Transradial Research Articles

Radial versus femoral access for left main percutaneous coronary intervention: An analysis from the Veterans Affairs Clinical, Reporting, and Tracking Program.

We aimed to compare clinical characteristics and procedural outcomes of left main percutaneous interventions (LM-PCI) by transradial (TRA) versus transfemoral (TFA) approach in the VA healthcare system. TRA for percutaneous coronary intervention (PCI) is steadily increasing. However, the frequency and efficacy of TRA for LM-PCI remain less studied. All LM-PCIs performed in the VA healthcare system were identified for fiscal year 2008 through 2018. Patients' baseline characteristics and procedure-related variables were compared by access site. Both short- and long-term clinical outcomes were analyzed using propensity score matching. A total of 4004 LM-PCI were performed in the VA via either radial or femoral access from 2008 to 2018. Among these, 596 (14.9%) LM PCIs were performed via TRA. Use of TRA for LM-PCI increased from 2.2% to 31.5% over the study period. Propensity matched outcome analysis, comparing TRA versus TFA, showed a similar procedural success (98.4% for TRA vs. 97.8% for TFA; RR: 1.01 [0.98, 1.03]) and 1-year major adverse cardiovascular events (MACE) (25.9% for TRA vs. 26.8% TFA; RR: 0.96 [0.74, 1.25]). There were no statistically significant differences among secondary outcomes analyses including major bleeding. Use of TRA for LM-PCI has been steadily increasing in the VA healthcare system. These findings demonstrate similar procedural success and 1-year MACE across access strategies, suggesting an opportunity to continue increasing TRA use for LM-PCI.

Abstract 13601: Cardiovascular Outcomes of Transradial versus Transfemoral Percutaneous Coronary Intervention in End Stage Renal Disease. A Meta Regression Analysis

Introduction: Limited data is available on comparison of outcomes among transradial (TR) and transfemoral (TF) access of percutaneous coronary intervention (PCI) in End Stage Renal Disease (ESRD). Hypothesis: Which access route is better for better cardiovascular outcomes or lower procedural complications among ESRD patients. Methods: Online databases including MEDLINE and Cochrane Central were queried to compare cardiovascular outcomes among TR and TF in ESRD patients. The primary outcome of this meta-analysis was to compare the bleeding complications and in-hospital mortality difference between TR PI and TF PCI in patients with ESRD. The secondary outcomes included differences in Mortality, Cardiovascular accident (CVA), Myocardial infarction (MI), Bleeding, Transfusion, Cardiogenic shock, and Heart failure. Unadjusted odds ratios (OR) were calculated using a random effect model with a 95% confidence interval (CI) and P <0.05 as a statistical significance. Results: A total of 5 studies including 7383 patients ( TR-PCI = 1208 ; TF-PCI = 6275) were included in this analysis. The overall mean age was 70 years; while the mean for TR-PCI and TF-PCI was 71 years and 69.1 years respectively. TR-PCI was associated with lower odds of bleeding (OR 0.48 95% CI 0.33, 0.69, p<0.05, I2 0.00%) (Figure 1A), transfusion requirement (OR 0.52 95% CI 0.40, 0.68, p<0.05, I2 0.00%), and mortality (OR 0.41 95% CI 0.26, 0.66, p<0.05, I2 0.00%) (Figure 1B). We did not find any statistically significant difference in CVA (OR 1.06 95% CI 0.37, 3.00 p>0.05, I2 0.00%), MI (OR 0.97 95% CI 0.57, 1.63, p>0.05, I2 0.00%), CS (OR 0.53 95% CI 0.06, 4.42, p>0.05, I2 48.48%) between TR and TF PCI in ESRD population. We didn’t find any effect modifier in our study on regression analysis. Conclusions: TR access is associated with better cardiovascular outcomes as compared to TF access PCI in ESRD patients with any coronary artery disease.

Abstract 12819: Feasibility of Transradial Primary Percutaneous Coronary Intervention for STEMI Complicated by Cardiac Arrest

Introduction: The American Heart Association recommends a “radial-first” strategy in patients with ST-elevation myocardial infarction (STEMI). It is uncertain whether the benefits of transradial (TR) access extends to high-risk patients who present with STEMI and cardiac arrest (CA). Methods: Consecutive patients with STEMI complicated by CA who underwent percutaneous coronary intervention (PCI) within 24 hours at the Cleveland Clinic between 2011-2018 were included. TR-PCI was implemented as the standard approach during the study period (2014). Temporal changes in the use and technical success rates of TR-PCI were assessed, and procedural outcomes were compared with those who underwent transfemoral (TF)-PCI as the initial attempted approach. To evaluate for predictors of major bleeding, variables were assessed in univariable logistic regression and those with p<0.10 were included in multivariable analysis. Results: Among 216 patients, TR-PCI use increased from 2.9% in 2011 to 87.1% in 2018 (p<0.001). TR-PCI was successful in 80/91 (87.9%) patients. Door-to-balloon-time (90 [68, 116] vs. 105 [76, 141] minutes, p=0.03) and contrast volume (150 vs. 153 mL, p=0.03) were significantly lower in TR-PCI relative to TF-PCI with no differences in fluoroscopy dose, mechanical circulatory support use (30.8% vs. 41.6%, p=0.14), or in-hospital mortality (13.2% vs. 19.2%, p=0.32). After adjusting for peripheral arterial disease, diabetes, fluoroscopy dose, mechanical circulatory support, and total femoral access, TR-PCI was an independent predictor for less major bleeding {OR=0.34 (95% CI [0.11-0.93], p=0.045)}. Conclusions: Among patients with STEMI and CA, TR-PCI is feasible and can be successfully adopted via implementation of a “radial-first” strategy. With a high technical success rate, no adverse effect on door-to-balloon-time, and reduced major bleeding, TR-PCI should be the initial access strategy in high-risk patients with STEMI and CA.

Transradial versus transfemoral access for acute stroke endovascular thrombectomy: a 4-year experience in a high-volume center.

To compare clinical outcomes and safety of transradial (TRA) versus transfemoral access (TFA) for endovascular mechanical thrombectomy in acute stroke patients. Retrospective analysis of 832 consecutive patients with acute stroke undergoing interventional thrombectomy using TRA (n = 64) or TFA (n = 768). Direct TFA failures occurred in 36 patients, 18 of which underwent crossover TFA to TRA, while direct TRA failures occurred in 2 patients having both crossovers to TFA. Successful catheterization was achieved in 96.8% (62/64) and 95.3% (732/768) of patients undergoing direct TRA and direct TFA, respectively, without significant differences. The median (IQR) catheterization time was 10 (8-16) min in the direct TRA group and 15 (10-20) in the direct TFA group (P < 0.001). This difference was also significant in the subgroup of anterior circulation strokes and in patients younger and older than 80years of age. The majority of procedures yielded thrombolysis in cerebral infarction grade 2b/2c/3 revascularization in patients undergoing direct TRA (88.5%) and direct TFA (90.8%), without statistically significant differences. The median (IQR) puncture to recanalization time was 37 (24-58) min for the direct TRA group and 42 (28-70) min for the direct TFA group. Significant differences in access site complications, symptomatic ICH, and mRS score 0-2 at 90days between both TRA and TFA accesses were not found. TRA is not inferior to TFA in the probability of catheterization, times of catheterization and revascularization, and other clinical outcomes for mechanical thrombectomy in acute stroke.

Abstract 1122‐000096: Transradial Results in Faster Recanalization in Left Anterior Circulation Stroke and Bovine Arch

Introduction : We compared technical and clinical outcomes of transradial (TRA) versus transfemoral (TFA) access for mechanical thrombectomy (MT) of acute ischemic stroke (AIS) due to large vessel occlusion (LVO) in the left anterior cerebral circulation of bovine origin. Methods : A single‐center retrospective review of a prospectively maintained neuro‐interventional database from a large volume service in a tertiary academic center. Procedural metrics, technical, and clinical outcomes data were collected and analyzed for patients who underwent MT presenting with AIS and LVO in the left anterior circulation of bovine origin. Primary outcomes included the average number of passes, single first effective pass, rate of successful recanalization (thrombolysis in cerebral infarction (TICI) score ≥ 2b), 3‐month disability modified Rankin Scale (mRS) score ≤2, time from skin puncture to microcatheter placement and recanalization. Results : Between January 2018 and January 2021, 26 patients (TRA = 13, TFA = 13) underwent MT. The TRA cohort had a significantly shorter time in minutes for skin puncture to microcatheter placement (TRA: 17.0± 5.8 vs TFA: 35.4± 20.5, P = 0.0001), shorter skin puncture to recanalization (TRA: 34.0± 15.6 vs TFA: 58.1± 34.6, P = 0.01), and shorter total fluoroscopy time (TRA: 13.8±9.4 vs TFA: 29.5±18.0, P = 0.03). The 3‐month mRS score of 0–1 was higher in the TRA group (38.5% vs 7.69%, P = 0.06). Conclusions : In patients with LVO in the left anterior cerebral circulation of bovine origin, right TRA access permits more direct navigation and provides a stable platform resulting in shorter procedure times and faster recanalization with the potential to improve functional outcomes.

TCT-268 Nicardipine to Avoid Spasm in Trans Radial Percutaneous Coronary Intervention: Results of an Ongoing Double Blinded Multicenter Randomized Trial

TCT-268 Nicardipine to Avoid Spasm in Trans Radial Percutaneous Coronary Intervention: Results of an Ongoing Double Blinded Multicenter Randomized Trial

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).

Outcomes of Transradial Versus Transfemoral Access of Percutaneous Coronary Intervention in STEMI: Systematic Review and Updated Meta-analysis

ABSTRACT Background Transradial (TR) percutaneous coronary intervention (PCI) is a preferable PCI route. The complication difference between TR and TF approaches is controversial. Methods PubMed, Embase, and the Cochrane databases were queried for PCI outcomes of TR TF in STEMI for major cardiac and cerebrovascular events (MACCE), major bleeding, and mortality. The odds ratio (OR) was calculated using the random-effect model. Results We included 56 studies comprising of 68,733 patients (TR, n = 26,179; TF, n = 42,537). TR-PCI was associated with statistically significant lower odds of MACCE (OR = 0.66, 95% CI: 0.49–0.88, p-value = 0.005), major bleeding (OR = 0.47, 95% CI 0.32–0.68, p-value<0.001), mortality (OR = 0.59, 95% CI 0.43–0.80, p-value<0.001) at in hospital follow-up. TR-PCI was associated with statistically significant lower MACCE (OR = 0.59, 95% CI 0.43–0.80, p-value<0.001), major bleeding (OR = 0.58, 95% CI 0.49–0.68, p-value<0.001), and mortality (OR = 0.61, 95% CI 0.44–0.86, p-value = 0.005) at 30-day follow-up. The same difference was seen at 1-year. Conclusion TR-PCI was associated with lower odds of MACCE, major bleeding, and mortality during short- and long-term follow-up.

Transradial approach for carotid artery stenting: A position paper from the Italian Society of Interventional Cardiology (SICI-GISE).

Carotid artery stenting (CAS) is a valid and effective alternative to endoatherectomy when performed by experienced operators. The conventional approach used is the transfemoral one, but in the last 10 years a transradial (TR) approach, the standard access for cardiac catheterization, became widely adopted for peripheral vascular interventions, included the extracranial carotids. Preliminary experiences suggest this approach as safe and effective, especially in specific anatomical and clinical settings that have been shown to be associated with high risk of complications from the femoral route. Lacking international guidelines, this document, promoted by the Italian Society of Interventional Cardiology - Gruppo Italiano Studi Emodinamici (SICI-GISE), was drawn-up by a panel of interventional cardiologists with a documented experience on the subject, focusing on the indications, techniques and materials that should be used for this type of intervention and the most recent literature on the subject.

115 The Impact of Burn Injury on Upper Extremity Prosthesis Users

Abstract Introduction Burns with upper extremity (UE) amputation present a unique rehabilitation challenge. The purpose of this study of UE amputees who are active prosthesis users was to compare outcomes for those with and without burns. Methods This is part of a larger nationwide study of U.S. military members and veterans with UE amputations. In-person data were collected at 5 sites. An therapist measured passive and active range of motion (PROM, AROM); administered the Quick Disability of the Arm, Shoulder, and Hand; Community Reintegration of Injured Service Members-Computer Adaptive-Test; Trinity Amputation and Prosthetic Experience Scale; health-related quality of life (VR-12); Activities Measure for Upper Extremity Amputees; Southampton Assessment Procedure; 9-Hole Peg Test; and Jebsen-Taylor Hand Function Test (JTHF); and recorded residual and phantom pain; timing of prosthesis receipt; and current prosthesis use. The IRB approved this study. Results Data were collected on 126 individuals with UE amputation, of whom 105 had data on etiology and were included. Of these, 13 (12.4%) had burns (B) vs non-burn (NB). The majority were unilateral amputees (69% B, 90% NB). Most were transradial (TR) amputees (B 84.6%, NB 66.3%) as opposed to transhumeral (TH). A minority received their prosthetics within the first 3 months post-amputation (11.1% B, 28.8% NB) (p=0.15). Average age was 57.6 (SD 15.6) years for NB and 53.0 (20.6) years for B. Mean time since amputation was 22.5 (18.0) years for NB and 25.2 (17.3) years for B. The following non-significant differences in outcomes between B and NB were observed. Thirty-nine percent of B were employed full-time vs 18.9% of NB (p=0.15). The primary prosthesis was, for NB, a body-powered prosthesis (66.7%); for B, myoelectric (50%) or body-powered (50%). For unilateral UE amputees, there were no differences between B and NB on performance testing for dexterity and functional tasks or in self-reported disability, quality of life or prevalence or intensity of pain. B trended towards more moderate to severe PROM deficits with shoulder forward flexion (TH B 50%, TH NB 23.1% [p=0.444]; TR B 20%, TR NB 5.6% [p=0.197]) and shoulder abduction (TH B 50%, TH NB 26.9% [p=0.497]; TR B 30%, TR NB 16.4% [p=0.376]). Also, TR amputees with burns trended towards more PROM deficits with elbow flexion (B 20%, NB 6.9% [p=0.212]) and elbow extension (B 20%, NB 8.6% [p=0.272]). AROM deficits also trended greater in B. Conclusions We did not observe differences in physical function, pain levels, or quality of life between those with and without burns. Further studies with larger samples are needed, to include analysis of burn location, burn size, hospital length of stay, and rehabilitation care.

Empirical Analysis of Artificial limb for Trans Radial Amputation People with the support of advanced machine learning strategies

For the improvement of performance of trans radial amputees, there will be identification of hand gestures using electromyogram. Whatever the data retrieved from the electrode will be used for controlling the prosthetic hands. In this paper, we are proposing the systematic hand gestures to improve the performance of the trans radial amputation people using the 2-channels amplifier. Different hand gestures like hands up, hands open, hands down, hands close are represented by the different variants and all these gestures will be preprocessed by the discrete approach. Extraction of the features will be done using the combination of ML Strategies. For identifying the pattern, LVQ mechanism is used. By this 2-Channel amplifier the identification of outcome can be evaluated effectively.

Access route selection for percutaneous coronary intervention among Vietnamese patients: Implications for in-hospital costs and outcomes

BackgroundLittle is known about rates of access site (transradial (TRI) or transfemoral (TFI)) preference for percutaneous coronary intervention (PCI) and in-hospital costs of patients undergoing these procedures in lower-and middle-countries. Here, we report on access site use, in-hospital costs and outcomes of patients undergoing PCI in Vietnam. MethodsInformation from 868 patients were included in the cohort of 1022 patients recruited into the first PCI registry in Vietnam. The total hospital costs and in-hospital outcomes of patients undergoing TRI and TFI were compared. Hospital costs were obtained from the hospital admission system, and major adverse cardiac events, major bleeding events and length of stay were identified through review of medical records. FindingsTRI was the dominant access site for interventionists (694/868 patients). The TFI group reported more lesions of the left main artery, more previous coronary artery bypass grafts and previous PCI in comparison with the TRI group (all p < 0.05). The TRI group was associated with a lower overall cost of admission (the adjusted difference was -1526.3 USD, 95% confident interval CI (-1996.2; -1056.3), shorter length of hospital stay (-2 days, CI (-2.8; -1.2)) and lower rates of major bleeding post-procedure. Procedural factors such as radial access site, left main disease, PCI ≥2 stents, and PCI ≥ 2 lesions having the most impact on the in-hospital cost of patients undergoing PCI. InterpretationsAmong patients undergoing PCI, TRI was associated with lower costs and favourable clinical outcomes relative to TFI FundingThis research received partial financial support from Curtin University, Australia.

Abstract P821: A New Era for Cerebral Angiograms: TransRadial Approach in NeuroInterventional Radiology

Background: Historically, femoral artery access has been the standard for neurointerventional radiology (NIR) procedures. However, recent advances in cerebral angiography have resulted in new arterial access locations, such as the TransRadial (TR) approach which has become more frequently utilized by proceduralists at our facility. This change necessitates staff competency when caring for TR-approach patients. In 2019, our facility received a recommendation for improvement (RFI) from The Joint Commission during the Comprehensive Stroke Center recertification survey related to incomplete post-TR-approach documentation. Upon initiation of TR-approach documentation audits, the team discovered documentation compliance rates of 46.2% for both TR wristband deflation volumes and wristband removal. Purpose: Due to the lack of knowledge associated with the novel TR-approach, the purpose of this project was to standardize post-NIR nursing care for patients who underwent a TR-approach cerebral angiogram. The goal was to observe a 25% increase in TR-approach care documentation elements by January 2020. Methods: Education created by the NIR manager was shared with nursing leadership and bedside nursing staff. Audits completed by the stroke quality nurse and NIR manager immediately followed to measure compliance with documentation of TR wristband deflation volumes and wristband removal. The NIR team collaborated with informatics leadership to develop a NIR documentation band within our electronic documentation system, resulting in a centralized location for documentation of all required TR-approach details. The two items specifically lacking compliance were included in the NIR documentation band build. Results: Audits demonstrated a 28.4% increase in compliance of TR wristband removal documentation and an 18.6% increase in compliance in TR wristband deflation protocol documentation. Conclusion: As a result of the RFI, our facility developed a protocol for post-TR-approach nursing care that can ultimately improve patient safety and outcomes, as well as be easily replicated at other facilities seeking to improve NIR patient care.

Comparison of Robotic Assisted Carotid Stenting and Manual Carotid Stenting Through the Transradial Approach

Weinberg, Joshua; Sweid, Ahmad MD; Sajja, Kalyan; Gooch, M. Reid MD; Herial, Nabeel; Tjoumakaris, Stavropoula I MD; Rosenwasser, Robert H MD; Jabbour, Pascal MD Author Information

Abstract 16151: Comparison of Safety and Efficacy of Transradial versus Transfemoral Percutaneous Coronary Intervention for St Elevation Myocardial Infarction: A Meta-analysis of Randomized Controlled Trials

Introduction: Studies have shown decreased rates of vascular complications and mortality with Transradial (TR) percutaneous coronary intervention approach for treating patients with acute ST elevation myocardial infarction (STEMI) compared to conventional Transfemoral (TF). Hypothesis: This meta-analysis aims to compare the safety and efficacy of TR vs TF approach in the light of recently published data. Methods: Electronic databases including MEDLINE, ClinicalTrials.gov and the Cochrane Library were searched for all randomized controlled trials (RCTs) published until April 2020 comparing outcomes of TR vs TF PCI in STEMI patients. End points were all-cause mortality, major bleeding, stroke, major adverse cardiac events (MACE), and vascular complications. The ratio risk ratio (RR) with 95% confidence interval (CI) were computed and p &lt;0.05 was considered as a level of significance. Results: A total of 18 RCTs (n=13,516) were included in the final analysis. All-cause mortality (RR: 0.72; CI: 0.59-0.88; p=0.002), major bleeding (RR: 0.53; CI: 0.40-0.70; p&lt;0.0001), MACE (RR: 0.78; CI: 0.69-0.88; p=0.0001), and vascular complications (RR: 0.42; CI: 0.33-0.53; p&lt;0.00001) were decreased in the TR group [Figure 1]. There was a non-significant decrease risk of stroke in TF group (RR: 1.51; CI: 0.81-0.2.83; p=0.20) compared to TR group [Figure 1]. Conclusions: In patients with STEMI, all-cause mortality, MACE and vascular complications were decreased with TR compared to TF group. Further studies needed to confirm the findings of this meta-analysis.

Comparison of different access sites (radial, brachial and femoral) for subclavian artery intervention

Abstract Introduction The primary purpose of this multicenter prospective register was to evaluate the success and complication rate of different access sites for subclavian artery intervention. Secondary purpose was to investigate the safety of the distal radial artery access for subclavian artery intervention. Methods The clinical and angiographic data of 223 consecutive patients with symptomatic subclavian and anonym artery stenosis treated via transradial (TR), transbrachial (TB) and transfemoral (TF) access between 2015 and 2019 were evaluated in a multicenter registry. The exclusion criteria of the intervention was the acute proximal subclavian artery thrombosis. Primary endpoint: angiographic outcome of the subclavian and anonym artery intervention, rate of major and minor access site complications. Secondary endpoints: procedural complications, consumption of the angioplasty equipment, cross over rate to another puncture site and hospitalization in days. Results The procedure was successful in 182/184 in TR, in 5/5 in TB and in 32/32 patients in TF group. The cross over rate in the TR, TB and TF group was 0%. Chronic total occlusion recanalization was successful in 75/77 cases in TR, and 15/15 cases in the TF group. Contrast consumption was 152±106 ml in TR, 99±22.5 ml in TB and 152±95 in TF group, respectively (p=ns). Cummulativ dose was 602±1205 mGray in RA, 455±210 mGray in BA and 1089±1674 mGray in FA group (p&amp;lt;0.05). Procedural complications occurred in 1/184 (0.5%) case in RA group, in 0 case (0%) in BA group and in 4/32 cases (12.5%) in the FA group (p&amp;lt;0.05). Major access site complication were detected in 3 patients (1.6%) in RA, in 1 patient in BA (20%) and in 1 patient in FA group (3.1%) (p&amp;lt;0.05). Minor access site complication were encountered in 9 patients in the RA (4.8%), in 1 patient in the BA (20%) and in 8 patients in the FA group (25%) (p&amp;lt;0.05). Distal radial access was used in 29 cases and proximal radial access in 155 patients. The rate of radial artery occlusion in proximal and distal radial group was 5.1% and 0% (p&amp;lt;0.05). Conclusions Subclavian artery intervention can be safely and effectively performed using radial access with acceptable morbidity and high technical success. Femoral and brachial access is associated with more access site complications than radial artery access. Distal radial access is associated with less radial artery occlusion than proximal radial artery access. Funding Acknowledgement Type of funding source: None

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.

Dexterity, activity performance, disability, quality of life, and independence in upper limb Veteran prosthesis users: a normative study

Purpose To present population data on standardized measures of dexterity, activity performance, disability, health-related quality of life (HRQoL) and community integration for persons with upper limb amputation (ULA), compare outcomes to normative values, and examine differences by prosthesis type and laterality (unilateral vs. bilateral amputation). Materials and methods Multi-site, cross-sectional design, with in-person evaluations, functional performance, and self-report measures. Descriptive and comparative analyses were performed by amputation level and prosthesis type, data were compared for unilateral and bilateral amputation. Results One hundred and twenty-seven individuals participated; mean age 57 years, 59% percent body-powered prostheses users. All measures of dexterity differed (p < 0.05) by amputation level and by laterality. All measures of activity differed by amputation level with the best scores in transradial (TR) amputation groups. Comparisons of body-powered users with TR amputation found that dexterity was better for those with bilateral compared to unilateral amputation. Conclusions Dexterity is markedly impaired in persons with ULA. Individuals with more proximal ULA levels are most impacted. HRQoL and community participation are less impacted and more equivalent to unimpaired persons. Further research is needed to examine differences by terminal device type and determine how best to match persons with ULA to the optimal prosthesis type and componentry, based on individual characteristics. Implications for Rehabilitation This study provides population-based, comparative data on dexterity, activity performance, disability, quality of life, and independence in upper limb prosthesis users. The study provides preliminary analyses comparing the effectiveness of body-powered devices, myoelectric devices with single degree of freedom and multi-degree of freedom terminal devices. The data presented in this study can be used to benchmark outcomes in patients who are upper limb prosthesis users. The data will also be useful to inform comparative evaluations of existing and emerging prosthetic technology.

Outcomes After Coronary Orbital Atherectomy at Centers Without On-Site Surgical Backup: Diabetics Versus Non-Diabetics and Impact of Access Site

Background/purposeThere is limited data available on atherectomy usage in hospitals or centers without on-site surgical backup. The purpose of this retrospective analysis was to gain further knowledge by analyzing the in-hospital and 30-day outcomes of complex PCI patients (including diabetics) treated with coronary orbital atherectomy (OA) at centers without on-site surgical back-up. Methods/materialsAll comers treated with OA at two centers without on-site surgical backup were included. Baseline, procedure, and outcome data were compared in diabetic and non-diabetic patients. The impact of transfemoral (TFA) versus transradial (TRA) vascular access was also assessed. ResultsOf the 221 patients treated with OA, 43% were diabetics. The diabetes and no-diabetes groups had similar baseline demographic and lesion characteristics, except for the higher rate of chronic kidney disease seen in the diabetics. Overall, there was a high freedom from major adverse cardiac events (MACE; in-hospital: 99.5%; 30-day: 98.6%), as well as a high success in stent delivery (99.5%) and procedural success (97.3%). The rate of angiographic complications was low in both the diabetes and no-diabetes groups (3.1% vs. 1.6%, p = 0.450). TFA and TRA were used in 36% and 64% of the patients, respectively—resulting in low angiographic complications in both groups (3.8% vs. 1.4%, p = 0.263). ConclusionsDespite the complexity of patient co-morbidities and the presence of heavily calcified lesions, the results indicate that coronary OA can be used safely and effectively without on-site surgical back-up. OA treatment resulted in a high rate of successful stent delivery and procedural success, as well as low rates of angiographic complications and MACE, in diabetic and non-diabetic patients, regardless of access site. Table of contents summaryThere is limited data available on atherectomy usage in centers without on-site surgical backup. The purpose of this retrospective analysis was to gain further knowledge by analyzing the outcomes of complex PCI patients (including diabetics) treated with coronary orbital atherectomy (OA) at centers without on-site surgical back-up. The impact of transfemoral (TFA) versus transradial (TRA) vascular access was also assessed. Despite the complexity of patient co-morbidities and the presence of heavily calcified lesions, the results indicate that coronary OA can be used safely and effectively without on-site surgical back-up. OA treatment resulted in a high rate of successful stent delivery and procedural success, as well as low rates of angiographic complications and major adverse cardiac events, in diabetic and non-diabetic patients, regardless of access site (TFA or TRA).

Vascular Assisted Tracking for Challenging Transradial Percutaneous Intervention

BackgroundTRA is recommended as the preferred approach to perform coronary angiography and PCI. Despite this, TRA-PCI is burdened by a high access site crossover rate. Assisted-tracking techniques (balloon-assisted tracking and pigtail-assisted tracking) have showed to solve some of the issues related with challenging TRA procedures, but few data exist about procedural outcomes.Aim of the study was to evaluate the efficacy and safety of the assisted-tracking (AsTra) techniques during transradial (TRA) percutaneous coronary intervention (PCI). MethodsFrom January 2016 to December 2019, 1682 TRA-PCI procedures were performed.Starting from January 2018, AsTra techniques were adopted in 72 cases of challenging TRA-PCI, and clinical data, procedural results and 30 days follow-up data were retrospectively collected. Because not all interventionalists used AsTra techniques, we had the opportunity to evaluate if their utilization influenced TRA-PCI rates. To this purpose, we identified two groups of interventionalists and tested the hypothesis that these techniques could lead to a significant improvement in TRA-PCI rates. ResultsBetween January 2016 and December 2019, TRA-PCI rates increased from 68.5% to 95%. The TRA-PCI success rate increased significantly for interventionalists who adopted assisted-tracking techniques (p-value < 0.0001 for year 2019; p-value = 0.003 for year 2018). ConclusionsAssisted-tracking techniques appear to be effective in increasing TRA-PCI rates. Their use is associated with low complication and low access crossover rates.