Reduction in operator radiation exposure during transradial catheterization and intervention using a simple lead drape.

BACKGROUND: Transradial access for cardiac catheterization and intervention is a recognized method for reducing complications and improving patient comfort. However, there are concerns over possible increased operator radiation exposure. We tested the hypothesis that a simple lead drape would reduce operator exposure in transradial procedures. METHODS: Patients undergoing either diagnostic or interventional procedures using transradial access were assigned in an alternating manner to the use of a 0.5-mm lead apron across the patient's abdomen in addition to standard operator protection. Patients were divided into 4 groups: (left enhanced shielding vs left standard shielding; right enhanced shielding vs right standard shielding). Dosimeters were taped to the primary and secondary operators' left wrist and outside the thyroid guard. The operator exposure was measured for each site on every case in centigray. RESULTS: In standard shielded patients, there was no increase in operator exposure between the left and right approach patients at any measurement site. Measured exposure was reduced with enhanced shielding at all dosimeter sites except the secondary operator's collar (both left and right) and the primary operator's collar from the right. There was no significant difference in fluoroscopy, air kerma, or dose area product between standard and enhanced shielded patients. CONCLUSIONS: The use of a lead drape reduces the rate of operator radiation exposure at multiple measurement sites. Use of the left radial approach was not associated with an increase in operator exposure compared with the right radial approach.

Predictors of rapid aortic dilatation in adults with a bicuspid aortic valve.

BACKGROUND AND AIM OF THE STUDY: The role of atherosclerosis and atherosclerotic risk factors in predicting progressive aortic dilatation in patients with bicuspid aortic valve (BAV) is not well defined. The study aim was to assess the role of these risk factors in progressive aortic dilatation in patients with this condition. METHODS: Adult patients were identified with BAV who displayed rapid aortic dilatation, and the association of the condition with hemodynamic and atherosclerotic risk factors was assessed. By using the Dartmouth-Hitchcock and Hartford Hospital echocardiographic databases between 1997 and 2009, a total of 135 patients with BAV and serial echocardiograms recorded at least one year apart were allocated to groups of rapid progressors (RP; n = 53) or slow progressors (SP; n = 82). Rapid aortic progression was defined as an annual rate of progression > or = 75th percentile at the sinus of Valsalva or ascending aorta level. Univariate atherosclerotic and hemodynamic variables that correlated with rapid aortic dilatation were analyzed, and independent predictors of rapid aortic dilatation identified. RESULTS: The RP group had higher mean random blood glucose levels, greater coronary artery disease, more tobacco use, and a higher National Heart, Lung and Blood Institute 10-year risk of developing coronary heart disease (10-year risk). An elevated 10-year risk of > 7% (OR 4.5; 95% CI 1.92-10.73), tobacco use (OR 5.05; 95% CI 1.51-16.86) and higher random blood glucose level (OR 1.01; 95% CI 1.002-1.03) were independent predictors of rapid aortic dilatation. CONCLUSION: In adults with BAV and non-dilated aortas at baseline, an elevated 10-year risk, tobacco use and hyperglycemia may serve as predictors of rapid aortic dilatation.

Impella assisted transradial coronary intervention in patients with acute coronary syndromes and cardiogenic shock: case series.

Operators may feel apprehension when considering the transradial approach in patients with cardiogenic shock due to concerns of the need for femoral access for mechanical support. There is however potential benefit of transradial approach in this setting by reducing bleeding complications in patients on potent anticoagulant and antiplatelet agents. We report three cases of patients with cardiogenic shock with successful transradial intervention (TRI) whilst using unilateral femoral access for Impella (ABIOMED, Danvers, MA) mechanical support. In two cases, the need for mechanical support was not clear at the beginning of the procedure, and in the third there was a clear need to combine femoral and radial access due to pre-existing anatomic issues. Two patients required transfusion of red blood cells but otherwise there were no vascular access complications.

Propensity matched analysis of bleeding and vascular complications associated with vascular closure devices vs standard manual compression following percutaneous coronary intervention.

BACKGROUND: In patients undergoing percutaneous coronary intervention (PCI), controversy exists regarding the effect of vascular closure device (VCD) use on bleeding and vascular complications with limited data available for comparison of the different devices. METHODS: We developed propensity score matched groups, manual compression (MC) (n = 1,407) and VCD (n = 2,814), who underwent PCI in an eight-year period and compared their bleeding and vascular complications. Vascular closure device subtype analysis was also done. RESULTS: Compared to MC, the VCD group had lower rates of hematoma > or = 10 cm (1.1% vs 2.1%, P < 0.01). Angioseal use was associated with the highest rate of surgical repair. Perclose had the lowest rates of bleeding and the lowest composite outcome of all vascular and bleeding complications at 5.6% vs 9.2% forAngiosealand 10.2% for Starclose (P < 0.001). CONCLUSION: In patients undergoing PCI, VCD use is a safe method for achieving femoral artery hemostasis. Perclose use is associated with the least complications.