Access For Coronary Intervention Research Articles

Distal Trans-radial Access Compared to Conventional Trans-radial Access in Coronary Interventions: A Meta-analysis.

Distal trans-radial access (dTRA) is a novel technique of arterial cannulation in coronary interventions. The comparative efficacy of dTRA and conventional trans-radial access (TRA) in attenuating peri-procedural complications is unknown. Embase and PubMed/MEDLINE were searched from their inception until June 25, 2022, for randomized clinical trials. Outcomes included were radial artery occlusion (RAO), radial artery spasm, hemostasis time, access time, unsuccessful cannulation, crossover rate, and early discharge after trans-radial stenting of coronary arteries (EASY) type I-III hematomas. Statistical analysis was conducted using the random effects model to derive risk ratios (RRs) and mean differences (MDs) with their corresponding 95% confidence intervals (CIs). A total of 6 randomized clinical trials comprising 3240 patients were included. Subjects were predominantly male (73%) and had a mean age of 66 years. The dTRA group had a lower risk of RAO [RR 0.43 (95% CI, 0.26-0.69); P = 0.0005; I 2 = 0%] and had a shorter hemostasis time [MD -22.85 min (95% CI, -39.06 to -6.65); P = 0.006; I 2 = 99%]. The dTRA group had a higher crossover rate [RR 3.04 (95% CI, 1.88-4.91); P = 0.00001; I 2 = 56%] and a longer access time [MD 0.68 min (95% CI, 0.17-1.18); P = 0.009; I 2 = 99%]. The TRA group had a lower rate of unsuccessful cannulation [RR 0.81 (95% CI, 0.70-0.95); P = 0.01; I 2 = 92%]. There was no significant difference between the groups for radial artery spasm and EASY type I-III hematomas. dTRA is a safe alternative to conventional TRA for coronary interventions with a lower risk of RAO. Future trials are required to further compare both approaches.

Single vascular access in coronary intervention protected with a ventricular mechanical assist device

Single vascular access in coronary intervention protected with a ventricular mechanical assist device

TOTAL risk score for predicting safe very early discharge in patients with ST-elevation myocardial infarction (STEMI)

Abstract Background/Introduction Previously validated risk scores for identifying low-risk patients after ST-segment elevation myocardial infarction (STEMI) have led to acceptance of the safety and feasibility of discharge after 48–72 hours of hospitalization, reducing hospital length of stay and costs. With ongoing improvements in outcomes, it may be possible to select patients who are safe to discharge very early (24–48 hours) but this has never been evaluated. Purpose We sought to develop and validate a novel risk score for identifying low-risk patients suitable for very early discharge (≤48 hours of hospitalization) post-STEMI. Methods We derived a novel risk score using data from patients enrolled in the Trial of Routine Aspiration Thrombectomy with PCI versus PCI alone in Patients with STEMI (TOTAL). The TOTAL database was randomly divided into a derivation cohort with 2/3 of the composite events and non-events and remaining 1/3 as the internal validation cohort. Using the derivation cohort, we identified risk factors for cardiovascular death (CV) or non-fatal cardiac arrest by performing a univariate and multivariable stepwise regression analysis of baseline clinical and angiographic characteristics. Each co-variate was assigned an integer score based on regression coefficients and the novel TOTAL risk score was developed by adding points from each risk factor profile. We externally validated the TOTAL score using data from the Radial versus Femoral Access for Coronary Intervention (RIVAL) trial. Results The TOTAL derivation cohort included 6331 participants with 287 events (CV death/cardiac arrest). Twelve independent risk-factors associated with risk of CV death and non-fatal cardiac arrest at 1 year were selected and weighted for the TOTAL risk score (Table 1). In the TOTAL validation cohort (n=3166), patients with a TOTAL score of 0–4 points (n=779 (24.6%)) were categorized as very low risk with only a 0.1% risk of CV death/cardiac arrest observed within 24 hours of hospitalization, and no further events observed between 24 hours and 30 days post-STEMI. In the RIVAL validation dataset (n=1451), patients with a TOTAL score of 0–4 points (n=737 (50.7%)) had a 0.3% risk of CV death/cardiac arrest within 24 hours, with no further events observed between 24 hours and 72 hours of hospitalization. Conclusion The TOTAL risk score identified a very low risk subset of patients for whom early discharge, 24–48 hours post-STEMI, is likely safe. These findings have the potential to change practice and support early discharge after STEMI. Funding Acknowledgement Type of funding sources: None.

Single vascular access in coronary intervention protected with a ventricular mechanical assist device

El dispositivo de asistencia mecánica Impella CP (Abiomed, Danvers, Massachussetts) es el más utilizado para el apoyo hemodinámico en el intervencionismo coronario percutáneo de alto riesgo. Si se desea evitar un acceso adicional radial o femoral, es posible usar el introductor 14 F del dispositivo de asistencia como acceso vascular único.

Medical Error, Adverse Events, and Complications in Interventional Radiology: Liability or Opportunity?

This review suggests that there is a critical need to renew understanding of adverse events and complications within interventional radiology and to redefine a robust commitment to patient safety a...

Abstract 15001: Radial Access Has No Impact on Medications Adherence Post Coronary Intervention: A Retrospective Observational Cohort Study Using Real-world Data

Introduction: The Transradial artery access for Primary Percutaneous Coronary Intervention (PCI) is the preferred access for coronary interventions in ST Elevation Myocardial Infarction STEMI due to less complications post intervention and it has been shown to improve quality of life of patients post intervention. This decrease in complications may give the patient sense of ease and underestimation of disease severity, and hence worsen the patient’s compliance with medications. This retrospective observation study aimed to assess the impact of radial versus femoral access coronary interventions on adherence to post-PCI medications. Methods: We conducted a retrospective analysis for all patients who presented with STEMI and underwent primary PCI in a tertiary cardiac hospital in Qatar between January 1, 2016 and December 31, 2018. Adherence was assessed by refilling the first prescription post discharge. Adherence rates were compared between the patients who underwent PCI with radial versus femoral access using the Chi square test. Results: A total of 1339 patients who presented with acute STEMI and underwent primary PCI were included in our retrospective analysis. The majority of patients included were male (96%) with mean age of 51 years. The majority of patients (1082; 81%) underwent radial access, while 257 (19%) underwent femoral access. The two groups were comparable in terms of age, nationality, the presence of full versus partial insurance, and using medications before admission. The patients adherence to medications post-PCI, including aspirin, P2Y12 inhibitor, statin, beta-blocker, angiotensin converting enzyme (ACE) inhibitor/ angiotensin II receptor blocker (ARB) was comparable between the radial versus femoral access ( aspirin: 78% vs. 74%; p-value= 0.16, P2Y12 inhibitor: 81% vs. 79%; p-value=0.45, statin: 80% vs. 76%; p-value= 0.15, beta-blocker: 72% vs. 70; p-value= 0.51, ACE inhibitor/ARB: 79% vs. 74%; p-value= 0.09). Conclusion: In comparison to femoral access in primary coronary intervention in STEMI, the radial access resulted in similar adherence to post-PCI medications assessed by refilling of first prescription post discharge. Therefore, the radial access is a safe approach in terms medications adherence.

TCT CONNECT-427 Initial Experience With the Distal Radial (“Snuffbox”) Access for Coronary Interventions

TCT CONNECT-427 Initial Experience With the Distal Radial (“Snuffbox”) Access for Coronary Interventions

818 Distal Radial Artery Access is as Safe and Feasible as Proximal Radial Artery Access for Coronary Interventions

818 Distal Radial Artery Access is as Safe and Feasible as Proximal Radial Artery Access for Coronary Interventions

Simultaneous computed tomographic angiography of the coronary and radial arteries.

Our aim was to assess a method of simultaneous computed tomographic (CT) angiography of the coronary and radial arteries without increasing contrast medium usage. Radial access is a standard approach in coronary interventions. However, radial artery puncture is difficult due to the small size of the radial artery and potential unexpected anomaly. If we can obtain anatomical information on the radial artery beforehand, the success rate of radial artery puncture may increase. Simultaneous CT angiography of the coronary and radial arteries without increasing contrast medium usage was planned. Contrast medium was injected in the right elbow vein. Time to peak concentration of contrast medium in the aorta (TPA) and time to peak concentration of contrast medium in the radial artery (TPR) were obtained by the test scan in each patient based on the time-density curve. The main scan was performed using 265mg iodine/kg of contrast medium. The start time was decided according to TPA and TPR, respectively. This study included 192 cases [age, mean ± standard deviation (SD),72.0 ± 9.9years]. Mean TPA and TPR were 19.0 ± 2.3(SD) seconds and 34.0 ± 10.0s, respectively. Clear images of radial arteries were obtained in 89.6% (right) and 84.9% (left). Radiation exposure during cardiac CT angiography (CCTA) and radial artery CT angiography (RCTA) was 269.9 ± 155.6mGycm and 31.1 ± 12.3mGycm as dose length product, respectively. RCTA immediately following CCTA was safely performed with minimal increase in radiation exposure and no additional contrast medium. These images can help in radial access as well as distal radial access in coronary interventions.

Are complication rates lower with 4-Fr versus 6-Fr transfemoral arterial access \u2013 prospective audit at a single interventional radiology centre

BackgroundFemoral arterial access constitutes the first step in a significant proportion of interventional endovascular procedures. Whilst existing reports describe sheath size as an independent risk factor for bleeding complications in radial arterial access for coronary intervention, the influence of sheath size on overall complication rates and morbidity following femoral arterial access is not well described. This prospective single centre study reports our experience of vascular sheath size, patient and procedural factors in influencing complication rates following femoral arterial access. From April 2010 to May 2013, data was collected prospectively for all femoral arterial access procedures performed in the Interventional Radiology department of a tertiary hospital. For vascular sheath size <6-Fr, haemostasis was achieved by manual compression. For 6-Fr sheath size, a closure device was used in the absence of any contraindication.ResultsOf the 320 femoral access cases with eligible inclusion criteria, 52.5% had 4-Fr whilst 47.5% had 6-Fr vascular sheaths inserted. Overall post procedure complications rates were significantly higher following 6-Fr sheath (17/152 (11.2%)) versus 4-Fr systems (3/168 (1.8%)) (p=0.0007) mostly comprising self-limiting hematoma. There was no significant difference in major complications that required escalation of treatment.ConclusionNo significant difference has been demonstrated between the use of either sheath systems for major complications. The practical limitations of a smaller system, combined with existing body of evidence, may not justify the routine use of 4-Fr sheath systems as the primary sheath size for all endovascular procedures.

CRT-200.17 Lack of “Learning Curve” in Transradial Carotid Artery Stenting: Comparison of Transfemoral vs. Transradial Access in a Single-Center, Single-Operator Experience

Initial transradial (TR) access in coronary intervention showed a “learning curve” regarding radiation exposure, dye use, and procedural times compared to transfemoral (TF) access. Data are limited in TR access in carotid artery stenting (CAS), and it is unclear whether a similar “learning

Option for the Radial versus Femoral Access in Coronary Intervention in Acute Coronary Syndromes: A Risk-Treatment Paradox

Abstract Background: In coronary procedures, although the radial approach protects patients from hemorrhagic complications, it is technically more complex than the femoral approach. Objectives: To test the hypothesis that the radial approach is the procedure of choice in ACS patients due to the high risk of bleeding; and to identify independent predictors of the choice for radial access. Methods: Patients admitted for ACS who underwent invasive coronary procedure were included. We registered the type of access (femoral or radial) chosen by the physician for the first angiography; the investigators did not interfere with this choosing process. Student’s t-test was used for comparisons between the CRUSADE and ACUITY scores. Predictors of radial access were compared between the groups. Statistical significance was defined by p < 0,05. Results: Radial access was chosen in 67% of 347 consecutive patients. Patients who underwent radial approach had lower risk of bleeding determined by CRUSADE (30 ± 14 vs. 37 ± 15; p < 0.001) as compared with femoral access. In multivariate analysis, four variables were identified as independent predictors negatively associated with radial access - age (OR = 0.98; 95%CI = 0.96 - 0.99), creatinine (OR = 0.54; 95%CI = 0.3 - 0.98), signs of left ventricular failure (OR = 0.45; 95% CI = 0.22 - 0.92) and previous CABG (OR = 0.022; 95%CI = 0.003 - 0.166). Conclusion: The propensity to choose radial over femoral access in coronary intervention was not primarily influenced by patients’ bleeding risk. Predictors of this decision, identified in the study, indicated less complex patients, suggesting that the difficulty in performing the technique was a stronger determinant than its potential antihemorrhagic effect. (Int J Cardiovasc Sci. 2018; [online].ahead print, PP.0-0)

UK experience of conversion of radial to femoral access in coronary interventions

UK experience of conversion of radial to femoral access in coronary interventions

Left anterior descending artery percutaneous coronary intervention from the right radial access via the left internal mammary artery: a case report

Trans-radial access in coronary intervention has gained popularity as it grants advantages in patients with higher risk of haemorrhage, especially those with non-cardiac conditions and those treated with oral anticoagulant therapy. We report a case of percutaneous coronary intervention (PCI) of the left anterior descending (LAD) artery distal to left internal mammary artery (LIMA) anastomosis from the usually contraindicated right radial approach, in an actively bleeding patient affected by gastric cancer and chronic atrial fibrillation, and with no other available low-risk route. LAD trans-LIMA PCI via right radial access can be attempted in selected cases with suitable anatomy.

Coronary stenting using the radial approach in two women with situs viscerum inversus and acute myocardial infarction

A situs inversus with dextrocardia (DC) is a rare condition in adults. Usually, patients have structurally normal hearts and normal life expectancy. The incidence of coronary artery disease in this setting is similar to that in the general population. Coronary revascularization may present potential difficulties related to the unusual anatomy. Although the radial artery is a safe and effective site of access for coronary interventions, some anatomical variations may make this procedure more complicated. We describe two cases of patients with situs viscerum inversus and acute myocardial infarction who underwent successful transradial percutaneous coronary intervention (PCI). We will show that coronary angioplasty with stent application via the radial approach in patients with DC is feasible and effective also in emergency and urgent care.

Radial Artery Access as an Emerging Factor for Decreasing Mortality in Cardiovascular Interventions

Transradial access for coronary interventions provides increased patient comfort, fewer access site complications, and reduced hospital stay and costs. However, the potential benefits favoring transradial access may be even more than these apparent advantages. Major bleeding after coronary interventions is an important factor contributing to mortality rates and can be dramatically reduced with the selection of the radial artery as the access site. Recent evidence suggests that the decrease in bleeding complications with transradial access may translate into a short- and long-term decrease in mortality in patients undergoing elective or urgent coronary interventions. In the era of complex coronary interventions with use of multiple antiplatelet and antithrombotic treatment regimens, the simple choice of transradial access for increasing patient comfort and decreasing bleeding complications and mortality is promising.

Angioplastie périphérique par voie radiale

Radial access for coronary intervention has gained popularity due to a low rate of access site bleeding complications and the possibility for early discharge. The preferential access site for peripheral intervention remains femoral, via antegrade or retrograde puncture. Not all peripheral lesions are suitable for transradial intervention due to the distance between the access site and the lesion location. This technique requires a precise strategy planning and knowledge of the available devices. We describe accessible sites from radial approach and the techniques to be used.

Percutaneous arterial aortoiliac intervention.

Historically reconstructive vascular surgery, has been a cornerstone of treatment for symptomatic obliterative aortoiliac disease. Surgical results include a reported aortobifemoral bypass 5-year patency rate from 85% to 90% and a 10-year patency rate of 70% to 75%. Operative mortality for aortoiliac reconstruction ranges from 1.6% to 3.3%, with an aggregated systemic morbidity of 8.3%. Clinical indications for surgical intervention are well-established and are limited primarily to severe claudication and limb-threatening ischemia. Broader application of surgical intervention is not recommended because of significant morbidity and mortality associated with the procedure. As balloon angioplasty and endovascular stenting technologies evolve, they are proving to be an effective modality for the treatment of aortoiliac disease. These lower risk procedures have allowed expansion of traditional indications for intervention. Treatment is recommended presently for patients with clinical symptoms that impact lifestyle and professional requirements. Less conventional indications include allowing access for coronary intervention or for placement of an intra-aortic balloon pump, or improving inflow prior to a distal surgical bypass procedure. Results of aortoiliac percutaneous interventions are difficult to compare with surgical data since methods and technology continue to improve and evolve, and randomized studies are limited. It is clear that as long as outcomes of percutaneous interventions are predictable and secondary patency rates acceptable, the low complication rates of a percutaneous intervention are clearly preferable to a riskier surgical alternative.