ABSTRACT
Radial access for cardiac catheterization and intervention in India has been growing steadily over the last decade with favorable clinical outcomes. However, its usage by interventional cardiologists varies greatly among Indian operators and hospitals due to large geographic disparities in health care delivery systems and practice patterns. It also remains unclear whether the advantages, as well as limitations of transradial (TR) intervention (as reported in the western literature), are applicable to developing countries like India or not. An evidence-based review involving various facets of radial procedure for cardiac catheterization, including practical, patient-related and technical issues was conducted by an expert committee that formed a part of Advancing Complex CoronariES Sciences through TransRADIAL intervention (ACCESS RADIAL™) Advisory Board. Emerging challenges in redefining TR management based on evidence supporting practices were discussed to formulate these final recommendations through consensus.
ABSTRACT
BACKGROUND/AIMS: Transradial intervention (TRI) is becoming the preferred method over transfemoral intervention (TFI) because TRI is associated with lower incidence of major bleeding and vascular complications. However, there has been limited published data regarding the clinical outcomes of TRI versus TFI in Korean patients with ST-elevation myocardial infarction (STEMI). METHODS: A total of 689 consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) from January to December of 2009 at nine university hospitals were enrolled in this study. Mid-term angiographic and 12-month cumulative clinical outcomes of the TRI group (n = 220, 31.9%) were compared to those of the TFI group (n = 469, 28.1%). RESULTS: After propensity score matching, in-hospital complications and the 12-month major clinical outcomes during follow-up in the two groups were similar to each other. However, the incidence rates of repeat revascularization (6.4% vs. 0.5%, p = 0.003), target vessel revascularization (6.4% vs. 0.5%, p = 0.003), and major adverse cardiac events (MACE; 11.6% vs. 4.6%, p = 0.018) in the TFI group were higher than those in the TRI group during the 12-month of follow-up. CONCLUSIONS: In our study, TRI in STEMI patients undergoing primary PCI with DESs was associated with lower incidence of access site hematoma, 12-month repeat revascularization, and MACE compared to TFI. Therefore, TRI might play an important role in reducing bleeding complications while improving major clinical outcomes in STEMI patients undergoing primary PCI with DESs.
Subject(s)
Humans , Drug-Eluting Stents , Follow-Up Studies , Hematoma , Hemorrhage , Hospitals, University , Incidence , Methods , Myocardial Infarction , Percutaneous Coronary Intervention , Propensity ScoreABSTRACT
Objectives: This study sought to compare both the safety and efficacy of transradial (TRI) versus transfemoral (TFI) approach in women undergoing percutaneous coronary intervention (PCI) in China. Methods: We retrospectively analyzed data from 5 067 women undergoing PCI in Fuwai Hospital, Beijing, China between 2006 and 2011. 4 105 patients underwent TRI and 962 patients underwent TFI. A One-to-one propensity score matching (PSM) was performed to control for potential biases. A total of 897 pairs were matched. Results: After controlling for confounders using PSM, baseline and procedural characteristics were well-balanced between TRI and TFI groups. Patients undergoing TRI had significantly fewer major post-PCI bleeding (1.0% vs 3.5%, P<0.001) and access site complications (8.5% vs 19.7%,P<0.001) after PSM. There was no statistical differences in the incidence rates of major adverse cardiac events (a composite of cardiac death, myocardial infarction, and target vessel revascularization) during hospitalization (P>0.05). Multiple logistic regression analysis showed that TRI was an independent predictor of reduced major bleeding (OR=0.64, 95%CI: 0.54-0.76, P<0.001) and access site complications (OR=0.67, 95%CI:0.61-0.74, P<0.001). Conclusions: Our result show that TRI is related to reduced major bleeding and access site complications as compared to TFI in Chinese female patients undergoing PCI.
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PURPOSE: To improve patient comfort and reduce complications, clinical benefit of a transradial approach for transcatheter arterial chemoembolization (TACE) was evaluated in patients with hepatocellular carcinoma (HCC). METHODS: A total of 284 patients with HCC for TACE was divided into transradial approach group (n = 126) and transfemoral approach group (n = 158). These two groups of cases were retrospectively compared with regard to complications, the procedural time, X‑ray exposure time, length of hospitalization, and hospital costs. RESULTS: There were lower incidence rates of complications including abdominal distension (42.85% vs. 87.97%, P < 0.001), vomiting (53.17% vs. 77.22%, P < 0.001), lumbago (1.59% vs. 97.46%, P < 0.001), and dysuria (0% vs. 62.03%, P < 0.001) in the transradial group as compared with the transfemoral group. The time required for catheterization and total X‑ray exposure time were less in the transradial group compared with the transfemoral group (Pall < 0.001). The hospital stay time and costs required for catheterization were less in the transradial group compared with the transfemoral group (P < 0.001 and P = 0.001, respectively). In addition, hepatic angiography and TACE were completed in 100% and 99.2% cases in transfemoral and transradial groups, respectively. CONCLUSIONS: Transradial approach for TACE improves quality of life in patients with HCC by offering fewer complications and lower costs compared with transfemoral approach.
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BACKGROUND: Transradial coronary intervention was introduced recently. It has less bleeding and vascular complications and advantage of early ambulation. METHODS: We compared 142 transradial coronary interventions (101 stents, 56 balloon angioplasty and 18 rotablation) with 120 transfemoral interventions in 230 patients from January to August 1998. RESULTS: Overall success rate was not different between two approaches (92% vs 89%), but smaller sized sheath and less amount of contrast agent were required in transradial interventions compared to transfemoral interventions. Conventional guiding catheters which are used in transfemoral approach were used in most cases (94%) of transradial interventions. Judkins left 3.5 (in stead of JL4.0 in femoral approach) and Judkins right 4.0 were the most frequently used guiding catheters in transradial approach. Stent implantation was successfully done in 99 out of 101 lesions (98%) in transradial intervention and 76 out of 78 lesions (97%) in transfemoral intervention. Rotational atherectomy and primary balloon angioplasty or stenting were done successfully in 10 - 20% of the patients in both groups. All procedures were done successfully without any major procedure-related complications (myocardial infarction, death, bypass surgery) or major vascular complications in both groups. During the clinical follow-up of transradial group, punctured arteries showed 10% incidence of radial artery pulse weakness with 3% of pulse loss. CONCLUSION: Transradial approach is useful another feasible route for coronary interventions. The feasibility of primary balloon angioplasty or stenting and rotational atherectomy by transradial approach should be evaluated in the future.