Transfemoral Artery Research Articles

Impact of proficiency in the transcatheter aortic valve implantation procedure on clinical outcomes: a single center retrospective study

BackgroundWe used transcatheter aortic valve implantation (TAVI) procedure time to investigate the association between surgical team maturity and outcome.MethodsAmong patients who underwent TAVI between October 2015 and November 2019, those who had Sapien™ implanted with the transfemoral artery approach were included in the analysis. We used TAVI procedure time and surgery number to draw a learning curve. Then, we divided the patients into two groups before and after the number of cases where the sigmoid curve reaches a plateau. We compared the two groups regarding the surveyed factors and investigated the correlation between the TAVI procedure time and survey factors.ResultsNinety-nine of 149 patients were analysed. The sigmoid curve had an inflection point in 23.2 cases and reached a plateau in 43.0 cases. Patients in the Late group had a shorter operating time, less contrast media, less radiation exposure, and less myocardial escape enzymes than the Early group. Surgical procedure time showed the strongest correlation with the surgical case number.ConclusionThe number of cases required for surgeon proficiency for isolated Sapien™ valve implantation was 43. This number may serve as a guideline for switching the anesthesia management of TAVI from general to local anesthesia.

COMPARISON BETWEEN DIFFERENT TRANSRADIAL ARTERY HEMOSTASIS PROTOCOLS IN LIGURIAN CARDIOLOGIES

Abstract Background Transradial artery access (TRA) for coronary angiography and percutaneous coronary intervention is associated with lower bleeding and vascular complications than transfemoral artery access. In our hospital, TRA is widely used and hemostasis is usually achieved using TRBand device. We used to remove the device in about 10 hours according to our protocol. Aims The aim of this study is to describe and compare different TRA hemostasis protocols in order to understand if a shorter protocol could be more effective. Methods This is an observational study performed in all Hospitals of our region (Liguria). All Cardiology Departments were included in this analysis. We requested to all to self–refer: a) which radial hemostasis device was used; b) which deflation protocol (DP) was used. c) If they usually report and analyze adverse events. Adverse events are described as: bleeding, hematoma, ecchymosis, skin damage, local infection, pseudoaneurysm, or artery occlusion. RESULTS In Liguria there are 9 Cardiology Departments with Cath Lab (CL); 8 of them accepted to participate. All the Cath Labs use the TRBAND device but the deflation protocols are very different. 5 Cath Labs follows the DP suggested by the manufacturer. Only 2 CL adopted different DP if and higher dose of heparin was administered. Only one report bleedings or any delete in the DP. None analyze periodically the incidence of adverse events. Conclusions There are different methods to achieve radial hemostasis furthermore with the same device different deflating protocols are used. Further studies are necessary to evaluate the best DP. Regular audits must be strongly suggested in all Cardiology Departments in order to monitorate and improve the adverse events.

Transradial versus transfemoral access for diagnostic cerebral angiography: frequency of acute MRI findings in 500 consecutive patients at a single center

BackgroundThe frequency of clinically symptomatic and asymptomatic diffusion-weighted imaging (DWI) hyperintense lesions and their correlation with the transradial artery (TRA) approach is unclear.ObjectiveTo assess the frequency of abnormal diffusion restriction...

Strategies to Minimize Access Site-related Complications in Patients Undergoing Transfemoral Artery Procedures with Large-bore Devices.

Large bore accesses refer to accesses with a diameter of 10 French or greater and are necessary for various medical devices, including those used in transcatheter aortic valve replacement, endovascular aneurysm repair stent-grafts, and percutaneous mechanical support devices. Notably, the utilization of these devices via femoral access is steadily increasing due to advancements in technology and implantation techniques, which are expanding the pool of patients suitable for percutaneous procedures. However, procedures involving large bore devices carry a high risk of bleeding and vascular complications (VCs), impacting both morbidity and long-term mortality. In this review article, we will first discuss the incidence, determinants, and prognostic impact of VCs in patients undergoing large bore access procedures. Subsequently, we will explore the strategies developed in recent years to minimize VCs, including techniques for optimizing vascular puncture through femoral cannulation, such as the use of echo-guided access cannulation and fluoroscopic guidance. Additionally, we will evaluate existing vascular closure devices designed for large bore devices. Finally, we will consider new pharmacological strategies aimed at reducing the risk of periprocedural access-related bleeding.

Transradial versus transfemoral access for middle meningeal artery embolization: Choice of the access route considering delirium in the elderly.

Treatment of chronic subdural hematoma (CSDH) with middle meningeal artery embolization (MMAE) is becoming well established. Transradial artery access (TRA) is considered less invasive than transfemoral artery access (TFA) and is increasingly indicated in the field of endovascular therapy. Therefore, this study focused on postoperative delirium and compared access routes. This is a single-center and retrospective study. The strategy was to perform MMAE for CSDH with symptomatic recurrence at our hospital. Cases from July 2018 to September 2022, when MMAE was introduced in our hospital, were included in this study. Patients were divided into TRA and TFA groups and were compared descriptively for patient background, procedure duration, and incidence of postoperative delirium. Twenty-five patients underwent MMAE, of whom 12 (48%) were treated with TRA. The overall median age was 82 years, with no clear differences between the TRA and TFA groups in the presence or absence of preexisting dementia or antithrombotic therapy. Delirium requiring medication tended to be lower in the TRA group: 2/12 (16.7%) in the TRA group versus 6/13 (46.2%) in the TFA group, and the mean procedure time for patients undergoing bilateral MMAE was 151 min (interquartile range [IQR]: 140-173 min) in the TRA group versus 174 min (IQR: 137-205 min) in the TFA group. TRA was associated with an overall shorter procedure time than TFA. MMAE through TRA tended to have a lower incidence of delirium. MMAE through TRA may be useful in recurrent CSDH with a high elderly population.

Making Neuroendovascular Therapy for Cerebrovascular Disease Using Distal/Trans-radial Artery Access Safer.

Neuroendovascular therapy using distal/trans-radial artery access (d/TRA) has attracted attention as a less invasive procedure. We have selected dTRA or TRA in all cases of carotid artery stenting (CAS). In recent years, TRA has been actively selected for mechanical thrombectomy for acute ischaemic stroke (MT for AIS) and Onyx embolisation for arteriovenous malformations. We compared the patient background, surgical strategy, perioperative complications, and outcome in 41 patients who underwent CAS in the first period (Apr 2017-Feb 2019) and 12 patients in the second period (Apr 2020-Feb 2022) avoiding trans-femoral artery access (TFA) as possible. We compared the patient background, surgical strategy, perioperative complications, and outcome in 46 patients who underwent MT for AIS via TFA from Apr 2022 to Dec 2022 as the first period and five patients who underwent MT for AIS via TRA from Jan 2023 to Sep 2023 as the second period. Concerning CAS, the second period included significantly more symptomatic cases, with a higher rate of edaravone use to prevent hyperperfusion and a significantly smaller sheath diameter. In the second period, CAS was performed in severe conditions; nevertheless, there was no significant difference between the two groups in terms of either the ratio of cases detected by postoperative diffusion-weighted imaging positive or the ratio of cases with puncture site-related complications (PSCs). Concerning MT for AIS, there were no significant differences between the two groups with the patient backgrounds. The percentage of effective reperfusion, time from puncture to recanalisation, and outcome in the second period were all non-inferior to those in the first period when conventional MT for AIS was performed. Even though we introduced d/TRA in patients with cognitive decline and inability to remain at rest during the perioperative period, we completely avoided PSCs via d/TRA. In particular, cerebral hyperperfusion syndrome after CAS and ischaemia-reperfusion injury or re-occlusion after MT were rare but critical perioperative complications, and near-infrared spectroscopy (NIRS) may be used to monitor these problems. We introduced intensive evaluation by NIRS if we had time to spare.

Surgical Specialty Impacts Quality of Operative Training in Carotid Endarterectomy

Carotid endarterectomy (CEA) is currently performed by multiple surgical specialties. The impact of surgical specialty and operative volume on post-CEA outcomes has been well described. However, it is unclear whether trainees of different surgical specialties have similar quality of operative training. Data from Accreditation Council for Graduate Medical Education annual reports were collected and compared between graduating vascular surgery (VS) residents, VS fellows, and neurological surgery (NS) residents. Only cases reported as chief/senior/lead resident, surgeon junior, or surgeon fellow were included in analysis. Linear regression analysis was utilized to evaluate trends in case-mix and volume. From 2013 to 2022, total CEA case volume was higher among VS residents and fellows, compared to NS residents (52.8±0.8 vs. 44.3±1.4 vs. 12.9±0.6, P<0.0001). Additionally, VS residents and fellows performed other carotid operations including transfemoral or transcarotid artery stenting (11.1±0.9 vs. 11.2±0.8 vs. 0), carotid body tumor resection (0.7±0.1 vs. 0.7±0.0 vs. 0), and extracranial cervical bypass (6.7±0.3 vs. 6.3±0.3 vs. 0) that were not reported by the NS resident cohort (P<0.0001 each). On linear regression analysis, total CEA procedures did not change for VS residents (R2=0.03, P=0.62), decreased for VS fellows (-1.29 cases/yr, R2=0.75, P<0.0001), and decreased among NS residents (-0.41 cases/yr, R2=0.44, P=0.01) over the study period. Although residents of multiple surgical specialties are trained in CEA, vascular training offers significantly greater numbers and diversity of extracranial carotid cases. It also appears that CEA volume is decreasing among neurosurgical trainees. In light of recent reports on the volume-outcome effect in carotid surgery, these data may have implications for future practice patterns in the domain of extracranial carotid artery disease.

Transradial intra-aortic catheter looping in the angioplasty of severe intracranial symptomatic arteriosclerotic diseases.

This study aims to investigate the effect and feasibility of intra-aortic catheter looping via transradial access in angioplasty for symptomatic intracranial severe (>70%) atherosclerotic stenosis or occlusion of large arteries (SISOLAs). Patients with SISOLAs who underwent transradial endovascular angioplasty using the catheter looping technique in the ascending aorta were retrospectively enrolled. The clinical data and treatment outcomes were analyzed. Fifteen patients aged 48-71 years were enrolled in this study. Left vertebrobasilar artery occlusion was present in 1 (6.7%) patient, severe left middle cerebral artery stenosis in 7 (46.7%) patients, severe left internal carotid artery (ICA) stenosis of the ophthalmic segment in 4 (26.7%) patients, severe left ICA stenosis of the cavernous segment in 2 (13.3%) patients, and severe right middle cerebral artery stenosis in 2 (13.3%) patients. The arterial stenosis ranged from 70 to 92% (mean 86%) before stenting. The looping of a guiding catheter in the ascending aorta via transradial access for angioplasty was successful in all patients (100%). The vertebral artery intracranial segment occlusion was successfully recanalized, while severe stenosis in the remaining 14 patients was successfully eliminated. After endovascular recanalization, the residual stenosis was reduced by 12-26% (median 18%). No puncture-related complications or surgical-related neurological complications occurred in these patients. In the follow-up angiography conducted on 10 (66.7%) patients after 6-25 months, no in-stent restenosis was detected. Intra-aortic guiding catheter looping via transradial access for endovascular angioplasty of SISOLAs is technically safe, feasible, and effective, especially when the transfemoral artery approach is difficult or impossible to undertake.

Transradial access with intra-aortic catheter looping for the treatment of intracranial aneurysms.

The study aimed to investigate the feasibility and effect of transradial access with intra-aortic catheter looping for the treatment of intracranial aneurysms. This retrospective one-center study was performed on patients with intracranial aneurysms which were embolized through transradial access with intra-aortic catheter looping because of the difficulty of transfemoral access or transradial access without intra-aortic catheter looping. The imaging and clinical data were analyzed. A total of 11 patients were enrolled, including seven (63.6%) male patients. Most patients were associated with one or two risk factors of atherosclerosis. There were nine aneurysms in the left internal carotid artery system and two aneurysms in the right internal carotid artery system. All 11 patients had complications with different anatomic variations or vascular diseases, which made endovascular operation via the transfemoral artery difficult or a failure. The right transradial artery approach was adopted in all patients, and the success rate of intra-aortic catheter looping was 100%. Embolization of intracranial aneurysms was successfully completed in all patients. No instability of the guide catheter was encountered. No puncture site complications or surgical-related neurological complications occurred. Transradial access with intra-aortic catheter looping for embolization of intracranial aneurysms is technically feasible, safe, and efficient as an important supplementary approach to the routine transfemoral access or transradial access without intra-aortic catheter looping.

Abstract No. 36 Radial Access in the Setting of Angiography and Embolization for Trauma: Our Experience

Traditionally, transradial artery access (TRA) has been secondary to transfemoral artery access (TFA) for interventional radiology (IR) procedures, especially in the setting of trauma. As interventionists have demonstrated increasing confidence in TRA in emergent settings such as in cardiac and stroke cases, the use of TRA in the setting of trauma has gained increasing traction. We aim to describe our experience with TRA for IR angiography and embolization in the setting of trauma. We performed a retrospective review of all arterial angiography and possible embolization cases in the setting of trauma performed by IRs at our level 1 trauma center from 2015 to 2022. Cases were extracted from our institutional database using the search terms “trauma,” “gunshot,” “gsw,” and “mvc.” We manually reviewed and excluded the non-trauma cases. 630 trauma patients (mean age, 41 years; 30.4% female) underwent 685 arterial angiography with possible embolization. 91.7% (628/685) of cases underwent TFA; 6.9% (47/685) underwent TRA; 0.1% (1/685) underwent brachial artery access; 0.1% (1/685) underwent subclavian artery access; and 0.4% (3/685) underwent TFA first but transitioned to TRA. There was no significant difference in age (mean, 40.9 TFA; mean, 39.1 TRA; P = 0.42) or sex (P = 0.87) between those who underwent TFA vs TRA. TRA were successfully performed for 23 pelvic, 1 splenic, 2 renal, 10 hepatic, 1 mesenteric, 2 intercostal artery, and 8 combination cases. Reasons for TFA to TRA transition include difficulty accessing the femoral artery or the bleeding target artery. Reasons given for attempting TRA before TFA include groin hematomas and pelvic binder. 87.2% (41/47) had a pre-procedural CT/CTA demonstrating hemorrhage or pseudoaneurysm. 72.3% (34/47) had a post-procedure CT/CTA for follow-up. The average contrast usage for TRA cases was 106.4 cc with mean fluoro time of 17.5 min. The reintervention rate was 14.9% (7/47) due to rebleeding or no active bleeding seen on the initial angiogram. There were no reported radial access site complications. Although IRs traditionally have relied on TFA for trauma angiography and embolization, TRA can be an alternative, safe option for a variety of emergent cases. TRA may be the route of choice in trauma patients with groin hematomas or pelvic binders.

Comparison of pain levels of traditional radial, distal radial, and transfemoral coronary catheterization.

The aim of our study was to compare the traditional radial artery, distal radial artery, and transfemoral artery, which are vascular access sites for coronary angiography, in terms of pain level using the visual analog scale. Between April 2021 and May 2022, consecutive patients from three centers were included in our study. A total of 540 patients, 180 from each of the traditional radial artery, distal radial artery , and transfemoral artery groups, were included. The visual analog scale was applied to the patients as soon as they were taken to bed. When the visual analog scale was compared between the groups, it was found to be significantly different (transfemoral artery: 2.7±1.6, traditional radial artery: 3.9±1.9, and distal radial artery: 4.9±2.1, respectively, p<0.001). When the patients were classified as mild, moderate, and severe based on the visual analog scale score, a significant difference was found between the groups in terms of body mass index, process time, access time, and number of punctures (p<0.001). Based on the receiver operating characteristic analysis, body mass index>29.8 kg/m2 predicted severe pain with 72.5% sensitivity and 73.2% specificity [(area under the curve: 0.770, 95%CI: 0.724-0.815, p<0.0001)]. In our study, we found that the femoral approach caused less access site pain and a high body mass index predicts severe pain.

Effects of different puncture approaches on the curative effect and safety of patients with combined cardiovascular and cerebrovascular angiography.

The relationship between different puncture points and perioperative complications and length of stay in hospital (LOS) in SCCAG patients has rarely been reported. To compare the curative effect and safety of the transradial artery approach and the transfemoral artery approach in combined heart-brain angiography. 120 patients who received combined cardio-cerebral angiography in our hospital were selected and divided into a transradial artery approach group (TRA) and a transfemoral artery approach group (TFA) according to a random number table. The postoperative efficacy and safety of the 2 groups were compared. There was no statistically significant difference in puncture time and operation time between the 2 groups (p > 0.05). Postoperative bed rest time, hospitalization time, and X-ray exposure time in the TRA group were shorter than those in the TFA group, and the difference was statistically significant (p < 0.05). Before operation and 3 days after operation, there was no significant difference in left ventricle ejection fraction between the 2 groups (p > 0. 05). The overall incidence of complications in the TFA group was higher than that in the TRA group. The incidence between haematoma and pseudoaneurysm in the TFA group was higher, and the difference was statistically significant (p < 0.05). For simultaneous heart-brain angiography, interventional therapy via radial artery and femoral artery has good curative effect and can improve cardiac function. However, interventional therapy through the radial artery can shorten the postoperative bed rest time and hospitalization time, and reduce the incidence of complications.

Endovascular Management of Ruptured Renal Angiomyolipoma: A Case Report

Renal angiomyolipoma is classified as a benign tumour comprising fat, smooth muscle cells, and vascular tissue. Renal giant angiomyolipoma with rupture is a relatively rare clinical emergency condition. Here, the authors present a case of a 37-year-old female patient who presented with complaints of right flank pain for six hours. The patient was anaemic and did not have haematuria. On non contrast Computed Tomography (CT) imaging, there was a right perirenal haematoma with a mixed-density, fat-containing tumour in the upper interpolar region of the right kidney. On Contrast-Enhanced Computed Tomography (CECT) imaging, the right renal tumour showed multiple abnormal tortuous vessels with moderate to intense enhancement, consistent with a large angiomyolipoma. She was managed with primary therapeutic endovascular embolisation for a ruptured right renal angiomyolipoma under local anaesthesia via a right transfemoral artery approach. The procedure was uneventful, and postembolisation syndrome was managed with medications. The patient was discharged in a stable condition. During the one-month follow-up, the patient’s symptoms improved, and the need for major surgery like nephrectomy was avoided. Super selective embolisation to devascularise the tumour and preserve renal parenchyma was done under local anaesthesia via a right transfemoral approach without any complications. Postembolisation syndrome was managed medically

Upper Extremity Function Following Transradial Percutaneous Coronary Intervention: Results of the ARCUS Trail

Background: Regardless of the recent rise in the number of articles published on transradial access (TRA) for diagnostic coronary intervention and complications of the upper extremity may be underestimated. The aim of this study to investigate the prevalence of upper extremity disorder by comparing the transradial and transfemoral artery percutaneous coronary intervention (TR-PCI). Study Design: This was cross-sectional study and conducted in the Ayub teaching hospital Abbotabad, for six months July 2022 to December 2022. Materials and Methods: The total participants were 250 which included 200 TRA and 50 TFA participants and involving any type of cerdiointervention, thrombectomies for acute ischemic stroke, and carotid artery stents. The participants were selected by sampling technique were interviewed in the Khyber teaching hospital Peshawar. We analyzed dependent and independent variables. Data analysis statistically by SPSS 22 version. The upper extremity scores were analyzed using Chi-squared test. Results: There were total 250 participants which include 80%TRA and 20% TFA in this research. The majority of the participants in TRA were in the age group (59.2±6.7) years and in TFA group (55.5±7.1) years. The baseline characteristics of the total participants was no significant difference between transradial artery (TRA) and transradial femoral artery (TFA). During follow-up, Cochran's Q-test revealed a significant increase in UED in the intervention extremity of the TRA group p=0.003 and in the TFA group's right upper extremity (p=0.001). During follow-up, 1% TRA participants had RAO, which recanalized over time. Three weeks after the procedure, 10% of participants in the TRA group were referred to a hand specialist then TFA participants. Conclusion: Transradial arterial access (TRA) for percutaneous coronary artery intervention has been linked to lower access site complication rates and higher patient satisfaction when compared to transfemoral access (TFA) after 3 weeks follow up. Keywords: Transradial artery (TRA), Transfemoral artery (TFA), Rotational acetabular osteotomy (RAO).

Effects of a back-care bundle for reducing back pain among patients undergoing transfemoral artery coronary angiography: A randomized controlled trial

ObjectiveThis study aimed to evaluate the effects of a back-care bundle on back pain in patients undergoing transfemoral coronary angiography (TFA). MethodologyThis randomized controlled trial was conducted between March and June 2020. Thirty-four patients undergoing TFA were randomly assigned to either the back-care bundle or comparison group. The back pain score was measured using a visual analogue scale at baseline and at 2, 3, 4, and 6 h after TFA. Haemorrhage and subcutaneous thrombosis were assessed using a soft measuring tape immediately after TFA, hourly until the 6th hour, or after participants changed their positions. Generalised linear estimating equation models were used to estimate the effects of the interventions on back pain scores. ResultsThe back pain scores in the intervention group decreased significantly over time (mean difference: −0.15; 95 % confidence interval [CI] -0.23 to −0.07; p-value <0.001), while the back pain scores in the comparison group increased significantly over time (mean difference: 1.30; 95 % CI 1.15 to 1.44; p-value <0.001). Overall, the mean difference of back pain scores between the two groups was −2.98 (95 % CI -3.32 to −2.64; p-value <0.001). Haemorrhage and subcutaneous thrombosis were not detected in either group of patients. Conclusion and recommendationsThe back-care bundle effectively alleviated back pain in individuals undergoing TFA, with varying levels of bleeding risk. However, the effects of the back-care bundle on vascular complications remain unclear. For patients who do not have prolonged bleeding time, the duration of bed rest and the placement of a sand cushion on the puncture site can be reduced. Future trials are needed to develop and examine the effect of interventions in reducing back pain in patients with extended bleeding time.

Successful trans-femoral retrieval of a stuck axillary Impella 5.0 device.

We describe a case in which an axillary Impella 5.0, stuck in an area of calcification in the right subclavian artery, could not be retrieved in the usual manner. However, it was successfully removed using a long 22-Fr sheath and snaring catheter by means of the trans-femoral artery. Device retrieval using the trans-femoral artery snare technique is considered a valid option for removing the Impella device in patients who exhibit this complication.

Postinterventional Patient Comfort After Uterine Artery Embolization and Superior Hypogastric Nerve Block.

To evaluate the duration and effect of superior hypogastric nerve block (SHNB) with ropivacaine and clonidine on postinterventional pain levels and opioid requirements in patients undergoing uterine artery embolization. Postinterventional pain levels (numeric rating scale, NRS 0-10) and opioid doses were retrospectively analyzed in 53 patients undergoing transfemoral uterine artery embolization and intraprocedural superior hypogastric nerve block during 24h. A mixture of 150mg of ropivacaine and 150µg of clonidine was used for the block. Postinterventional pain averaged between 1.4 and 2.0 during the first 9h, after which a small but significant increase was observed (NRS 1.7 ± 1.6 vs. NRS 2.6 ± 2.2, p < 0.001). 70% of patients did not exceed a tolerable pain threshold of NRS 4 during the first 9h after the intervention. Thirty-three patients (62%) did not require any opioid medication. Mean iv morphine dose was 3.1 ± 4.7mg, whereas 71% of opioid doses were administered after 9h. Superior hypogastric nerve block using a mixture of ropivacaine and clonidine provides good pain relief for 9h after uterine artery embolization requiring only very low amounts of additional opioids.

Remimazolam Requires Less Vasopressor Support during Induction and Maintenance of General Anesthesia in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement: A Retrospective Analysis from a Single Center.

Introduction We compared the hemodynamics during general anesthesia with remimazolam and conventional anesthetics in patients with severe aortic stenosis (AS). Methods This was a retrospective single-center analysis. We reviewed the records of 42 patients who underwent transcatheter aortic valve implantation with a transfemoral artery approach under general anesthesia from January to December 2020. Patients were divided into three groups based on the general anesthetic used for (induction/maintenance) remimazolam/remimazolam (Group R/R), propofol/sevoflurane (Group P/S), and midazolam/propofol (Group M/P). Vasopressor use (ephedrine, phenylephrine, and noradrenaline) was compared among the groups. Results The number of patients in each group was 15 (Group R/R), 13 (Group P/S), and 14 (Group M/P), with no significant difference in background characteristics and intraoperative vital signs. For anesthesia induction, doses of ephedrine and phenylephrine used were significantly lower in Group R/R (ephedrine [mg]: Group R/R 2 [0–4] vs. Group P/S 8 [8–12], P < 0.001, Group R/R vs. Group M/P 5 [0–15], P = 0.39; phenylephrine (mg): Group R/R 0 [0–0.08] vs. Group P/S 0.15 [0.10–0.20], P = 0.03, Group M/P 0.21 [0.04–0.40], P = 0.08). For anesthesia maintenance, the noradrenaline dose used was low in the Group R/R (noradrenaline [μg/kg/min]: Group R/R 0.019 [0.015–0.039], Group P/S 0.042 [0.035–0.045], P = 0.02, Group M/P 0.048 [0.040–0.059], P < 0.01). Conclusion In patients with severe AS, induction and maintenance of anesthesia with remimazolam resulted in less overall vasopressor use than conventional general anesthetics.

Stenting of critical aortic coarctation in neonates between 600 and 1,350 g. Using a transfemoral artery approach. A single center experience.

BackgroundStenting of aortic coarctation (CoA) in newborns with a very low bodyweight remains rare and challenging. In this study we aim to highlight on two points: first the feasibility of CoA stenting in such babies and second the importance of using echocardiogram for guiding the intervention without the need for contrast agent.MethodsBetween 2020 and 2022 three preterm babies with very low (VLWB) and extremely low weight (ELWB) underwent CoA-stenting in our center. The weight of the patients at time of intervention was 1,350, 1,200, and 600 g, respectively. The femoral artery was chosen in all patients as vascular access. Transthoracic echocardiography, sonography of the femoral arteries and head ultrasound were applied for follow up.ResultsAll three interventions were successfully done, with no complications. Coronary stents were implanted. In one Patient (1,350 g) the stent was inserted without sheath. In two patients with renal failure, the stenting was performed under echocardiography-guidance without contrast agent. The follow up showed a preserved function of the left ventricle in all patients. No relevant gradient was reported and no stent re-intervention was required. Sonographic follow up showed a patent femoral artery in all patients. Two patients were operated 73 and 110 days after stenting, and the stents were successfully removed. In the third patient the intervention was performed 130 days ago and he is waiting for the operation.ConclusionCoA-stenting in VLWB and ELWB is feasible and can bridge them to the next surgery without complications. Echocardiography-guided CoA-stenting in VLWB is a considerate option especially in patients with renal failure. Accessing the femoral artery by experienced doctors, using local anesthesia before the puncture and before removing the sheath might help to protect the vessel from stenosis or occlusion.

Effect of Thin-Walled Radial Sheath for Large-Bore Access On Reducing Periprocedural Radial Artery Occlusion Following Complex PCI: The REDUCE-RAO Randomized Trial.

Transradial artery (TRA) access for percutaneous coronary intervention (PCI) was associated with lower risks of major bleeding and vascular complications compared to transfemoral artery access. Use of large-bore ( 7-Fr) guiding catheters through TRA approach increased the likelihood of radial artery occlusion (RAO). This study aimed to investigate whether use of the thin-walled 7-Fr Glidesheath Slender, allowing PCI with large-caliber guiding catheters, is superior to standard 7-Fr Cordis sheath with respect to periprocedural RAO within 24 hours after transradial coronary intervention (TRI) in complex lesions. A prospective randomized, controlled, single-blinded (patient-blinded) trial was conducted, randomizing 504 patients with TRI for complex lesions to either 7-Fr Glidesheath Slender or conventional 7-Fr Cordis sheath. The primary outcome was defined as the incidence of periprocedural RAO with Doppler ultrasound during the first 24 hours after TRI. The incidence of early RAO was 10.3% for 7-Fr Glidesheath Slender and 13.5% for conventional 7-Fr sheath (p = 0.271). The procedural success rate for Glidesheath Slender was 92.9% and for Cordis sheath was 93.7% (p = 0.722). There was no signficiant difference between treatment arms in terms of local hematoma and radial spasm, whereas use of the Glidesheath Slender was associated with significantly less pain during the procedure (numeric rating scale [NRS], 2.27 0.75 vs. 2.45 0.95, p = 0.017). The assessment of radial artery in ultrasound parameters after complex TRI was improved with Glidesheath Slender. Among patients with complex coronary lesions undergoing TRI, 7-Fr Glidesheath Slender was not superior to conventional 7-Fr in the prevention of periprocedural RAO within 24 hours following complex PCI, without reducing RAO occurrence. NCT04748068.