To Transfemoral Access Research Articles

Abstract 250: Radial vs femoral access for neuroendovascular diagnostic and therapeutic procedures. A systematic review and Meta‐analysis

Introduction Transradial access (TRA) has become increasingly utilized among neurointerventionalists. There is evidence of reduced complications and higher patient satisfaction compared to transfemoral access (TFA), but more data directly comparing the safety and efficacy of the two approaches is needed. To assess the proportion of technical success and complications with TRA versus TFA in patients who underwent neuroendovascular diagnostic and therapeutic procedures. Methods PRISMA guidelines were used to conduct a systematic review of the literature with PubMed/Medline, Scopus, Embase, and Cochrane databases up to February 2023. Randomized clinical trials (RCT) and observational studies that compared TRA and TFA were included. Studies reporting results of patients who underwent diagnostic angiograms, endovascular management of acute stroke, aneurysm repair, and carotid or vertebral stenting were included. Our primary outcome was technical success, defined as successful arterial access and completion of the intended procedure without crossover. Secondary safety outcomes were rate of complications including access site and non‐access site related, and other efficacy measures such as procedure duration, fluoroscopy time, and radiation exposure. Random effects model was used to perform a meta‐analysis. The Mantel‐Haenszel method was used to calculate risk ratio (RR) and 95% confidence intervals (CI) for each outcome. Heterogeneity was evaluated using I2 and considered high if over 70%. Results Twenty‐nine studies comprising 14,523 patients met inclusion criteria. TRA was attempted in 5,865 (40.38%) patients and TFA in 8,658 (59.62%). Baseline characteristics were similar between groups. The rate of technical success was 95.46% (95% CI: 93.59 – 96.81; p < 0.01) in the TRA group compared with 98.43% (95% CI: 97.60 – 98.97; p = 0.02) in the TFA group. Patients who underwent a diagnostic or therapeutic angiogram via TRA had a slightly lower chance of achieving technical success (RR = 0.98; 95% CI: 0.96 – 0.99; p < 0.01) compared to TFA, with substantial heterogeneity (I2 = 68%). Major access site complications were non‐significantly lower in the TRA group (RR = 0.64; 95% CI: 0.29 – 1.41; p = 0.81) with null heterogenicity (I2 = 0%) between groups. Minor access site complications were significantly lower in the TRA group (RR = 0.43; 95% CI 0.28 – 0.67; p < 0.01), with moderate heterogeneity (I2 = 57%). Non‐access site related complications (including mortality) were lower in the TRA group (RR = 0.69; 95% CI 0.51 – 0.94; p = 0.14) with low heterogeneity (I2 = 26%) between groups; for this outcome, the TRA approach shows a protective but not statistically significant result. Conclusion Our study suggests TRA is feasible and safe for diagnostic and therapeutic neuroendovascular procedures with low certainty of evidence. Minor complications were lower in the TRA group. RCTs directly comparing TRA vs TFA for these procedures are needed to confirm these results.

Abstract 054: Transradial Thrombectomy Using "Sheathless PV" Guide Catheter in Armenia: Three‐Year Institutional Experience in 103 Cases

Introduction Transradial access (TRA) in neuroendovascular procedures has gained popularity in recent years (1). It offers numerous advantages and stimulated development of long flexible large lumen guiding catheters as well as adoption of existing cost‐efficient alternatives used in cardiac and peripheral interventions (2,3). We report our three‐year experience using the Sheathless PV guide catheter (Asahi Intecc, Japan) in a consecutive series of acute stroke patients undergoing endovascular thrombectomy (ET) at a Comprehensive Stroke Center in Yerevan, Armenia. The interest in its use specifically for TRA stemmed from competitive price (∼ $100 per catheter vs ), hydrophilic coating of the outer shaft, as well as lack of femoral closure devices in the country. Methods We retrospectively identified all consecutive acute stroke patients who had undergone ET via TRA from a prospectively maintained institutional stroke database between June 2020 and June 2023. Data were collected on determinants of decision to proceed with TRA‐first approach, baseline patient imaging and clinical characteristics, location of the occlusion, puncture‐to‐reperfusion time (PT‐RT), conversion to transfemoral access (TFA), periprocedural complications, and procedural/clinical outcomes. Results were compared to patients who underwent TFA‐first ET over the same time period. The Mann‐Whitney U‐test was used to analyze the continuous variables and chi‐square test was used for categorical variables. Standardized TRA technique involved exchanging the puncture needle to a short 6Fr introducer first, then over a J‐wire, to a 90cm (0.090" ID/0.110" OD) Sheathless PV guide catheter over a dilator. The dilator was then removed, and a long JR4 diagnostic catheter was used to select cervical vessels over a 0.035 wire and advance the guide over in a triaxial fashion. Results A total of 538 patients underwent ET during the analyzed 3‐year period, of which access was either not recorded, or was other than TRA/TFA in 23 patients (excluded from analysis). Of the remaining 515 patients, 103 had TRA‐first (all using Sheathless PV guide catheter) and 412 had TFA‐first (various guide catheters). The decision to proceed with TRA was at the discretion of the operator and was influenced by presence of bovine arch on CTA (for left anterior occlusions), favorable angle between the right subclavian and the right common carotid arteries (for right anterior occlusions), dominant right vertebral artery or favorable angle of V1 origin (for posterior circulation occlusions). Of 103 TRA cases, 71 (68.9%) were in the right carotid circulation, 18 (17.5%) ‐ in the left carotid circulation, and 14 (13.6%) in posterior circulation. TRA‐>TFA conversion occurred in 5 patients (4.8%), TFA‐>TRA ‐ in 1 patient (0.24%) all of which were due to prohibitive anatomy, rather than guide catheter limitations. There were no significant differences in baseline patient characteristics between the TRA and TFA groups. Angiographic outcomes (TICI 2B or greater) were similar for TRA vs TFA (96.1% vs 93.9%, p=0.39), as were good clinical outcome (discharge mRS 0‐2) rates (58% vs 55.4%, p=0.63). There was a trend towards shorter PT‐RT with TRA (29.5 min vs 38.3 min) although it did not reach statistical significance (p=0.11). No access‐related complications were noted with TRA. Conclusion Transradial thrombectomy using Sheathless PV Guide catheter is safe, effective, and offers substantial cost‐savings and shorter procedural times with low rate of access conversions, similar to other reported TRA thrombectomy series. Randomized trials are needed to validate its rates of technical success and complications against other frequently‐used TRA guide catheters.

Strategies to Reduce Transfemoral Access Complications inContemporary Interventional Cardiology.

Vascular access-site complications due to transfemoral access (TFA) for cardiac procedures are common as patients receiving femoral access are more complex. Furthermore, TFA-related vascular access-site complications are associated with substantial excess morbidity. An updated narrative review is warranted as technique, technology, and knowledge have rapidly progressed in the last decade. We will review preprocedural (transradial (TRA) first approach and risk factors), procedural (ideal cannulation site, ultrasound (US)-guidance, micropuncture needle, femoral angiography, and sheath size), and post-procedural (vascular closure devices) considerations to reduce vascular access-site complications (Figure 1). The fully referenced version of the manuscript is available in the supplementary materials.

Transradial Versus Transfemoral Access for Mechanical Thrombectomy: A Systematic Review and Meta‐Analysis

Background In patients undergoing mechanical thrombectomy for acute ischemic stroke, a few studies have compared transradial access (TRA) to transfemoral access (TFA) with inconsistent results. We conducted this systematic review and meta‐analysis to provide comprehensive evidence regarding the comparison of procedural and clinical outcomes of TRA versus TFA in patients with acute ischemic stroke undergoing mechanical thrombectomy. Methods We performed a comprehensive literature search of 4 electronic databases from inception until May 1, 2022. After title and full text screening, relevant data were extracted and then analyzed. For outcomes that constituted continuous data, the mean difference between the 2 groups and its SD were pooled. For outcomes that constituted dichotomous data, the frequency of events and the total number of patients in each group were pooled as odds ratio (OR) between the 2 groups. Results Nine observational studies were included in this meta‐analysis. The population of the studies was homogenous comprising a total of 2161 patients undergoing mechanical thrombectomy, including 446 patients via TRA and 1715 patients via TFA. There were no significant differences across the 2 groups in terms of successful recanalization (OR, 0.83 [95% CI, 0.55–1.25]; P =0.36), complete recanalization (OR 1.16 [95% CI, 0.50–2.68]; P =0.73), favorable functional outcomes (OR, 0.86 [95% CI, 0.53–1.41]; P =0.56), first‐pass reperfusion (OR, 0.88 [95% CI, 0.64–1.19]; P =0.41), number of passes (mean difference, 0.12 [95% CI, −0.18 to 0.42]; P =0.43), access‐to‐reperfusion time (mean difference, −3.92 minutes [95% CI, −9.49 to 1.65]; P =0.17), or symptomatic intracranial hemorrhage (OR, 0.86 [95% CI, 0.47–1.57]; P =0.62). However, access site complications were significantly less frequent in the TRA group as compared with the TFA group (OR, 0.18 [95% CI, 0.06–0.51; P =0.001). Conclusion In patients undergoing mechanical thrombectomy for acute ischemic stroke, the collective evidence suggests that TRA seems to result in lower rates of access site complications than TFA without significant compromise in other clinical or procedural metrics. Randomized or prospective studies are warranted to confirm these results.

Abstract Number ‐ 9: Prospective Evaluation Of The Safety And Suitability Of The 088 Infinity Catheter For Radial Neurointerventions

Introduction Transradial access (TRA) for neuroendovascular interventions has been associated with multiple benefits, including decreased risk of complications, faster recovery times, and improved overall patient satisfaction in comparison to transfemoral access (TFA). We sought to assess the safety and suitability of an 088 catheter, in this case the Infinity guide catheter, to understand the optimal patient population for utilization in neurointerventions. To our knowledge, this is the first prospective study to investigate procedural characteristics and complications associated with the use of an 088 catheter. Methods After obtaining approval from our Institutional Review Board, prospective patients undergoing neurointerventional procedures at our institution, beginning from December 2020 to present, were serially enrolled after evaluation for suitability for TRA by ultrasound visualization and measurement of vessel diameter. A prospective Excel database was generated on an encrypted and password‐protected computer, with variables including patient demographics, co‐morbidities, procedure type, catheter specifics, vessel diameter, procedural characteristics, TRA to TFA conversion, and complications. Results 78 patients were enrolled over a 1.5 year study period (Table 1). The average patient age was 62.4 ± 16.1 years, with a moderate male predilection (46/78 (59%)). Procedure subtypes for enrolled patients included 36 (46.2%) patients who underwent stroke intervention, 6 (7.7%) aneurysm coil embolization, 9 (11.5%) aneurysm flow diversion, 5 (6.4%) carotid stenting, 5 (6.4%) AVM/AVF embolization, 4 (5.1%) tumor embolization, and 13 other procedures (9 (11.5%) MMA embolization, 3 (3.8%) vessel embolization, 1 (1.3%) aneurysm Onyx embolization). All procedures were performed via right radial access under direct ultrasound visualization. Average radial diameter was 2.97 ± 0.46mm and average fluoroscopy time was 48.99 ± 23.54 minutes. Parent vessel spasm was noted in 25/78 (32.1%) of cases and guide catheter kinking was noted in 4/78 (5.1%). TRA to TFA conversion was noted in 14/78 (17.9%) patients, primarily due to vessel tortuosity (57.1%; 8/14 cases). Minor complications included post‐procedural hand/wrist pain in 14/78 (17.9%) patients, and hand bruising in 6/78 (7.7%). Post‐operative vessel patency was noted in 71/78 (91%) of cases via ultrasound, with 57/78 (73.1%) having good pulsation noted on reverse Barbeau testing. No serious radial artery complications were noted. The overall rate of major complications was 7.7%, with two cases of ischemic stroke, contrast extravasation/intracerebral hemorrhage, and vessel rupture noted. Conclusions This prospective pilot study demonstrates the safety and suitability of the 088 Infinity guide catheter via TRA radial approach for neuroendovascular interventions. Further studies will be needed to assess the efficacy of the 088 Infinity in comparison to other 088 catheters, as well as the optimal settings by which we can minimize rates of TFA conversion and TRA‐related complications.

Early clinical outcomes after transaxillary versus transfemoral TAVI. Data from the Spanish TAVI registry

Introduction and objectivesTransaxillary access (TXA) has become the most widely used alternative to transfemoral access (TFA) in patients undergoing transcatheter aortic valve implantation (TAVI). The aim of this study was to compare total in-hospital and 30-day mortality in patients included in the Spanish TAVI registry who were treated by TXA or TFA access. MethodsWe analyzed data from patients treated with TXA or TFA and who were included in the TAVI Spanish registry. In-hospital and 30-day events were defined according to the recommendations of the Valve Academic Research Consortium. The impact of the access route was evaluated by propensity score matching according to clinical and echocardiogram characteristics. ResultsA total of 6603 patients were included; 191 (2.9%) were treated via TXA and 6412 via TFA access. After adjustment (n=113 TXA group and n=3035 TFA group) device success was similar between the 2 groups (94%, TXA vs 95%, TFA; P=.95). However, compared with the TFA group, the TXA group showed a higher rate of acute myocardial infarction (OR, 5.3; 95%CI, 2.0-13.8); P=.001), renal complications (OR, 2.3; 95%CI, 1.3-4.1; P=.003), and pacemaker implantation (OR, 1.6; 95%CI, 1.01-2.6; P=.03). The TXA group also had higher in-hospital and 30-day mortality rates (OR, 2.2; 95%CI, 1.04-4.6; P=.039 and OR, 2.3; 95%CI, 1.2-4.5; P=.01, respectively). ConclusionsCompared with ATF, TXA is associated with higher total mortality, both in-hospital and at 30 days. Given these results, we believe that TXA should be considered only in those patients who are not suitable candidates for TFA.

Peripheral intravascular lithotripsy to facilitate transfemoral TAVR: a multicentric prospective registry

Abstract Background The presence of severe calcific atherosclerotic disease at iliac artery level is a contraindication to transfemoral (TF) TAVI procedures, challenging TF delivery in 15–20% of cases. Many case reports described the efficacy of Intravascular lithotripsy (IVL) to facilitate TF access but only one prospective registry has been reported in literature and dates back 2018. For this reason a new multicenter prospective registry was ideated to confirm the role of IVL technology in facilitating TF TAVR. Aims The aims of this study were 1)to analyze the trend of TF TAVR compared to alternative approaches in the last 5 years and 2)to evaluate the prevalence of IVLassistedTAVR since it was introduced in this specific setting in 2018 3) to evaluate the success rate in terms of valve performance and procedural success of TF-TAVR system delivery after IVL lesion preparation. Materials and methods We prospectively collected data from all consecutive TAVRprocedures performed between Jan2016 andDec2020 at 4Italian and 1 Denmark centres. All patients underwent CT angiography of lower extremity before the procedure in order to assess the severity of aorto-iliac-femoral calcification and to select those patients who required specific lesion preparation to preserve TF access. For each target calcified lesion we measured length, diameter and %of stenosis, circumferential extension and minimal cross-sectional area. Angiographic IVL-related and access site complications (dissection, perforation, major bleeding) were examined. Results Between 2016 and 2020, a total of 3710 TAVR were performed, 3428 (92%) via TF route while the remaining 240 (8%) included alternative approaches mainly represented by subclavian and transapical access. IVL-assisted TAVR were 0 in 2016 and 2017, 13 (2%) in 2018 when the first IVL-assisted aortic valve implantation was performed and doubled in 2019, reaching a total of 112 in the whole 5-year period considered. The number of IVL-facilitated TAVR has been increased in the 5-year period, achieving 7% of the TF procedures while non-TF TAVR decreased considerably from 10% to 6%. Common and external iliac axis was the target lesion in the majority of cases (54%) followed by common iliac artery alone. lesion minimum diameter 4.7mm, with average stenosis of 50%. The maximum calcium angle was 332°. The majority of IVL was performed with a 7-mm catheter (78.6%). 1 balloon per lesion was employed. 1 perforation and 2 severe dissections occurred, that required stent placement. In 55% of cases the aortic regurgitation was absent or minimal. Conclusions TF approach remained the first choice for TAVR procedure in the majority of cases compared to non-TF thanks to the progressive increase of IVLassistedTAVR that allowed operators to preserve TF route. Peripheral IVL appeared feasible, safe and effective in patients with severe peripheral artery disease, with high success rate in terms of valve performance and low rate of complications. Funding Acknowledgement Type of funding sources: None.

Transradial Access for Non-Coronary Intervention: Initial Experience of Ramathibodi Hospital

Objective: To describe initial experience of transradial access (TRA) for non-coronary intervention performed at body interventional radiology unit. Materials and Methods: A retrospective descriptive study was performed and included 31 cases from 27 patients that underwent TRA in the present study’s unit between May 2018 and January 2019. All cases were pre-operatively evaluated for radial artery size by ultrasound (US) and verified palmar arch patency using Barbeau test. To proceed to TRA, the radial artery diameter must be at least 1.8 mm and the Barbeau test must not be classified in type D. The primary endpoint was success rate. Secondary endpoints were patency of radial artery and other access site complication after TRA. Results: The technical success rate was 100% without crossover to transfemoral access (TFA). Asymptomatic radial artery occlusion (RAO) was observed in four cases (12.9%) using US at 24-hour after the procedure. According to statistical analysis, none of the present studied parameters showed statistically significant association with the RAO. The other access site complication detected was pseudoaneurysm, which was found in two cases. Conclusion: TRA is a promising alternative access for non-coronary intervention. Vascular access site complications are rarely clinically significant but nevertheless still a concern. Keywords: Transradial access; Non-coronary intervention; Complication; Radial artery; Patency

Resultados clínicos tempranos tras el implante percutáneo de válvula aórtica por acceso transaxilar comparado con el acceso transfemoral. Datos del registro español de TAVI

Introduction and objectivesTransaxillary access (TXA) has become the most widely used alternative to transfemoral access (TFA) in patients undergoing transcatheter aortic valve implantation (TAVI). The aim of this study was to compare total in-hospital and 30-day mortality in patients included in the Spanish TAVI registry who were treated by TXA or TFA access. MethodsWe analyzed data from patients treated with TXA or TFA and who were included in the TAVI Spanish registry. In-hospital and 30-day events were defined according to the recommendations of the Valve Academic Research Consortium. The impact of the access route was evaluated by propensity score matching according to clinical and echocardiogram characteristics. ResultsA total of 6603 patients were included; 191 (2.9%) were treated via TXA and 6412 via TFA access. After adjustment (n=113 TXA group and n=3035 TFA group) device success was similar between the 2 groups (94%, TXA vs 95%, TFA; P=.95). However, compared with the TFA group, the TXA group showed a higher rate of acute myocardial infarction (OR, 5.3; 95%CI, 2.0-13.8); P=.001), renal complications (OR, 2.3; 95%CI, 1.3-4.1; P=.003), and pacemaker implantation (OR, 1.6; 95%CI, 1.01-2.6; P=.03). The TXA group also had higher in-hospital and 30-day mortality rates (OR, 2.2; 95%CI, 1.04-4.6; P=.039 and OR, 2.3; 95%CI, 1.2-4.5; P=.01, respectively). ConclusionsCompared with ATF, TXA is associated with higher total mortality, both in-hospital and at 30 days. Given these results, we believe that TXA should be considered only in those patients who are not suitable candidates for TFA.

Randomized Comparison Between Radialand Femoral Large-Bore Accessfor Complex Percutaneous Coronary Intervention.

The aim of this study was to investigate whether transradial (TR) percutaneous coronary intervention (PCI) is superior to transfemoral (TF) PCI in complex coronary lesions with large-bore guiding catheters with respect to clinically relevant access site-related bleeding or vascular complications. The femoral artery is currently the most applied access site for PCI of complex coronary lesions, especially when large-bore guiding catheters are required. With downsizing of TR equipment, TR PCI may be increasingly applied in these patients and might be a safer alternative compared with the TF approach. An international prospective multicenter trial was conducted, randomizing 388 patients with planned PCI for complex coronary lesions, including chronic total occlusion, left main, heavy calcification, or complex bifurcation, to either 7-F TR access (TRA) or 7-F TF access (TFA). The primary endpoint was defined as access site-related clinically significant bleeding or vascular complications requiring intervention at discharge. The secondary endpoint was procedural success. The primary endpoint event rate was 3.6% for TRA and 19.1% for TFA (p<0.001). The crossover rate from radial to femoral access was 3.6% and from femoral to radial access was 2.6% (p=0.558). The procedural success rate was 89.2% for TFA and 86.0% for TRA (p=0.285). There was no difference between TFA and TRA with regard to procedural duration, contrast volume, or radiation dose. In patients undergoing PCI of complex coronary lesions with large-bore access, radial compared withfemoral access is associated with a significant reduction in clinically relevant access-site bleeding or vascular complications, without affecting procedural success. (Complex Large-Bore Radial Percutaneous Coronary Intervention [PCI] Trial [Color]; NCT03846752).

Use of the CHA2DS2-VASc Score in Assessing Transradial Approach Failure

BackgroundRadial access is now considered the preferred approach for coronary angiography and percutaneous coronary intervention because of the low risk of vascular complications. However, radial access failure is not uncommon, leading to crossover to a different access site. The CHA2DS2-VASc score is used to estimate stroke risk in patients with atrial fibrillation. Our study aimed to assess the CHA2DS2-VASc score in predicting failure of the transradial approach, resulting in crossover to transfemoral access (TFA) for coronary angiography. MethodsWe performed a single-center, non-randomized, retrospective study. The study included 1775 patients who underwent coronary angiography with or without subsequent percutaneous intervention between July 2018 and October 2019. The study population was divided into three groups based on the CHA2DS2-VASc score: low (≤2), intermediate (3–4), and high score (≥5) groups. The association between the CHA2DS2-VASc score and radial access failure was evaluated and compared between the groups. ResultsA total of 197 patients (11.1%) had crossover to the femoral artery. A large percentage of patients (19.2%) had radial access failure in the high CHA2DS2-VASc score group (≥5) compared with 12.5% in the intermediate score group (3–4) and only 6.3% in the low score group (≤2). The highest crossover rate (42.9%) was observed in patients with a CHA2DS2-VASc score of 8. Higher CHA2DS2-VASc scores were also associated with increased fluoroscopy time, contrast administration, and radiation exposure. ConclusionThe CHA2DS2-VASc score can predict failure of the transradial approach, with a score of ≥5 having the highest correlation of failure requiring crossover to TFA.

A comparative study of transradial versus transfemoral approach for flow diversion.

Data in neurointerventional literature is extremely limited regarding the safety and efficacy of flow diversion using transradial access (TRA). We aim to demonstrate the safety and efficacy of intracranial aneurysm treatment with the Pipeline Embolization Device (PED) using TRA compared to transfemoral access (TFA). We conducted a retrospective analysis of a prospectively maintained database and identified 79 consecutive patients who underwent neuroendovascular embolization for cerebral aneurysms using the PED from April 2018 through October 2019. Patients were divided into 2 groups: TRA (32 patients) and TFA (47 patients). A comparative analysis was performed between the two groups. There was no significant difference in postoperative intracranial hemorrhage (p>.99), symptomatic ischemic stroke (p=.512), access site complications (p=.268), or other complications (p=.512). However, there was a significant increase in overall complications (14.9% vs. 0.0%, p=.038) and procedure duration (71.4 min ± 31.2 vs. 58.5 ± 20.3, p=.018) in the TFA group. There was no significant difference in complete occlusion at latest follow-up (19/25, 76.0% vs. 35/40, 87.5%; p=.311), 6-month follow-up (17/23, 73.9% vs. 33/38, 86.8%; p=.303), or 12-month follow-up (8/8, 100.0% vs. 5/6, 83.3%; p=.429). There was also no significant difference in rate of retreatment (p>.99), morbidity (p=.512), mortality (p>.99), latest follow-up (p=.985), or loss of follow-up (p=.298). The feasibility and efficacy of flow diversion with the PED via TRA for the treatment of intracranial aneurysms is comparable to TFA. Widespread adoption of this approach may be facilitated by improvements in device navigation and manipulation via radial-specific engineering.

The effect of transcatheter aortic valve implantation approaches on mortality.

We aimed to evaluate the effect of transcatheter aortic valve implantation (TAVI) approaches on mortality and identify effect modifiers and predictors for mortality. Alternative access routes to transfemoral (TF) TAVI include the surgical intra-thoracic direct-aortic (DA) and transapical (TA) approach. TA TAVI has been associated with a higher mortality rate. We hypothesized that this is related to effect modifiers, in particular the left ventricular ejection fraction (LVEF). This multicentre study derived its data from prospective registries. To adjust for confounders, we used propensity-score based, stabilized inverse probability weighted Cox regression models. In total, 5,910 patients underwent TAVI via TF (N= 4,072), DA (N= 524), and TA (N= 1,314) access. Compared to TF, 30-day mortality was increased among DA (HR 1.87, 95%CI 1.26-2.78, p= .002) and TA (HR 3.34, 95%CI 2.28-4.89, p< .001) cases. Compared to TF, 5-year mortality was increased among TA cases (HR 1.50, 95%CI 1.24-1.83, p< .001). None of the variables showed a significant interaction between the approaches and mortality. An impaired LVEF (≤35%) increased mortality in all approaches. The surgical intra-thoracic TA and DA TAVI are both associated with a higher 30-day mortality than TF TAVI. TA TAVI is associated with a higher 5-year mortality than TF TAVI. The DA approach may therefore have some advantages over the TA approach when TF access is not feasible.

Meta-Analysis of Transradial vs Transfemoral Access for Percutaneous Coronary Intervention in Patients With ST Elevation Myocardial Infarction

Transradial access (TRA) has emerged as an alternative to transfemoral access (TFA) for percutaneous coronary intervention (PCI) in ST elevation myocardial infarction (STEMI) patients. However, the rate of TRA adoption has been much slower in the acute coronary syndrome (ACS) patient population. This meta-analysis was conducted to assess clinical outcomes of TRA compared with TFA in STEMI patients undergoing PCI. A manual search of PubMed, EMBASE, Cochrane library database, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov, and recent major scientific conference sessions from inception to October 15th, 2019 was performed. Primary outcomes in our analysis were all-cause mortality and trial-defined major bleeding. Secondary outcomes included vascular complications, myocardial infarction, stroke, procedure, and fluoroscopy time. 17 randomized controlled trials (RCTs) (N = 12,018) met inclusion criteria. TRA was associated with lower all-cause mortality (risk ratio [RR]: 0.71, 95% confidence interval [CI]: 0.57 to 0.88), major bleeding (RR: 0.59, 95%CI: 0.45 to 0.77), and vascular complications (RR: 0.42, 95%CI: 0.32 to 0.56) compared with TFA. There was no difference in the incidence of myocardial infarction (MI), stroke, or procedure duration between the 2 groups. The difference in all-cause mortality between TRA and TFA was statistically nonsignificant when major bleeding was held constant. In conclusion, TRA was associated with lower risk of all-cause mortality, major bleeding, and vascular complications compared with TFA in STEMI patients undergoing PCI.

The efficacy and safety of transradial and transfemoral approach in treatment of coronary chronic total occlusion: a systematic review and meta-analysis

ABSTRACT Background The clinical efficacy and safety of transradial (TR) percutaneous coronary intervention (PCI) in comparison to transfemoral (TF) for chronic total occlusion (CTO) is not well studied in literature. Objectives: We sought to study the outcome and complications associated with TR compared with TF for CTO interventions. Methods After a systematic literature search was done in PubMed and EMBASE, we performed a meta-analysis of studies comparing TF and TR for CTO PCI. Results: Twelve studies with 19,309 patients were included. Compared to those who has TF access, individuals who were treated via TR approach had statistically significant lower access complication rates [odds ratio (OR): 0.33; 95% confidence interval (CI): 0.22 to 0.49; p < 0.0001]. The procedural success was in the favor of TR method (OR: 1.4; 95% CI: 1.31–1. 51; p < 0.0001). The incidence of major adverse cardiovascular and cerebrovascular events (MACCE) and contrast-induced nephropathy were similar in both groups. Conclusion When compared with TF access interventions in CTO PCI; the TR approach appears to be associated with far less access-site complications, higher procedural success, and comparable MACCE.

TransRadial versus transUlnar artery approach for elective invasive percutaneous coronary interventions: a randomized trial on the feasibility and safety with ultrasonographic outcome - RAUL study.

IntroductionTransradial access (TRA) for coronary angiography (CAG) and percutaneous coronary intervention (PCI) is superior to transfemoral access (TFA). Transulnar access (TUA) is an alternative to TRA.AimTo compare the efficacy and safety of TRA vs. TUA in patients scheduled for CAG or PCI.Material and methodsThis was a prospective, single-center, randomized study conducted between 2013 and 2016. Two hundred patients referred for the first elective CAG were included in the study. Eligible patients were then randomly assigned to the TRA or TUA group. Before and after the invasive procedure, all patients underwent ultrasonographic measurements of the right upper limb arteries.ResultsThe primary endpoint was efficacy, defined as a successful CAG without a crossover of vascular access. The secondary endpoint was safety, assessed as the number of vascular complications. Successful coronary angiography via the access site was 95% vs. 75% in the TRA vs. TUA groups, respectively (p < 0.001). It depended on the anatomy of UA and the operator experience. No differences were observed in early and late follow-up complications.ConclusionsTRA was superior to TUA with regard to efficacy. TUA occurred a safe approach for CAG and PCI and could be used as an alternative method of forearm access.

Abstract No. 456 Radiation dose during uterine fibroid embolization in a major health care system: transradial vs. transfemoral access

Transradial access (TRA) is now seen as an alternative to transfemoral access (TFA) for performing uterine fibroid embolization (UFE). To assess for non-inferiority of technique, our study compares dose area product (DAP) and fluoroscopy time (FT) after UFE between TRA and TFA across multiple hospitals in a single health system. All UFE cases performed from 7/2013 and 7/2018 in a large academic health system were reviewed. Patient demographics, clinical factors, and procedure characteristics were reviewed including patient age, DAP, FT, and access site. Adverse events were recorded. Statistical comparison between the TRA and TFA groups was performed with paired t tests. 387 UFE procedures were performed across five hospital sites (TRA n=313, TFA n =74) (Table 1). The median FT after TRA was 15.9 minutes and 17.7 minutes after TFA (p=0.14). The median DAP after TRA was 152503.5 mGycm2 and 228135 mGycm2 after TFA (p=0.12). There was no statistically significant difference between DAP and FT for UFE performed after TRA and UFE performed after TFA despite multiple sites and providers, although there was a trend towards lower DAP and FT with TRA.Table 1TRATFATotal patients31374 Site A19916 Site B445 Site C1107 Site D05 Site E01Fluoro time (min)15.917.7p=0.14Median dose (mGycm2)152503.5228135p=0.12 Open table in a new tab

SAFETY AND EFFICACY OF TRANSRADIAL VERSUS TRANSFEMORAL ACCESS FOR PERCUTANEOUS CORONARY INTERVENTION OF UNPROTECTED LEFT MAIN DISEASE: A META- ANALYSIS

Transradial access (TRA) has emerged as an alternative to Transfemoral access (TFA) in percutaneous coronary intervention (PCI) of unprotected left main (ULM) lesions. Evidence is based on retrospective studies with a lack of robust clinical trials. We conducted this meta-analysis to evaluate the

SHORT AND LONG-TERM OUTCOMES OF MEDICARE PATIENTS WITH ACUTE CORONARY SYNDROME UNDERGOING PERCUTANEOUS CORONARY INTERVENTION VIA THE TRANSRADIAL VERSUS TRANSFEMORAL APPROACH: INSIGHTS FROM THE WASHINGTON STATE CLINICAL OUTCOMES ASSESSMENT PROGRAM

Transradial access (TRA) for percutaneous coronary intervention (PCI) reduces vascular complications in patients with acute coronary syndrome (ACS) and short-term mortality in patients with ST-elevation myocardial infarction (STEMI) compared to transfemoral access (TFA). Long-term outcomes of TRA

TCT-849 Safety of Transradial Access compared to Transfemoral Access with Hemostatic Devices (Vessel Plugs, Suture Devices & Vascular Clips) after Percutaneous Coronary Interventions: A systematic review and meta analysis

Transradial access (TRA) is associated with fewer bleeding and vascular complications compared to transfemoral access (TFA). The use of vascular closure devices (VCD) to establish early hemostasis after TFA mitigates bleeding risk. However, data comparing TRA and TFA with VCD is limited. We aimed to