM, Conroy R, Pham H, Gordon IL. Comparison of CT and Catheter Arteriography for Evaluation of Peripheral Arterial Disease. Vasc Endovascular Surg 2016; 39:481-90. [PMID: 16382269 DOI: 10.1177/153857440503900604] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Computed tomographic arteriography (CTA) has emerged as a promising technique for less invasive imaging of the lower extremity arteries. The aim of this study was to determine the concordance between CTA and catheter arteriography (CA) in patients with peripheral arterial disease (PAD). Twenty-five patients underwent both CTA and CA, and each set of images was interpreted independently by 3 readers. The infrarenal arteries were divided into 16 segments, and each segment was scored as: 1 = stenosis <50%; 2 = 50–99% stenosis; 3 = occlusion. Modal scores from 3 readers were used to compare results for each segment, with CA assumed to represent true arterial anatomy. Agreement between CTA and CA readings was defined as: concordance (modal scores were identical); moderate discrepancy (MD) (modal scores differed by 1); or severe discrepancy (SD) (modal scores differed by 2). In total, 718 segments were assessed by both CTA and CA. For all segments, the sensitivity and specificity of CTA for <50% stenosis was 86% and 90%; for 50–99% stenosis, sensitivity and specificity were 79% and 89%; and for occlusion, 85% and 98%. Above-knee (AK) CTA scores had slightly better concordance of 86.1% than below-knee (BK) readings (82.3%) (p = 0.104). Severe discrepancies between AK CTA and CA scores were observed in 1.8% of segments compared to 5.4% of BK segments (p = 0.038). Poor CTA image quality was the cause in 20% of AK segments and 28% of BK segments. Poor CA image quality was the cause in 8% of AK and 7% of BK discrepancies. Registration disagreement (stenosis observed in a level in 1 study attributed to a different level in the other) accounted for 18% of AK and 17% of BK discrepancies. In 54% of AK and 48% of BK discrepancies, neither image quality nor registration errors were identified, indicating that inherent differences in the depiction of stenosis by CA and CTA were responsible. When discrepancies caused by registration error were excluded, SD observed in BK segments (4.0%) remained significantly higher than in AK segments (1.25%) (p = 0.029), and poor CTA quality image was the most common cause (76%) of severe BK discrepancies. In AK discrepancies without an identifiable technical cause, CTA uniformly showed more stenosis, suggesting greater CTA diagnostic precision in larger vessels. In general, agreement between CTA and CA was moderately good. Compared to CA, CTA may be better at depicting stenosis in large, proximal vessels owing to the superior accuracy of cross-sectional images in the measurement of stenosis. There appeared to be poorer CT resolution and higher frequency of severe discrepancies between CTA and CA in BK arteries.
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Affiliation(s)
- Trung D Bui
- VA Long Beach Healthcare System, Department of Vascular Surgery, Long Beach, CA and UCI Medical Center, Department of Vascular and Endovascular Surgery, Orange, CA 92868, USA.
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Abstract
Purpose: To retrospectively review the long-term outcome as well as the cost effectiveness of thrombolytic therapy and balloon angioplasty (TBA) versus surgical thrombectomy and balloon angioplasty (SBA) in the treatment of prosthetic dialysis access grafts. Methods: Between February 1996 and February 1999, 63 hemodialysis patients (35 women; mean age 62.2 years) were treated for 105 thromboses in 6-mm polytetrafluoroethylene straight or loop bridge arteriovenous grafts. Choice of treatment was at the discretion of the surgeon or interventional radiologist: either Fogarty balloon thrombectomy followed by balloon dilation of the venous anastomotic stenosis or urokinase thrombolysis followed by angioplasty. Results: Forty-eight SBAs and 55 TBAs were performed in 63 patients without complications. The primary patency rates in the entire cohort were 34%, 29%, and 17% at 1, 2, and 3 months, respectively. Primary patency after TBA was 29%, 18%, and 11%, and that for SBA, 45%, 45%, and 33% over the same time intervals. The mean graft survival was 10 days for TBA versus 31 days for SBA. Repeat angioplasty performed in 23 grafts produced secondary patency rates of 52% at 1 month, 34% at 3 months, and 5% at 5 months. The Medicare reimbursement for both treatments was identical ($1638 for TBA and $1670 for SBA). Conclusions: The poor patency rate and high cost of TBA and SBA suggests that these procedures should not be routinely used for salvage of thrombosed arteriovenous grafts with outflow stenosis. Patch angioplasty or creation of simultaneous temporary and new permanent accesses may be a more cost-effective approach in these patients.
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Affiliation(s)
- P Anain
- Department of Surgery, State University of New York at Buffalo, USA
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Bhargava S, Parakh R, Manocha A, Ali A, Srivastava LM. Prevalence of Hyperhomocysteinemia in Vascular Disease: Comparative Study of Thrombotic Venous Disease Vis-è-Vis Occlusive Arterial Disease. Vascular 2016; 15:149-53. [PMID: 17573020 DOI: 10.2310/6670.2007.00031] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Studies on hyperhomocysteinemia in vascular occlusive disease have included mostly patients with arterial occlusion. However, more recent studies have included cases of venous occlusive disease as well. Our present study is aimed at comparing the prevalence of hyperhomocysteinemia in venous occlusive disease vis-è-vis arterial occlusive disease in the North Indian urban population. Homocysteine was estimated by chemiluminescent immunoassay in 205 normal controls and 536 patients, 244 presenting with arterial occlusion and 292 with venous thrombotic disease. The mean homocysteine in patients with arterial occlusion was 21.79 ± 0.09 μmol/L (mean ± standard error of measurement), in patients with venous thrombosis was 25.53 ± 0.1 μmol/L, and in controls was 11.33 ± 0.18 μmol/L. The prevalence of hyperhomocysteinemia (> 15 μmol/L) was 56.38% in arterial occlusive disease and 54.64% in venous thrombosis. In patients with peripheral vascular occlusive disease, patients with deep venous thrombosis (DVT) had the highest mean homocysteine level (25.51 μmol/L), which was even higher (32.14 μmol/L) when associated with pulmonary embolism (PE). There is a high prevalence of hyperhomocysteinemia in arterial and venous occlusive disease. Hence, in all patients with vascular occlusive disease, hyperhomocysteinemia should be elucidated and treated. In addition, long-term follow-up is required to ascertain whether the reduction in homocysteine decreases the thrombotic events and whether homocysteine levels can actually be of prognostic or predictive value in cases of DVT with PE.
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Affiliation(s)
- Seema Bhargava
- Department of Biochemistry, Sir Ganga Ram Hospital, New Delhi, India
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Levin D, Adawi S, Halon DA, Shiran A, Asmer I, Rubinshtein R, Jaffe R. Long-Term Radial Artery Patency Following Transradial Coronary Catheterization via a 7-Fr Sheath. Isr Med Assoc J 2016; 18:290-293. [PMID: 27430087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Radial artery occlusion (RAO) may occur following transradial catheterization, precluding future use of the vessel for vascular access or as a coronary bypass graft. Recanalization of RAO may occur; however, long-term radial artery patency when revascularization is more likely to be required has not been investigated. Transradial catheterization is usually performed via 5-Fr or 6-Fr catheters. Insertion of 7-Fr sheaths into the radial artery enables complex coronary interventions but may increase the risk of RAO. OBJECTIVE To assess the long-term radial artery patency following transradial catheterization via 7-Fr sheaths. METHODS Antegrade radial artery blood flow was assessed by duplex ultrasound in 43 patients who had undergone transradial catheterization via a 7-Fr sheath. RESULTS All patients had received intravenous unfractionated heparin with a mean activated clotting time (ACT) of 247 ± 56 seconds. Twenty-four patients (56%) had received a glycoprotein IIbIIIa inhibitor and no vascular site complications had occurred. Mean time interval from catheterization to duplex ultrasound was 507 ± 317 days. Asymptomatic RAO was documented in 8 subjects (19%). Reduced body weight was the only significant univariate predictor of RAO (78 ± 11 vs. 89 ± 13 kg, P = 0.031). In a bivariate model using receiver operator characteristic (ROC) curves, the combination of lower weight and shorter ACT offered best prediction of RAO (area under the ROC curve 0.813). CONCLUSIONS Asymptomatic RAO was found at late follow-up in approximately 1 of 5 patients undergoing transradial catheterization via a 7-Fr sheath and was associated with lower body weight and shorter ACT.
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Vasan SK, Rostgaard K, Majeed A, Ullum H, Titlestad KE, Pedersen OBV, Erikstrup C, Nielsen KR, Melbye M, Nyrén O, Hjalgrim H, Edgren G. ABO Blood Group and Risk of Thromboembolic and Arterial Disease: A Study of 1.5 Million Blood Donors. Circulation 2016; 133:1449-57; discussion 1457. [PMID: 26939588 DOI: 10.1161/circulationaha.115.017563] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 02/24/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND ABO blood groups have been shown to be associated with increased risks of venous thromboembolic and arterial disease. However, the reported magnitude of this association is inconsistent and is based on evidence from small-scale studies. METHODS AND RESULTS We used the SCANDAT2 (Scandinavian Donations and Transfusions) database of blood donors linked with other nationwide health data registers to investigate the association between ABO blood groups and the incidence of first and recurrent venous thromboembolic and arterial events. Blood donors in Denmark and Sweden between 1987 and 2012 were followed up for diagnosis of thromboembolism and arterial events. Poisson regression models were used to estimate incidence rate ratios as measures of relative risk. A total of 9170 venous and 24 653 arterial events occurred in 1 112 072 individuals during 13.6 million person-years of follow-up. Compared with blood group O, non-O blood groups were associated with higher incidence of both venous and arterial thromboembolic events. The highest rate ratios were observed for pregnancy-related venous thromboembolism (incidence rate ratio, 2.22; 95% confidence interval, 1.77-2.79), deep vein thrombosis (incidence rate ratio, 1.92; 95% confidence interval, 1.80-2.05), and pulmonary embolism (incidence rate ratio, 1.80; 95% confidence interval, 1.71-1.88). CONCLUSIONS In this healthy population of blood donors, non-O blood groups explain >30% of venous thromboembolic events. Although ABO blood groups may potentially be used with available prediction systems for identifying at-risk individuals, its clinical utility requires further comparison with other risk markers.
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Affiliation(s)
- Senthil K Vasan
- From Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (S.K.V., A.M., O.N., G.E.); Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark (K.R., M.M., H.H.); Department of Clinical Immunology, Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Denmark (H.U.); Department of Clinical Immunology, Odense University Hospital, Denmark (K.-E.T.); Department of Clinical Immunology, Næstved Hospital, Denmark (O.B.V.P.); Department of Clinical Immunology, Aarhus University Hospital, Denmark (C.E.); Department of Clinical Immunology, Aalborg University Hospital, Denmark (K.R.N.); and Hematology Centre, Karolinska University Hospital, Stockholm, Sweden (A.M., G.E.).
| | - Klaus Rostgaard
- From Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (S.K.V., A.M., O.N., G.E.); Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark (K.R., M.M., H.H.); Department of Clinical Immunology, Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Denmark (H.U.); Department of Clinical Immunology, Odense University Hospital, Denmark (K.-E.T.); Department of Clinical Immunology, Næstved Hospital, Denmark (O.B.V.P.); Department of Clinical Immunology, Aarhus University Hospital, Denmark (C.E.); Department of Clinical Immunology, Aalborg University Hospital, Denmark (K.R.N.); and Hematology Centre, Karolinska University Hospital, Stockholm, Sweden (A.M., G.E.)
| | - Ammar Majeed
- From Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (S.K.V., A.M., O.N., G.E.); Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark (K.R., M.M., H.H.); Department of Clinical Immunology, Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Denmark (H.U.); Department of Clinical Immunology, Odense University Hospital, Denmark (K.-E.T.); Department of Clinical Immunology, Næstved Hospital, Denmark (O.B.V.P.); Department of Clinical Immunology, Aarhus University Hospital, Denmark (C.E.); Department of Clinical Immunology, Aalborg University Hospital, Denmark (K.R.N.); and Hematology Centre, Karolinska University Hospital, Stockholm, Sweden (A.M., G.E.)
| | - Henrik Ullum
- From Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (S.K.V., A.M., O.N., G.E.); Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark (K.R., M.M., H.H.); Department of Clinical Immunology, Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Denmark (H.U.); Department of Clinical Immunology, Odense University Hospital, Denmark (K.-E.T.); Department of Clinical Immunology, Næstved Hospital, Denmark (O.B.V.P.); Department of Clinical Immunology, Aarhus University Hospital, Denmark (C.E.); Department of Clinical Immunology, Aalborg University Hospital, Denmark (K.R.N.); and Hematology Centre, Karolinska University Hospital, Stockholm, Sweden (A.M., G.E.)
| | - Kjell-Einar Titlestad
- From Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (S.K.V., A.M., O.N., G.E.); Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark (K.R., M.M., H.H.); Department of Clinical Immunology, Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Denmark (H.U.); Department of Clinical Immunology, Odense University Hospital, Denmark (K.-E.T.); Department of Clinical Immunology, Næstved Hospital, Denmark (O.B.V.P.); Department of Clinical Immunology, Aarhus University Hospital, Denmark (C.E.); Department of Clinical Immunology, Aalborg University Hospital, Denmark (K.R.N.); and Hematology Centre, Karolinska University Hospital, Stockholm, Sweden (A.M., G.E.)
| | - Ole B V Pedersen
- From Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (S.K.V., A.M., O.N., G.E.); Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark (K.R., M.M., H.H.); Department of Clinical Immunology, Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Denmark (H.U.); Department of Clinical Immunology, Odense University Hospital, Denmark (K.-E.T.); Department of Clinical Immunology, Næstved Hospital, Denmark (O.B.V.P.); Department of Clinical Immunology, Aarhus University Hospital, Denmark (C.E.); Department of Clinical Immunology, Aalborg University Hospital, Denmark (K.R.N.); and Hematology Centre, Karolinska University Hospital, Stockholm, Sweden (A.M., G.E.)
| | - Christian Erikstrup
- From Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (S.K.V., A.M., O.N., G.E.); Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark (K.R., M.M., H.H.); Department of Clinical Immunology, Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Denmark (H.U.); Department of Clinical Immunology, Odense University Hospital, Denmark (K.-E.T.); Department of Clinical Immunology, Næstved Hospital, Denmark (O.B.V.P.); Department of Clinical Immunology, Aarhus University Hospital, Denmark (C.E.); Department of Clinical Immunology, Aalborg University Hospital, Denmark (K.R.N.); and Hematology Centre, Karolinska University Hospital, Stockholm, Sweden (A.M., G.E.)
| | - Kaspar Rene Nielsen
- From Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (S.K.V., A.M., O.N., G.E.); Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark (K.R., M.M., H.H.); Department of Clinical Immunology, Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Denmark (H.U.); Department of Clinical Immunology, Odense University Hospital, Denmark (K.-E.T.); Department of Clinical Immunology, Næstved Hospital, Denmark (O.B.V.P.); Department of Clinical Immunology, Aarhus University Hospital, Denmark (C.E.); Department of Clinical Immunology, Aalborg University Hospital, Denmark (K.R.N.); and Hematology Centre, Karolinska University Hospital, Stockholm, Sweden (A.M., G.E.)
| | - Mads Melbye
- From Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (S.K.V., A.M., O.N., G.E.); Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark (K.R., M.M., H.H.); Department of Clinical Immunology, Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Denmark (H.U.); Department of Clinical Immunology, Odense University Hospital, Denmark (K.-E.T.); Department of Clinical Immunology, Næstved Hospital, Denmark (O.B.V.P.); Department of Clinical Immunology, Aarhus University Hospital, Denmark (C.E.); Department of Clinical Immunology, Aalborg University Hospital, Denmark (K.R.N.); and Hematology Centre, Karolinska University Hospital, Stockholm, Sweden (A.M., G.E.)
| | - Olof Nyrén
- From Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (S.K.V., A.M., O.N., G.E.); Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark (K.R., M.M., H.H.); Department of Clinical Immunology, Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Denmark (H.U.); Department of Clinical Immunology, Odense University Hospital, Denmark (K.-E.T.); Department of Clinical Immunology, Næstved Hospital, Denmark (O.B.V.P.); Department of Clinical Immunology, Aarhus University Hospital, Denmark (C.E.); Department of Clinical Immunology, Aalborg University Hospital, Denmark (K.R.N.); and Hematology Centre, Karolinska University Hospital, Stockholm, Sweden (A.M., G.E.)
| | - Henrik Hjalgrim
- From Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (S.K.V., A.M., O.N., G.E.); Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark (K.R., M.M., H.H.); Department of Clinical Immunology, Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Denmark (H.U.); Department of Clinical Immunology, Odense University Hospital, Denmark (K.-E.T.); Department of Clinical Immunology, Næstved Hospital, Denmark (O.B.V.P.); Department of Clinical Immunology, Aarhus University Hospital, Denmark (C.E.); Department of Clinical Immunology, Aalborg University Hospital, Denmark (K.R.N.); and Hematology Centre, Karolinska University Hospital, Stockholm, Sweden (A.M., G.E.)
| | - Gustaf Edgren
- From Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (S.K.V., A.M., O.N., G.E.); Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark (K.R., M.M., H.H.); Department of Clinical Immunology, Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Denmark (H.U.); Department of Clinical Immunology, Odense University Hospital, Denmark (K.-E.T.); Department of Clinical Immunology, Næstved Hospital, Denmark (O.B.V.P.); Department of Clinical Immunology, Aarhus University Hospital, Denmark (C.E.); Department of Clinical Immunology, Aalborg University Hospital, Denmark (K.R.N.); and Hematology Centre, Karolinska University Hospital, Stockholm, Sweden (A.M., G.E.)
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Abstract
Data on the association between peripheral artery occlusive disease (PAOD) and leptospirosis are limited. We conducted a retrospective cohort study for determining whether leptospirosis is one of the possible risk factors for PAOD. Patients diagnosed with leptospirosis by using 2000 to 2010 data from the Taiwan National Health Insurance Research Database. Patients with leptospirosis without a history of PAOD were selected. For each leptospirosis patient, 4 controls without a history of leptospirosis and PAOD were randomly selected and frequency-matched for sex, age, the year of the index date, and comorbidity diseases. The follow-up period was from the time of the initial diagnosis of leptospirosis to the diagnosis date of PAOD, or December 31, 2011. The Cox proportional hazard regression models were used for analyzing the risk of PAOD. During the follow-up period, the cumulative incidence of PAOD was higher among the patients from the leptospirosis cohort than among the nonleptospirosis cohort (log-rank test, P < 0.001). In total, 29 patients with PAOD from the leptospirosis cohort and 81 from the nonleptospirosis cohort were observed with the incidence rates of 2.1 and 1.3 per 1000 person-years, respectively, yielding a crude hazards ratio (HR) of 1.62 (95% confidence interval [CI] = 1.44-1.81) and adjusted HR (aHR) of 1.75 (95% CI = 1.58-1.95).The risk of PAOD was 1.75-fold higher in the patients with leptospirosis than in the general population.
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Affiliation(s)
- Chun-Hsiang Chiu
- From the Division of Infectious Diseases and Tropical Medicine (C-HC), Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center; Institute of Clinical Medicine (C-HC), School of Medicine, National Yang-Ming University; Management Office for Health Data (C-LL), China Medical University Hospital; College of Medicine, China Medical University(C-LL); Department of Emergency Medicine (F-YL), Taichung Tzu Chi Hospital, Taichung; Department of Family Medicine (Y-CW), Tri-Service General Hospital, National Defense Medical Center; Graduate Institute of Clinical Medical Science and School of Medicine (C-HK), College of Medicine, China Medical University; and Department of Nuclear Medicine and PET Center (C-HK), China Medical University Hospital, Taichung, Taiwan
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Rashid M, Kwok CS, Pancholy S, Chugh S, Kedev SA, Bernat I, Ratib K, Large A, Fraser D, Nolan J, Mamas MA. Radial Artery Occlusion After Transradial Interventions: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2016; 5:e002686. [PMID: 26811162 PMCID: PMC4859386 DOI: 10.1161/jaha.115.002686] [Citation(s) in RCA: 223] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/22/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Radial artery occlusion (RAO) may occur posttransradial intervention and limits the radial artery as a future access site, thus precluding its use as an arterial conduit. In this study, we investigate the incidence and factors influencing the RAO in the current literature. METHODS AND RESULTS We searched MEDLINE and EMBASE for studies of RAO in transradial access. Relevant studies were identified and data were extracted. Data were synthesized by meta-analysis, quantitative pooling, graphical representation, or by narrative synthesis. A total of 66 studies with 31 345 participants were included in the analysis. Incident RAO ranged between <1% and 33% and varied with timing of assessment of radial artery patency (incidence of RAO within 24 hours was 7.7%, which decreased to 5.5% at >1 week follow-up). The most efficacious measure in reducing RAO was higher dose of heparin, because lower doses of heparin were associated with increased RAO (risk ratio 0.36, 95% CI 0.17-0.76), whereas shorter compression times also reduced RAO (risk ratio 0.28, 95% CI 0.05-1.50). Several factors were found to be associated with RAO including age, sex, sheath size, and diameter of radial artery, but these factors were not consistent across all studies. CONCLUSIONS RAO is a common complication of transradial access. Maintenance of radial patency should be an integral part of all procedures undertaken through the radial approach. High-dose heparin along with shorter compression times and patent hemostasis is recommended in reducing RAO.
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Affiliation(s)
- Muhammad Rashid
- St. Helens & Knowsley Teaching Hospital (NHS) TrustWhiston HospitalPrescotUK
- Keele Cardiovascular Research GroupUniversity of KeeleStoke‐on‐TrentUK
| | - Chun Shing Kwok
- Keele Cardiovascular Research GroupUniversity of KeeleStoke‐on‐TrentUK
| | - Samir Pancholy
- The Wright Center for Graduate Medical EducationThe Commonwealth Medical CollegeScrantonPA
| | | | | | - Ivo Bernat
- University Hospital and Faculty of Medicine PilsenPilsenCzech Republic
| | - Karim Ratib
- Royal Stoke HospitalUniversity Hospital North Midlands TrustStoke‐on‐TrentUK
| | - Adrian Large
- Royal Stoke HospitalUniversity Hospital North Midlands TrustStoke‐on‐TrentUK
| | - Doug Fraser
- Manchester Heart CentreManchester Royal InfirmaryManchesterUK
| | - James Nolan
- Royal Stoke HospitalUniversity Hospital North Midlands TrustStoke‐on‐TrentUK
| | - Mamas A. Mamas
- Keele Cardiovascular Research GroupUniversity of KeeleStoke‐on‐TrentUK
- Royal Stoke HospitalUniversity Hospital North Midlands TrustStoke‐on‐TrentUK
- Farr InstituteInstitute of Population HealthUniversity of ManchesterUK
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Lazutkina AY, Gorbunov VV. [Assessing the influence of predictors of the development of chronic obliterating diseases of lower-limb arteries]. Angiol Sosud Khir 2016; 22:30-36. [PMID: 27935877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The authors assessed the probability and terms of the development of chronic obliterating diseases of lower-limb arteries under the influence of the predictors studied. Using the Statistica 6.0 programme we carried out the analysis of the function of survival on a sample of 7,959 people. Based on the Kaplan-Mayer method and Cox regression model we determined the most significant predictors influencing the development of subclinical lesions of lower-extremity arteries. Also determined was the duration of the influence of each predictor prior to clinical manifestation and contribution of each predictor to the development of the examined outcomes.
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Affiliation(s)
- A Yu Lazutkina
- Regional Administration of Medical Provision on the Trans-Baikal Railway, Chita, Russia
| | - V V Gorbunov
- Department of Internal Medicine Propaedeutics, Chita State Medical Academy, Chita, Russia
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Lin CS, Chen SJ, Sung CC, Lin CL, Lin SH, Cheng SM, Wang IK, Huang WS, Kao CH. Hemodialysis Is Associated With Increased Peripheral Artery Occlusive Disease Risk Among Patients With End-Stage Renal Disease: A Nationwide Population-Based Cohort Study. Medicine (Baltimore) 2015; 94:e1164. [PMID: 26181560 PMCID: PMC4617093 DOI: 10.1097/md.0000000000001164] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
To investigate the effect of different dialysis modalities on the incidence of peripheral artery occlusive disease (PAOD) among patients with end-stage renal disease (ESRD) in a large population-based cohort study. The cohort study included 26,927 ESRD patients who underwent hemodialysis (17,737 patients, hemodialysis [HD] cohort) or peritoneal dialysis (PD, 9190 patients, PD cohort), and 107,588 matched controls between 2000 and 2010. A Cox proportional hazards model was to evaluate the risk of PAOD in the ESRD underwent HD or PD. Based on a mean follow-up period of 2.92, 3.64, and 4.91 years in the PD, HD, and control cohorts, respectively, the incidences of PAOD were 18.1% and 8.10% higher in the HD and PD cohorts, respectively, compared with the control cohort (log-rank test P < 0.001). The patients who underwent HD or PD exhibited a higher risk of PAOD compared with the control cohort regardless of age, sex, and presence or absence of comorbidities. In addition, the incidence of PAOD in the PD cohort and the propensity score-matched HD cohort were 12.4 and 20.7 per 1000 person-years, respectively, with a hazard ratio of 1.92 (95% confidence interval = 1.62-2.28) in HD patients, compared with the PD cohort. This nationwide population-based cohort study suggested a significantly increased risk of PAOD among ESRD patients. Moreover, the PD patients have a lower risk of developing PAOD compared with the HD cohort, indicating the beneficial roles of PD in reducing PAOD risk in ESRD patients.
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Affiliation(s)
- Chin-Sheng Lin
- From the Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (C-SL, S-MC); Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (S-JC); Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (C-CS, S-HL); Management Office for Health Data, China Medical University Hospital (C-LL); College of Medicine, China Medical University (C-LL); Graduate Institute of Clinical Medical Science and School of Medicine (I-KW, C-HK); Department of Internal Medicine, College of Medicine, China Medical University (I-KW); Division of Kidney Disease, China Medical University Hospital, Taichung (I-KW); Department of Nuclear Medicine, Changhua Christian Hospital, Changhua (W-SH); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK)
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Flemma RJ, Walker JA, Gale H, Manley J, Tector AJ, Lepley D. Is vein bypass here to stay? Early and long-term observations. Adv Cardiol 2015; 9:124-33. [PMID: 4542755 DOI: 10.1159/000393431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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van Buuren F, Sommer JA, Kottmann T, Horstkotte D, Mellwig KP. [Extracardiac manifestation of elevated lipoprotein(a) levels--cumulative incidence of peripheral arterial disease and stenosis of the carotid artery]. Clin Res Cardiol Suppl 2015; 10:39-45. [PMID: 25666916 DOI: 10.1007/s11789-015-0069-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Elevated lipoprotein(a) (Lp(a)) levels are an accepted risk factor for coronary heart disease. The role of Lp(a) in the development of extracardiac arteriosclerosis like peripheral arterial disease (PAD) and stenosis of the arteria carotis (ACIS) has hardly been documented so far. We aimed to investigate the incidence of extracardiac arteriosclerosis in individuals with elevated Lp(a) values. METHODIK In our center, we measured Lp(a) levels in 31,734 consecutive patients over 5 years. Of these, 1411 patients were selected retrospectively for the presented analysis. Patients were matched according to age, sex, and other accepted cardiovascular risk factors and were assigned to 6 groups according to their Lp(a) values. Retrospectively, we analysed the incidence of PAD and ACIS. RESULTS In the group with Lp(a) values < 2 mg/dl the incidence of PAD was 1.9 % (ACIS 2.8 %), in the group with Lp(a) 23-29 mg/dl 7.3 % (6.1 %), 30-60 mg/dl 9.0 % (8.3 %), 60-91 mg/dl 11.4 % (7.9 %), 91-110 mg/dl 8.6 % (6.0 %) and > 110 mg/dl 12.7 % (10.9 %). None of the patients had LDL levels > 130 mg/dl or HbA1c 6.1 %. CONCLUSION Elevated Lp(a) levels seem to be associated with an increased incidence of PAD and ACIS. Even Lp(a) concentrations between 23 and 29 mg/dl show a threefold increased risk of PAD when compared to patients with Lp(a) < 2 mg/dl. However, these findings have to be verified in large prospective studies. In this context cut-off values have to be reevaluated as well.
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Affiliation(s)
- Frank van Buuren
- Klink für Kardiologie, Herz- und Diabeteszentrum NRW, Ruhr Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland,
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Garg N, Madan BK, Khanna R, Sinha A, Kapoor A, Tewari S, Kumar S, Goel PK. Incidence and predictors of radial artery occlusion after transradial coronary angioplasty: Doppler-guided follow-up study. J Invasive Cardiol 2015; 27:106-112. [PMID: 25661763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To evaluate the incidence and predictors of radial artery occlusion (RAO) after transradial coronary angioplasty (TRA). BACKGROUND RAO can occur after TRA but has not been well studied by serial vascular Doppler examination. METHODS A total of 198 patients undergoing TRA were included. Radial pulse and Doppler examination of the radial artery were performed 1 day before, 1 day after, and 3 months after the procedure. RAO was defined as an absence of antegrade flow on Doppler studies. Logistic regression analysis was done to evaluate the predictors of RAO. RESULTS The mean radial arterial diameter was 2.8 ± 0.4 mm. On the day after TRA, radial artery Doppler examination revealed RAO in 30 patients (15.2%). Radial pulse was still palpable in 30.0% of these patients. All of them were asymptomatic. At 3-month follow-up, no new RAO was noted. Interestingly, the radial artery had spontaneously recanalized in 8 patients (26.7%) with RAO. Patients with persistent RAO remained asymptomatic. On univariate analysis, female sex, diabetes, lower body mass index, radial artery diameter ≤2.5 mm, lower peak systolic velocity, and radial artery to sheath ratio <1 were predictors of RAO. Interestingly, procedural characteristics and duration of the procedure were not identified as predictors of RAO. On multivariate analysis, radial artery diameter ≤2.5 mm and preprocedural peak systolic velocity emerged as independent predictors for RAO. CONCLUSION Asymptomatic RAO occurs in about 15% of patients after TRA. Spontaneous recanalization occurs in about one-fourth of these patients. Preprocedure radial artery inner diameter ≤2.5 mm and peak systolic velocity are the independent predictors of RAO.
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Affiliation(s)
- Naveen Garg
- Department of Cardiology, Sanjay Gandhi PGIMS, Raibareli Road, Lucknow, India.
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