Vascular complications and access crossover in 10,676 transradial percutaneous coronary procedures. Am Heart J

Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy.
American heart journal (Impact Factor: 4.46). 02/2012; 163(2):230-8. DOI: 10.1016/j.ahj.2011.10.019
Source: PubMed


Randomized trials have shown that transradial approach, compared with transfemoral, reduces vascular complications (VCs) of coronary procedures in selected patients. Yet, radial approach is associated to a variety of access-site VC as well as to a higher failure rate compared with femoral access.
At our institution, from May 2005 to May 2010, we prospectively assessed the occurrence and outcome of VC in consecutive patients undergoing transradial percutaneous coronary procedures performed by trained radial operators. The need of access crossover to complete the procedure was also prospectively investigated. Vascular complications were classified as "radial related" or "nonradial related" (in the case of access crossover). Vascular complications were also classified "major" if requiring surgery and/or blood transfusions or causing hemoglobin drop >3 g/dL.
Ten thousand six hundred seventy-six procedures were performed using a right radial (87.5%), left radial (12.4%), or ulnar (0.1%) artery as primary access. A total of 53 VCs (0.5%) were observed: 44 (83%) radial related and 9 (17%) nonradial related. Major VCs occurred in 16 patients only (0.2%) and were radial related in 10 (62.5%) and nonradial related in 6 (37.5%) patients. Vascular complications rate was stable during the study and independent of operator's experience. Access crossover rate was 4.9%, differed according to the operator radial experience and significantly decreased over time.
The present study, conducted in a center with high volume of radial procedures, shows that transradial approach is associated with a very low rate of VC, which is stable over time. On the contrary, access crossover rate decreased over time and differed according to operator (radial) experience.

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    • "Similarly, in the only multicenter study to delineate the transradial learning curve, Hess used data from 54,561 radial PCI procedures performed at 704 sites by 942 operators and found that the slope of improvement in procedural metrics flattened beyond 30– 50 cases [11]. Beyond this threshold, the metrics continued to improve, and data suggest continued improvement in proficiency even among experienced operators [12]. This shallow curve indicates that even lower volume operators may be able to overcome the learning curve by routinely using radial access in consecutive patients. "

    Full-text · Article · Jun 2014 · Cardiovascular revascularization medicine: including molecular interventions
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    • "In our study, multivariate analysis showed that a previous history of CABG was a major predictor for prolonged DTB time. It is well known that TRI has a steep learning curve compared with TFI, and cases of prior CABG should not be selected for TRI unless the procedure is performed by the most experienced operators [17]. We have not compared DTB time between groups with and without a previous history of CABG, but after propensity score matching, our results showed significantly shorter DTB time in the TRI group. "
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    ABSTRACT: Background: In the emergent setting of ST-elevation myocardial infarction (STEMI), transradial intervention (TRI) is less frequently employed than transfemoral intervention (TFI). Because of the greater technical complexity of TRI, a potential compromise in door-to-balloon (DTB) time remains a major concern of centers adopting TRI for STEMI. Methods: We performed a propensity-matched analysis, with 1:1 matching of TRI and TFI patients comparing DTB time, 30-day major adverse cardiac event (MACE), and bleeding outcomes of 1052 consecutive STEMI patients managed at our center during a 2-year transition program from routine TFI to TRI access for STEMI. Results: From January 2008 to April 2010, 359 (34.1%) STEMI patients underwent TRI and the remaining 693 (65.9%) STEMI patients underwent TFI. In 283 propensity score matched pairs of TRI and TFI patients, TRI was associated with shorter DTB time (63.6min vs 69.4min, p=0.027) and more patients having DTB time<90min (88.3% vs 82.3%, p=0.043). Thirty-day MACE occurred in 1.0% in the TRI group and 3.0% in the TFI group (p=0.129). There was no significant difference in major (p=0.313) or minor bleeding (p=0.714) between the TRI and TFI groups. There was a twofold greater use of glycoprotein (GP) IIb/IIIa inhibitor in the TRI group (68.5%) compared with the TFI group (36.4%) (p<0.001). Conclusion: Compared with TFI, TRI was not associated with longer DTB time during our center's transition from routine TFI to TRI in STEMI. Our experience suggests that the transition to TRI in STEMI can be safely achieved with DTB times that are comparable and possibly better than propensity-matched TFI cases.
    Full-text · Article · Apr 2013 · Journal of Cardiology
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    ABSTRACT: Since its advent over two decades ago, transradial access for cardiac catheterization and percutaneous intervention has evolved into a versatile and evidence-based approach for containing the risks of access-site bleeding and vascular complications without compromising the technical range or success associated with contemporary percutaneous coronary intervention (PCI). Early studies demonstrated reduced rates of vascular complications and access-site bleeding with radial-access catheterization but at the cost of increased access-site crossover and reduced procedural success. Contemporary data demonstrate that while the rates of major bleeding with femoral-access PCI in standard-risk cohorts have declined significantly over time, the transradial approach still retains significant advantages by way of reductions in vascular complications, length of stay, and enhanced patient comfort and patient preference over the femoral approach, while maintaining procedural success. Major adverse cardiovascular events and bleeding are lowest with the transradial approach when procedures are performed at high-volume radial centers, by experienced radial operators, or in the context of ST-segment elevation myocardial infarction. Choice of procedural anticoagulation appears to differentially impact access-site bleeding in transradial versus transfemoral PCI; however, non-access site bleeding remains a significant contributor to major bleeding in both groups. Despite abundant supporting data, adoption of transradial technique as the default strategy in cardiac catheterization in the United States has lagged behind many other countries. However, recent trends suggest that interest and adoption of the technique in the United States is growing at a brisker pace than previously observed.
    No preview · Article · Jun 2012 · Current Cardiology Reports
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