TCT-392 Silent Cerebral Infarcts Following Cardiac Catheterization: A Randomized Comparison Of Radial And Femoral Approaches
ABSTRACT Single center studies using serial cerebral diffusion-weighted magnetic resonance imaging in patients having cardiac catheterization have suggested that cerebral microembolism might be responsible for silent cerebral infarct (SCI) as high as 15% to 22%. We evaluated in a multicenter trial the incidence of SCIs after cardiac catheterization and whether or not the choice of the arterial access site might impact this phenomenon.
Patients were randomized to have cardiac catheterization either by Radial (n = 83) or Femoral (n = 77) arterial approaches by experimented operators. The main outcome measure was the occurrence of new cerebral infarct on serial diffusion-weighted magnetic resonance imaging. Patient and catheterization characteristics, including duration of catheterization, were similar in both groups. The risk of SCI did not differ significantly between the Femoral and Radial groups (incidence of 11.7% versus 17.5%; OR, 0.85; 95% CI, 0.62-1.16; P = .31). At multivariable analysis, the independent predictors of SCI were the patient's higher height and lower transvalvular gradient.
The high rate of SCI after cardiac catheterization of patients with aortic stenosis was confirmed, but its occurrence was not affected by the selection of Radial and Femoral access.
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ABSTRACT: In European Ambulance Acute Coronary Syndrome Angiography (EUROMAX), bivalirudin improved 30-day clinical outcomes with reduced major bleeding compared with heparins plus optional glycoprotein IIb/IIIa inhibitors. We assessed whether choice of access site (radial or femoral) had an impact on 30-day outcomes and whether it interacted with the benefit of bivalirudin. In EUROMAX, choice of arterial access was left to operator discretion. Overall, 47% of patients underwent radial and 53% femoral access. Baseline risk was higher in the femoral access group. Unadjusted proportions for the primary outcome (death or noncoronary artery bypass graft protocol major bleeding at 30 days) were lower with radial access, however, without differences in major or major plus minor bleeding proportions. After multivariable adjustment, ischemic outcomes were no longer different between access site groups, except for a lower risk of stroke in radial patients. Bivalirudin was associated with lower proportions of the primary outcome in both the radial (odds ratio, 0.58; 95% CI, 0.33-1.03; P=0.058) and the femoral groups (odds ratio, 0.59; 95% CI, 0.37-0.93; P=0.022; interaction P=0.97). Bleeding was significantly lower in the bivalirudin group both in the radial- and femoral-treated patients but no significant difference was observed in ischemic outcomes. In multivariable analysis, bivalirudin emerged as the only independent predictor of reduced major bleeding (odds ratio, 0.45; 95% CI, 0.27-0.74; P=0.002). In this prespecified analysis from EUROMAX, radial access was preferred in lower risk patients and did not improve clinical outcomes. Bivalirudin was associated with less bleeding irrespective of access site. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01087723. © 2015 American Heart Association, Inc.Circulation Cardiovascular Interventions 06/2015; 8(6):e002049. DOI:10.1161/CIRCINTERVENTIONS.114.002049 · 6.98 Impact Factor
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ABSTRACT: Background Since the first cardiac catheterization in 1929, the procedure has continually evolved with advances in understanding, capabilities, and ease of operation. Though historically performed by cut down of the brachial artery, cardiologists soon learned that transfemoral access was both easier to perform and more efficacious with regard to patient outcome. In the last 20 years, the transradial approach has been adopted, and is being utilized with increasing frequency. Methods We conducted a survey of literature published concerning safety, efficacy, cost-effectiveness, and global uptake of transradial catheterization with specific attention to how transradial interventions compare with transfemoral interventions. Results This review of literature indicates that when performed by an experienced interventionalist, radial catheterization is as effective as femoral catheterization and has additional benefits of shorter length of hospital stay and reduced patient costs. Transradial access is superior to transfemoral access in some, but not all, clinical scenarios; in addition, it is an effective alternative for catheterization in patients contraindicated for transfemoral procedures. Adoption of radial access in the United States is at a faster rate than previously expected, though rate of use varies drastically worldwide. Conclusion The transradial approach is an excellent option for carrying out cardiovascular interventions, and will be adopted by more cardiologists in the upcoming years.International Journal of Angiology 06/2014; 23(2):77-84. DOI:10.1055/s-0034-1372243
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ABSTRACT: zet Abstract Koroner arter hastalığının tanısında konvansiyonel koroner anjiografi altın standart olarak kabul edilmektedir. Ancak tanısal veya girişimsel amaçlı koroner anjiografi sırasında serebrovasküler olay gerçekleşebilir. Bu durum hastaya ait risklere veya işlemin invaziv olmasına bağlıdır. Hastada yaygın aterosklerotik damar hastalığı, kalsifik veya mural trombüs içeren aort anevrizması ya da inflamatuvar aortit gibi patolojilerden biri varsa ateroembolizm için risk oluşturur. Bu yazıda tanısal amaçlı koroner anjiografiden sonra sol homonim hemianopsi bulgusuyla beyin BT'de serebral enfarktüs tanısı konan olgu sunuldu. In coronary artery disease, coronary angiography is considered as a golden standard diagnostic tool. But, during diagnostic or interventional procedure of coronary angiography, cerebrovascular accidents may occur due to the procedure itself or risk factors related to the patient, mainly when the patient has diffuse atherosclerosis, aortic aneurysm with calcification, mural thrombosis or inflammatory aortitis. In this case report, we will present a case of left homonymous hemianopsia (HH) occurred after diagnostic coronary angiography and identified by CT-Scan which showed a cerebral infarction.