scholarly journals Extremity Dysfunction After Large‐Bore Radial and Femoral Arterial Access

2022 ◽  
Author(s):  
Thomas A. Meijers ◽  
Adel Aminian ◽  
Marleen van Wely ◽  
Koen Teeuwen ◽  
Thomas Schmitz ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Coronary Intervention ◽  
Lower Extremity Function ◽  
Access Site ◽  
Functional Scale ◽  
Femoral Access ◽  
Arterial Access ◽  
Extremity Function ◽  
Percutaneous Coronary

Background The use of large‐bore (LB) arterial access and guiding catheters has been advocated for complex percutaneous coronary intervention. However, the impact of LB transradial access (TRA) and transfemoral access (TFA) on extremity dysfunction is currently unknown. Methods and Results The predefined substudy of the COLOR (Complex Large‐Bore Radial PCI) trial aimed to assess upper and lower‐extremity dysfunction after LB radial and femoral access. Upper‐extremity function was assessed in LB TRA‐treated patients by the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire and lower‐extremity function in LB TFA‐treated patients by the Lower Extremity Functional Scale questionnaire. Extremity pain and effect of access site complications and risk factors on extremity dysfunction was also analyzed. There were 343 patients who completed analyzable questionnaires. Overall, upper and lower‐extremity function did not decrease over time when LB TRA and TFA were used for complex percutaneous coronary intervention, as represented by the median Quick Disabilities of the Arm, Shoulder, and Hand score (6.8 at baseline and 2.1 at follow‐up, higher is worse) and Lower Extremity Functional Scale score (56 at baseline and 58 at follow‐up, lower is worse). Clinically relevant extremity dysfunction occurred in 6% after TRA and 9% after TFA. A trend for more pronounced upper‐limb dysfunction was present in female patients after LB TRA ( P =0.05). Lower‐extremity pain at discharge was significantly higher in patients with femoral access site complications ( P =0.02). Conclusions Following LB TRA and TFA, self‐reported upper and lower‐limb function did not decrease over time in the majority of patients. Clinically relevant limb dysfunction occurs in a small minority of patients regardless of radial or femoral access. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03846752.

Abstract 16049: A Comparison of Short- and Medium-Term Outcomes Between Men and Women Undergoing Percutaneous Coronary Intervention in a Chinese Population During the Contemporary Era of Drug-Eluting Stents

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Peiyuan He ◽  
Yuejin Yang ◽  
Shubin Qiao ◽  
Bo Xu ◽  
Yongjian Wu ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Major Bleeding ◽  
Chinese Population ◽  
Coronary Intervention ◽  
Drug Eluting Stents ◽  
Access Site ◽  
Men And Women ◽  
Percutaneous Coronary ◽  
Drug Eluting

Background: Very few studies have compared the percutaneous coronary intervention (PCI) outcomes between men and women among Asian population in the era of drug-eluting stents (DES). We aimed to evaluate the sex-specific disparities in a Chinese population. Methods: From June 1, 2006 to April 30, 2011, a total of 21,964 coronary artery disease patients who have undergone PCI with stents implantation were included from one single Chinese heart center. Among them, 17209 were males, and 4755 were females. The primary endpoint was defined as major cardiovascular events (MACE) during hospitalization and at 1 year follow-up, which included cardiac death, myocardial infarction (MI), and target vessel revascularization (TVR). The secondary endpoint was defined as each component of MACE. Major bleeding after the procedure was recognized as the safety endpoint. Results: The rates of MACE during hospitalization and at 1 year follow-up were similar between men and women (in-hospital: 1.5% vs. 1.6%, P=0.730, at 1 year follow-up: 4.0% vs. 4.1%, P=0.589). The adjusted rates of the primary endpoint was still similar (in-hospital odds ratio [OR], 0.94; 95% confidence interval [CI], 0.66–1.33, at 1 year follow-up hazard ratio [HR], 1.00; 95% CI, 0.96-1.04). No significant differences were detected in each component of MACE (P all > 0.05). But major bleeding after PCI occurred more in women than in men (1.2% vs. 0.7%, P=0.002), mainly driven by the access site-related major bleeding (0.8% vs. 0.4%, P=0.002). The access site complications were also more frequent in women (2.5% vs. 1.6%, P <0.001). Conclusions: In the Chinese population with frequent use of DES, women present similar in-hospital and 1 year major outcomes compared with men. But women have higher risk of major bleeding and access site complications.

scholarly journals Complex Large-Bore Radial percutaneous coronary intervention: rationale of the COLOR trial study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038042
Author(s):  
Thomas A Meijers ◽  
Adel Aminian ◽  
Koen Teeuwen ◽  
Marleen van Wely ◽  
Thomas Schmitz ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Ethics Committee ◽  
Bleeding Complications ◽  
Access Site ◽  
Femoral Access ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Coronary Lesions

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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