scholarly journals Slender Sheath/Guiding Catheter Combination vs. Sheathless Guiding Catheter for Acute Coronary Syndrome: A Propensity-Matched Analysis of the Two Devices

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Tsuyoshi Isawa ◽  
Kazunori Horie ◽  
Taku Honda ◽  
Masataka Taguri ◽  
Norio Tada
Keyword(s):  
Acute Coronary Syndrome ◽  
Univariate Analysis ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Access Site ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Transradial Pci ◽  
Sheathless Guiding Catheter ◽  
Guiding Catheter

A Glidesheath slender (Terumo, Tokyo, Japan) and a sheathless Eaucath guiding catheter (Asahi Intecc, Nagoya, Japan) are two major slender devices utilized in percutaneous coronary intervention (PCI). This study aimed to investigate the differences in access-site complications between these devices in PCI for acute coronary syndrome (ACS). A total of 1108 consecutive patients who underwent transradial PCI for ACS were enrolled. Transradial PCI was performed using either a 7-Fr Glidesheath slender/7-Fr guiding catheter combination (Glidesheath group) or a 7.5-Fr sheathless guiding catheter (Sheathless group); 1 : 1 propensity score matching was performed, and 728 patients (364 in each group) were included in the propensity-matched population. In the matched patients, univariate analysis revealed that the Glidesheath group had less radial artery occlusion (RAO) at 30 days (Glidesheath: 1.4% vs. Sheathless: 4.1%, odds ratio (OR) = 0.33, 95% confidence interval (CI) =  0.12–0.91, p=0.039), whereas no significant between-group differences were observed in severe radial spasm (Glidesheath: 1.4% vs. Sheathless: 1.9%, OR = 0.71, 95% CI = 0.23–2.22, p=0.58) or access-site major bleeding (Glidesheath: 1.4% vs. Sheathless: 1.6%, OR = 0.83, 95% CI = 0.26–2.71, p=1.00). Multivariate analysis revealed that the choice for Glidesheath was significantly associated with less RAO (OR = 0.32, 95% CI = 0.11–0.93, p=0.036). In conclusion, 7-Fr Glidesheath slender/7-Fr guiding catheter combination is obviously more advantageous than 7.5-Fr sheathless guiding catheters for decreased risk of RAO. The potential low risk of RAO in our findings supports the adoption of the 7-Fr Glidesheath slender sheath/7-Fr guiding catheter combination in transradial PCI for ACS.

Sheathless guiding catheter versus “slender” sheath/guiding catheter combination in acute coronary syndrome: a propensity-matched analysis of two downsized devices

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Isawa ◽  
K Horie ◽  
T Honda
Keyword(s):  
Acute Coronary Syndrome ◽  
Radial Artery ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Access Site ◽  
Coronary Syndrome ◽  
Radial Artery Occlusion ◽  
Transradial Pci ◽  
Sheathless Guiding Catheter ◽  
Guiding Catheter

Abstract Purpose We investigated the differences between a sheathless guiding catheter and a Glidesheath slender/guiding catheter combination regarding access-site complications in percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Methods We enrolled consecutive 1108 patients undergoing transradial primary PCI for ACS at our hospital using either a 7.5-Fr sheathless guiding catheter (Sheathless group) or a 7-Fr Glidesheath slender/7-Fr guiding catheter combination (Glidesheath group); 1:1 propensity score matching was performed, and 718 subjects (359 in each group) were included in the propensity-matched sample. Results Compared with the Sheathless group, the Glidesheath group had significantly less frequent ultrasound-diagnosed radial artery occlusion at 30 days (Sheathless: 4.7% vs. Glidesheath: 1.4%, p=0.015). No significant differences were observed in severe radial spasm (Sheathless: 1.4% vs. Glidesheath: 2.0%, p=0.77) or access-site bleeding (Sheathless: 9.8% vs. Glidesheath: 8.6%, p=0.70). Conclusion Thus, 7-Fr Glidesheath slender/7-Fr guiding catheter combination is clearly more advantageous than 7.5-Fr sheathless guiding catheters for decreased risk of radial artery occlusion in transradial PCI for ACS. “Sheathless” vs. “Glidesheath slender” Funding Acknowledgement Type of funding source: None

Assessment Framework for Recognizing Clinical Deterioration in Patients With ACS Undergoing PCI

2021 ◽  
Vol 41 (4) ◽  
pp. 18-28
Author(s):  
Kevin White ◽  
Judy Currey ◽  
Julie Considine
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Signs And Symptoms ◽  
Coronary Artery Occlusion ◽  
Coronary Intervention ◽  
Clinical Deterioration ◽  
Access Site ◽  
Mortality And Morbidity ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Topic Patients with acute coronary syndrome undergoing primary percutaneous coronary intervention are at risk of clinical deterioration that results in similar general signs and symptoms regardless of its cause. However, specific causes and forms of clinical deterioration are associated with key differences in assessment findings. Focused clinical assessments using a modified primary survey enable nurses to rapidly identify the cause and form of clinical deterioration, facilitating targeted treatment. Clinical Relevance Clinical deterioration during percutaneous coronary intervention is associated with increased mortality and morbidity. Previous studies identified nursing inconsistencies when recognizing clinical deterioration, with inconsistent collection of cues and prioritization of cues related to cardiac performance over more sensitive indicators of clinical deterioration. Purpose of Paper To describe a framework to help nurses optimize physiological cue collection to improve recognition of clinical deterioration during periprocedural care of patients undergoing percutaneous coronary intervention for unstable acute coronary syndrome. Content Covered Literature analysis revealed 7 forms of clinical deterioration in patients undergoing percutaneous coronary intervention: coronary artery occlusion, stroke, ventricular rupture, valvular insufficiency, lethal cardiac arrhythmias, access-site and non–access-site bleeding, and anaphylaxis. Evidence for the pathophysiology, incidence, severity, and clinical features of each form of clinical deterioration is identified. A framework is proposed to help nurses conduct highly focused patient assessments, enabling prompt recognition of and response to the specific forms of clinical deterioration that occur in patients undergoing percutaneous coronary intervention.

Radial Artery Occlusion after Percutaneous Coronary Intervention through Transradial Approach

2021 ◽  
Vol 15 (8) ◽  
pp. 2246-2249
Author(s):  
Muhammad Asif Farooqi ◽  
Bilal Rafique Malik ◽  
Rehan Anwar
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Radial Artery ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Good Opportunity ◽  
Transradial Approach ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Radial Artery Occlusion

Introduction: Radial artery occlusion may occur after percutaneous coronary intervention when done via transradial approach. The frequency of radial artery occlusion is almost nil in patients after PCI through transradial approach. Thus radial artery approach for PCI can be a good opportunity to conduct the procedure. Objective: To assess the frequency of radial artery occlusion after percutaneous coronary intervention through transradial approach in patients of acute coronary syndrome Material & Methods Study Design: Descriptive case study Settings: Department of Cardiology, Punjab Institute of Cardiology, Lahore. Duration: Six months i.e. 1st July 2020 to 31st December 2020. Data Collection: Total 100 patients who underwent PCI through transradial approach 6 months ago were studied. All the selected patients then underwent Doppler scan to assess patency of radial artery. Radial artery occlusion was confirmed by when there was reduced flow in radial artery as compared to the adjacent side artery Results: In this study, the mean age of patients was 54.56 ± 8.96 years. There were 43 (43%) males and 57 (57%) females. The frequency of radial artery occlusion in patients after PCI through transradial approach was seen in 3 (3%) of the patients. Conclusion: Results of this study demonstrates that the frequency of radial artery occlusion is almost nil in patients after PCI through transradial approach. Thus radial artery approach for PCI can be a good opportunity to conduct the procedure. Key Words: Radial artery Occlusion, Transradial approach, percutaneous coronary intervention, acute coronary syndrome

scholarly journals Risk factors for repeat percutaneous coronary intervention in young patients (≤45 years of age) with acute coronary syndrome

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e6804 ◽  
Author(s):  
Tianwen Han ◽  
Qun Wang ◽  
Huanwan Yang ◽  
Shanshan Zhou ◽  
Jing Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Young Patients ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Second Procedure

Background The incidences of premature coronary heart disease present a rising trend worldwide. The possible risk factors that may predict the incidence of repeat percutaneous coronary intervention (PCI) in premature acute coronary syndrome (ACS) remains unclear. Methods A total of 203 patients ≤45 years with ACS from Chinese PLA General Hospital who have undergone angiography twice were included in this report. Data were collected from medical records of patients during hospitalization. Baseline characteristics which have significant differences in the univariate analysis were enrolled into the multiple logistic regression analysis. According to the odds ratio (OR) of these variables, different values were assigned to build a risk model to predict the possible risk of the premature ACS patients undergoing repeat PCI. Results Of the 203 young patients, 88 patients (43.3%) underwent repeat PCI. The intermit time (OR 1.002, (95% CI [1.001–1.002])), diastolic blood pressure of second procedure (OR 0.967, (95% CI [0.938–0.996])), stent diameter (OR 0.352, (95% CI [0.148–0.840])), HbA1C of the first procedure (OR 1.835, (95% CI [1.358–2.479])), and Troponin T of the second procedure (OR 1.24, (95% CI [0.981–1.489])) were significantly associated with the incidence of repeat PCI in patients with premature ACS. An aggregate score between 0 and 6 was calculated based on these cutpoints. Conclusion For young patients with premature ACS, risk of undergoing repeat PCI was high. HbA1C was a significant, independent predictor for the incidence of repeat revascularization, and weighed more than traditional lipid profile. The glucose metabolism and disorders in patients with premature ACS should be routinely screened.

P4597Impact of operator experience with radial approach for clinical outcome on percutaneous coronary intervention in acute coronary syndrome performed with femoral artery access site

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Tokarek ◽  
A Dziewierz ◽  
K Plens ◽  
T Rakowski ◽  
M Zabojszcz ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Radial Artery ◽  
Femoral Artery ◽  
Coronary Intervention ◽  
Access Site ◽  
Radial Approach ◽  
Coronary Syndrome ◽  
Radial Access ◽  
Percutaneous Coronary

Abstract Introduction Radial approach (RA) for percutaneous coronary intervention (PCI) is associated with reduced mortality and access site complications. The routine use of the RA in patients should be strongly considered, keeping in mind the learning curve associated with the technique. However, promotion of RA may interfere with the equally important goal of maintaining proficiency in the femoral approach (FA), which is essential in a variety of procedures as well as when RA fails. There is possible risk of higher rate of complications in PCI with FA performed by operators mainly using radial artery as access site. Purpose The aim of this study was to evaluate impact of experience and proficiency with RA for clinical outcomes on PCI via FA in “real-world” patients with acute coronary syndrome (ACS). Methods A total of 539 invasive cardiologists performing PCI in 151 invasive cardiology centers on the Polish territory between 2014 and 2017 were included in study analysis. Proficiency threshold has been set at >400 procedures during four consecutive years per individual operator. They were categorized to quartiles according to total volume of radial artery utilization during all PCIs. Procedures performed on patients with Killip-Kimball class IV on admission to catheterisation laboratory were excluded from analysis. Results The most of the operators performed >75% of all procedures via radial artery (326 (60.5%)), 112 (20.8%) used RA in 50–75% of cases, 67 (12.4%) in 25–50% of all PCIs and only 34 (6.3%) invasive cardiologist were using RA in less than 25% of all procedures. Mortality during PCI via FA was higher in group of invasive cardiologist with >75% of all procedures performed with radial access (>75% vs. 50–75% vs. 25–50% vs. <25%: 1.63% (±2.52%) vs. 0.93% (±1.05%) vs. 0.68% (±0.73%) vs. 0.31% (±0.40%); p=0.01). A trend towards higher rate of bleeding at the puncture site during PCI procedures with femoral artery were reported in groups of operators with higher expertise in RA (>75% vs. 50–75% vs. 25–50% vs. <25%: 0.43% (±1.09%) vs. 0.14% (±0.36%) vs. 0.21% (±0.45%) vs. 0.14% (±0.37%); p=0.09). Conclusions Higher experience in radial access might be linked to worse outcome in PCI via FA in ACS settings. Femoral artery is important vascular approach and should not be abandoned while learning procedures with radial artery utilization. Acknowledgement/Funding None

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