Comparison of radial access versus femoral access with the use of a vascular closure device for the prevention of vascular complications and mortality after percutaneous coronary intervention

IntroductionThe radial artery has become the standard access site for percutaneous coronary intervention (PCI) in stable coronary artery disease and acute coronary syndrome, because of less access site related bleeding complications. Patients with complex coronary lesions are under-represented in randomised trials comparing radial with femoral access with regard to safety and efficacy. The femoral artery is currently the most applied access site in patients with complex coronary lesions, especially when large bore guiding catheters are required. With slender technology, transradial PCI may be increasingly applied in patients with complex coronary lesions when large bore guiding catheters are mandatory and might be a safer alternative as compared with the transfemoral approach.Methods and analysisA total of 388 patients undergoing complex PCI will be randomised to radial 7 French access with Terumo Glidesheath Slender (Terumo, Japan) or femoral 7 French access as comparator. The primary outcome is the incidence of the composite end point of clinically relevant access site related bleeding and/or vascular complications requiring intervention. Procedural success and major adverse cardiovascular events up to 1 month will also be compared between both groups.Ethics and disseminationEthical approval for the study was granted by the local Ethics Committee at each recruiting center (‘Medisch Ethische Toetsing Commissie Isala Zwolle’, ‘Commissie voor medische ethiek ZNA’, ‘Comité Medische Ethiek Ziekenhuis Oost-Limburg’, ‘Comité d’éthique CHU-Charleroi-ISPPC’, ‘Commission cantonale d'éthique de la recherche CCER-Republique et Canton de Geneve’, ‘Ethik Kommission de Ärztekammer Nordrhein’ and ‘Riverside Research Ethics Committee’). The trial outcomes will be published in peer-reviewed journals of the concerned literature.Trial registration numberNCT03846752.

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LONG TERM OUTCOMES ASSOCIATED WITH VASCULAR CLOSURE DEVICE USE IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION VIA THE FEMORAL APPROACH: A PROPENSITY SCORE ADJUSTED, PROPENSITY SCORE MATCHED ANALYSIS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(10)62036-0 ◽

2010 ◽

Vol 55 (10) ◽

pp. A215.E2035

Author(s):

Sripal Bangalore ◽

Venkatesan Vidi ◽

Frederick G. Welt ◽

Pinak B. Shah ◽

Frederic Resnic

Keyword(s):

Percutaneous Coronary Intervention ◽

Propensity Score ◽

Coronary Intervention ◽

Closure Device ◽

Long Term Outcomes ◽

Vascular Closure Device ◽

Femoral Approach ◽

Percutaneous Coronary ◽

Device Use

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Radial Versus Femoral Access for Percutaneous Coronary Intervention: Implications for Vascular Complications and Bleeding

Current Cardiology Reports ◽

10.1007/s11886-012-0287-5 ◽

2012 ◽

Vol 14 (4) ◽

pp. 502-509 ◽

Cited By ~ 40

Author(s):

Sandeep Nathan ◽

Sunil V. Rao

Keyword(s):

Percutaneous Coronary Intervention ◽

Vascular Complications ◽

Coronary Intervention ◽

Femoral Access ◽

Percutaneous Coronary

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Comparison of Radial and Femoral Percutaneous Coronary Intervention

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v18i3.2587 ◽

2020 ◽

Vol 18 (3) ◽

pp. 366-372

Author(s):

Mahesh Bhattarai ◽

Arun Maskey ◽

Ram Kishore Shah ◽

Buna Bhandari ◽

Chandramani Adhikari ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Target Lesion ◽

Access Site ◽

Femoral Access ◽

Radial Approach ◽

Radial Access ◽

Clinical Events ◽

Percutaneous Coronary ◽

Heart Center

Background: The use of radial access for percutaneous coronary intervention is increasing in Nepal. However, there is limited study on the comparison of radial and femoral access in Nepal. This is the study comparing net adverse clinical events of radial with femoral access for intervention. Methods: This prospective study was conducted at Shahid Gangalal National Heart Center from January 2014 to June 2015 among 849 participations who underwent percutaneous coronary interventions, and 418 radial interventions were compared with 418 femoral interventions. A comparison was done in terms of 30- day rate of net adverse clinical events defined as the composite of death, myocardial infarction, stroke, target lesion revascularization and major bleeding. Results: Incidence of net adverse clinical events was significantly lower in radial compared to femoral approach 18(4.30%) vs. 51 (12.2%), p= <0.001). Mortality observed in the radial approach was significantly lower (p=<0.001) compared to femoral. Procedure success was not significantly different p=0.629. The trans-radial approach had significantly higher crossover rate (p=0.001). Observed vascular access site complications (p=0.026) and hospital stay (p=<0.0001) were lower in the radial group. Radiation exposure measured by fluoroscopy exposure time was not significantly different between the two groups (p=0.290). Conclusions: Radial access is associated with a lower rate of net adverse clinical events at 30 days compared to femoral access. Radial access is safer and equally effective compared to femoral access in the context of Nepal. Keywords: Femoral; percutaneous coronary intervention; radial

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Management of Haemostasis with Combined Use of Vascular Closure Devices and Bivalirudin – A Review

Interventional Cardiology Review ◽

10.15420/icr.2011.6.2.177 ◽

2011 ◽

Vol 6 (2) ◽

pp. 177

Author(s):

Emanuela de Cillis ◽

Giuseppe Massimo Sangiorgi ◽

Alessandro Santo Bortone ◽

◽

...

Keyword(s):

High Risk ◽

Vascular Complications ◽

Coronary Intervention ◽

Closure Device ◽

Vascular Closure Device ◽

High Risk Patients ◽

Vascular Closure Devices ◽

Combined Use ◽

Percutaneous Coronary ◽

Risk Patients

Bleeding and vascular complications related to invasive cardiovascular procedures are associated with significant morbidity and mortality. The aim of this article is to evaluate the literature to determine haemostasis strategies in percutaneous coronary intervention when using bivalirudin with or without a vascular closure device. The literature data seem to underline that the combination of vascular closure devices and bivalirudin was associated with significantly lower bleeding rates. However, these strategies were less often used among high-risk patients. We recommend that prospective clinical studies are undertaken to determine the potential disadvantages of using vascular closure devices and bivalirudin in combination in high-risk patients.

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