Abstract 64: Transradial Approach: The Future of Neurointervention-A Muticenter Collaboration

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Eyad Almallouhi ◽  
Sami Al Kasab ◽  
Robert Starke ◽  
Jonathan R Lena ◽  
Ahmad Sweid ◽  
...  
Keyword(s):  
Interventional Procedures ◽  
Early Stage ◽  
Major Complication ◽  
High Volume ◽  
The United States ◽  
Access Site ◽  
Femoral Access ◽  
Transradial Approach ◽  
Wide Range ◽  
Forearm Pain

Introduction: Transradial approach (TRA) has gained significant popularity in the neuroendovascular world over the past few years. The purpose of this study is to report early experience in TRA from high volume centers. Methods: We reviewed charts from 4 institutions in the United States to include consecutive patients who underwent diagnostic or interventional neuroendovascular procedure through TRA from July 2018 to July 2019. Collected data included baseline characteristics, procedural variables, whether there was crossover to transfemoral access and complications. Results: A total of 1272 patients were included in the series (age 57.2 ± 15.3, 46.3% females). Out of those, 1054 (82.9%) patients underwent diagnostic cerebral angiograms and 218 (17.1%) underwent interventional procedures. Successfully completed procedures included aneurysm primary coiling (62 patients), stent assisted coiling (44 patients), flow diversion (40 patients), balloon assisted coiling (21 patients), and stroke thrombectomy (24 patients). The large vessels were selected as following: right vertebral artery (VA) in 74.2% of the cases, right internal carotid artery (ICA) in 75.4% of the cases, left VA in 51.4% of the cases, left ICA in 69.1% of the cases. Crossover to femoral access was required in 82 (6.4%) patients (most common cause was inability to reach the target vessel in 13 patients). None of the included patients had major complication related to the access site. Minor complications related to access site were seen in 30 (2.4%) patients. Of those, 11 patients had forearm hematoma, 8 had mild-moderate vasospasm, 6 had forearm pain, and 5 had oozing from the access site. Conclusion: In this early stage of transforming to radial-first approach for neurointerventions, TRA was reasonably safe with relatively low complication rate for both diagnostic and interventional procedures. Wide range of procedures were completed successfully using TRA.

Incorporation of transradial approach in neuroendovascular procedures: defining benchmarks for rates of complications and conversion to femoral access

2020 ◽  
Vol 12 (11) ◽  
pp. 1122-1126 ◽  
Author(s):  
Eyad Almallouhi ◽  
Sami Al Kasab ◽  
Mithun G Sattur ◽  
Jonathan Lena ◽  
Pascal M Jabbour ◽  
...  
Keyword(s):  
Interventional Procedures ◽  
Early Stage ◽  
Diagnostic Procedures ◽  
Complication Rates ◽  
Access Site ◽  
Femoral Access ◽  
Transradial Approach ◽  
Wide Range ◽  
The Usa ◽  
Baseline Characteristics

BackgroundThe transradial approach (TRA) has gained increasing popularity for neuroendovascular procedures. However, the experience with TRA in neuroangiography is still in early stages in most centers, and the safety and feasibility of this approach have not been well established. The purpose of this study is to report the safety and feasibility of TRA for neuroendovascular procedures.MethodsWe reviewed charts from six institutions in the USA to include consecutive patients who underwent diagnostic or interventional neuroendovascular procedures through TRA from July 2018 to July 2019. Collected data included baseline characteristics, procedural variables, complications, and whether there was a crossover to transfemoral access.ResultsA total of 2203 patients were included in the study (age 56.1±15.2, 60.8% women). Of these, 1697 (77%) patients underwent diagnostic procedures and 506 (23%) underwent interventional procedures. Successfully completed procedures included aneurysm coiling (n=97), flow diversion (n=89), stent-assisted coiling (n=57), balloon-assisted coiling (n=19), and stroke thrombectomy (n=76). Crossover to femoral access was required in 114 (5.2%). There were no major complications related to the radial access site. Minor complications related to access site were seen in 14 (0.6%) patients.ConclusionIn this early stage of transforming to the ‘radial-first’ approach for neuroendovascular procedures, TRA was safe with low complication rates for both diagnostic and interventional procedures. A wide range of procedures were completed successfully using TRA.

From Femoral to Radial Approach in Coronary Intervention

Angiology ◽  
2016 ◽  
Vol 68 (4) ◽  
pp. 281-287 ◽  
Author(s):  
Renatomaria Bianchi ◽  
Ludovica D’Acierno ◽  
Mario Crisci ◽  
Donato Tartaglione ◽  
Maurizio Cappelli Bigazzi ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Coronary Angiography ◽  
Coronary Intervention ◽  
Access Site ◽  
Femoral Access ◽  
Transradial Approach ◽  
Operator Experience ◽  
Transradial Access ◽  
Hemorrhagic Events ◽  
Duration Of Hospitalization

Since the first cardiac catheterization in 1929, this procedure has evolved considerably. Historically performed via the transfemoral access, in the last years, the transradial access has been spreading gradually due to its many advantages. We have conducted a review of published literature concerning efficacy, safety, and cost-effectiveness, and we analyzed our patients’ data, including the results of the recently published Minimizing Adverse hemorrhagic events by TRansradial access site and systemic implementation of angioX (MATRIX) study. This review confirmed the superiority of the transradial access compared to the femoral access, especially regarding complications related to the access site, duration of hospitalization, and comfort for the patient. The transradial approach is an excellent option for coronary angiography, and the procedure’s risks are reduced by increased operator experience.

Outcomes of Radial Versus Femoral Approach in Patients with St Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

2021 ◽  
Vol 23 (Supplement_D) ◽  
Author(s):  
Emad Torkey ◽  
Mohamed Sanhoury ◽  
Mohammad Sadaka ◽  
Amr Zaki
Keyword(s):  
Hospital Stay ◽  
Anticoagulation Therapy ◽  
Vascular Complications ◽  
University Hospital ◽  
P Value ◽  
Access Site ◽  
Transfemoral Approach ◽  
Femoral Access ◽  
Transradial Approach ◽  
Procedural Time

Abstract Aim of the work To compare transradial and transfemoral approaches in 1ry and rescue PCI for STEMI. Methods This prospective observational study was done at Alexandria University Hospital and International Cardiac Center from January 2020 to August 2020 by recruiting every patient had met our inclusion criteria (the third universal definition of MI) admitted to the coronary care unit after doing primary or rescue PCI 200 patients were involved. Exclusion criteria were (Thrombophilia and thrombocytopenia, known hematological abnormalities, and patients with known sever peripheral vascular disease. Randomization made by a computer-generated program into two equal parallel groups that were randomly assigned to either Radial access approach or femoral access approach for primary or rescue PCI. Chest pain to time of first medical contact (FMC), and the procedural time were computed. Coronary angiography and PCI procedure were described including materials used and the intra-procedure complications. MACE (Major Adverse Cardiac Events) or other hemodynamic complications were documented. All the patients were contacted for follow up to 6 months after the procedure by interviewing with the patients via telephone or the responsible physician to determine the outcomes procedure. Results The distribution of demographic variables and risk factors were similar among 200 patients in the radial and femoral groups. There had been significant differences between the groups concerning the primary end point MACE after 6 months in favor of radial group patients with p value (0.004), there was significant deference between the two studied groups concerning the total bleeding complication with higher risk in femoral group 11% compared to radial group 3% with P value (0.02). Despite the nearly equal mean time from pain to FMC (9.01 hours in radial group and 9.2 hours in femoral group), the total procedural time was significantly longer in radial group compared to femoral group with (p value 0.037). However the rate of non-culprit vessel revascularsation was significantly higher in radial group 17% compared to 6% in femoral group with p value of (0.015). In-hospital stay was significantly shorter in the radial group patients P value (0.02). Conclusion Transradial approach is safe, and effective with a high procedural success rate as the transfemoral approach but with lower risk for bleeding vascular complications and other access site complications as hematoma especially for patients where aggressive antiplatelet and anticoagulation therapy is needed, or patients who are expected to suffer from access site complications as those who need rescue PCI. Transradial approach has major additional advantages of decreasing the incidence of MACE compared to transfemoral approach. Transradial approach has another advantages of decreasing the in hospital stay.

Transradial approach for flow diversion treatment of cerebral aneurysms: a multicenter study

2019 ◽  
Vol 11 (8) ◽  
pp. 796-800 ◽  
Author(s):  
Stephanie H Chen ◽  
Brian M Snelling ◽  
Sumedh Subodh Shah ◽  
Samir Sur ◽  
Marie Christine Brunet ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Cerebral Aneurysms ◽  
High Volume ◽  
Flow Diverter ◽  
Acute Angle ◽  
Flow Diversion ◽  
Left Internal Carotid Artery ◽  
Access Site ◽  
Transradial Approach ◽  
Aneurysm Treatment

BackgroundThe transradial approach (TRA) to endovascular procedures decreases access site morbidity and mortality in comparison with the traditional transfemoral technique (TFA). Despite its improved safety profile, there is a concern that TRA is less favorable for neurointerventional procedures that require large coaxial systems to manage the small tortuous cerebral vessels.ObjectiveTo report our experience with TRA for flow diverter placement for treatment of unruptured cerebral aneurysms.MethodsWe performed a retrospective review of prospective institutional databases at two high-volume centers to identify 49 patients who underwent flow diversion for aneurysm treatment via primary TRA between November 2016 and November 2018. Patient demographics, procedural techniques, and clinical data were recorded.ResultsOf the 49 patients, 39 underwent successful flow diversion placement by TRA. Ten patients were converted to TFA after attempted TRA. There were no procedural complications. Reasons for failure included tortuosity in eight patients and severe radial artery spasm in two.ConclusionsIn the largest reported series to date of flow diverter deployment via TRA for aneurysm treatment, we demonstrate the technical feasibility and safety of the method. The most common reason for failure of TRA was an acute angle of left common carotid artery origin or left internal carotid artery tortuosity. Overall, our data suggest that increasing adoption of TRA is merited given its apparent equivalence to the current TFA technique and its documented reduction in access site complications.

Abstract WMP2: Pearls and Pitfalls of the Transradial Approach for Neurointerventions: Lessons Learned After 570 Cases

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ahmad Sweid ◽  
Omaditya Khanna ◽  
Somnath Das ◽  
Julie Kim ◽  
Darcy Curtis ◽  
...  
Keyword(s):  
Radial Artery ◽  
Lessons Learned ◽  
Fluoroscopy Time ◽  
Access Site ◽  
Safe Alternative ◽  
Transradial Approach ◽  
Access Site Complication ◽  
Wide Range ◽  
Therapeutic Procedures ◽  
Web Device

Background and Purpose: Trans radial catheterization is an alternate route of access that has started to gain more widespread use for neuroendovascular procedures. There are several randomized controlled trials from cardiac field that had established its safety and efficacy. We present our institution’s experience in performing neuroendovascular interventions via a transradial approach. Methods: We conducted a retrospective analysis and identified 570 patients who underwent consecutive neuroendovascular interventions via radial artery access. Data collection was performed on indication for procedure, sheath size, catheter type, number of vessels selectively catheterized, fluoroscopy time, procedure duration, radiation exposure, conversion to femoral approach, access site complication, and procedure success. Results: Of 570 patients with an average age of 59.4 years ± 14.7, 406 (71.2%) underwent diagnostic angiograms and 164 (28.7%) underwent therapeutic procedures. The overall mean number of vessels catheterized was 2.9 ± 1.7 per procedure. The RCCA was the most frequent selectively catheterized artery; 340 (22.9%), followed by LCCA; 306 (20.6%), RICA; 250 (16.8%), LICA; 238 (16.0%), RVA; 159 (10.71%), LVA; 76 (5.1%), RECA; 61 (4.1%), and lastly the LECA selectively catheterized in 54 (3.6%). The average amount of contrast given was 83.4 cc ± 51.Successfully completed therapeutic procedures included aneurysm simple coiling (34 patients), stent assisted coiling (30 patients), flow diversion (34) patients), ICA balloon angioplasty and stenting (20 patients), Web device (8), AVM embolization (14), IAC for retinoblastoma (1 patient), and stroke thrombectomy (23 patients). The average duration was 72 mins ± 43, and average fluoroscopy time was 13.20 mins ± 11.20. Seventeen patients (3.2%) required conversion to transfemoral access. Twelve minor complications (2.3%) were reported including mild oozing after deflation of the balloon, ecchymosis, mild swelling. No major complications were encountered. Conclusions: Radial artery catheterization is a safe and effective access site to perform a wide range of diagnostic and therapeutic procedures. Complication and conversion rate are low making it a safe alternative.

Comparison of transradial and transfemoral access for the Woven EndoBridge embolization of intracranial aneurysms: A single-center experience

2021 ◽  
pp. 159101992110437
Author(s):  
Nimer Adeeb ◽  
Mahmoud Dibas ◽  
Abdallah Amireh ◽  
Sandeep Kandregula ◽  
Hugo Cuellar
Keyword(s):  
Intracranial Aneurysms ◽  
Early Stage ◽  
High Volume ◽  
Senior Author ◽  
Complication Rates ◽  
Femoral Access ◽  
Single Center Experience ◽  
Transradial Access ◽  
Included Patient ◽  
Woven Endobridge

Background Transradial access has been adopted more commonly in the neuroendovascular field. However, the experience of using this access for the Woven EndoBridge embolization of intracranial aneurysms is still in the early stage. Objective This study aimed to compare the outcomes between transradial access and transfemoral access for the Woven EndoBridge embolization of intracranial aneurysms. Methods This is a retrospective analysis of consecutive intracranial aneurysms treated with Woven EndoBridge placement between May 2019 and August 2020 by the senior author at a high-volume center. The aneurysms of all sizes and locations treated with Woven EndoBridge placement with or without adjunctive stent or coiling were included. Patient demographics, aneurysm and treatment characteristics, procedural complications, and angiographic and functional outcomes were compared between two approaches. Results This study included a total of 34 patients with intracranial aneurysms (median age 60 years, female-to-male ratio 2:1). Of these, the radial access was utilized in 20 (58.8%) patients, while the femoral access was used in 14 (41.2%) patients. A Woven EndoBridge device was successfully deployed in all cases, and none of the patients required a crossover to another access. There were no significant differences in baseline characteristics, procedure time and fluoroscopy time, outcomes, and complication rates between both groups. Conclusion Our report suggests the possible feasibility and safety of the transradial access for the Woven EndoBridge embolization of intracranial aneurysms. However, the results of this study are suggestive rather than conclusive, and there is still a need for future large prospective studies.

scholarly journals Medicolegal implications of radial and femoral access for coronary angiography and intervention in 2016: Focus on retroperitoneal hemorrhage

2016 ◽  
Vol 4 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Konstantinos V. Voudris ◽  
Mladen I. Vidovich
Keyword(s):  
Coronary Angiography ◽  
Standard Of Care ◽  
Coronary Intervention ◽  
The United States ◽  
Access Site ◽  
Transfemoral Approach ◽  
Retroperitoneal Hemorrhage ◽  
Femoral Access ◽  
Percutaneous Coronary ◽  
Wrongful Death

Abstract Background and Objectives Retroperitoneal hemorrhage is a rare but serious complication of transfemoral approach (TFA) and TFA percutaneous coronary intervention (PCI). Radial approach for coronary angiography and intervention (transradial approach, TRA) is associated with lower access site complications and reduced blood transfusion rates. Retroperitoneal bleeding has not been described with TRA. This study sought to evaluate the relationship between femoral access for coronary angiography (TFA) and PCI-induced retroperitoneal hemorrhage and the resulting medical litigation in the United States. Methods From 342 lawsuit claim records identified in LexisNexis database search, 17 cases of TFA and TFAPCI-related retroperitoneal hemorrhage decided between 1995 and 2015 were included in the study. Claims were thoroughly reviewed and information about the date the case was decided, patient outcome, the plaintiff, the defendant, the claim, and the trial outcome were extracted. Results The most common filled claim was medical malpractice (53% of the cases), followed by wrongful death (18%) and review of the Commissioner's decision to deny the application for supplemental security income (12%). Forty-seven percent of the cases were won by the defense, 29% by the plaintiff, and 24% were remanded for a new trial. In 82% of the cases, physicians were sued, but only 14% of the cases were won by the plaintiff. In 59% of the claims, the patient died; however, 70% of those cases were decided in favor of the defending physician and hospital. Conclusion Retroperitoneal hemorrhage is an uncommon complication of TFA and TFA PCI and is associated with high mortality rates. Physicians should able to identify this complication early and address it in a timely manner based on the applicable standard of care. TRA and TRA PCI is a reliable alternative and may potentially reduce medicolegal liability related to access site choice.

scholarly journals Lower complication rates associated with transradial versus transfemoral flow diverting stent placement

2020 ◽  
Vol 13 (1) ◽  
pp. 91-95 ◽  
Author(s):  
Yangchun Li ◽  
Stephanie H Chen ◽  
Alejandro M Spiotta ◽  
Pascal Jabbour ◽  
Michael R Levitt ◽  
...  
Keyword(s):  
Complication Rate ◽  
Large Scale ◽  
Cerebral Aneurysms ◽  
Pooled Analysis ◽  
Flow Diversion ◽  
Complication Rates ◽  
Access Site ◽  
Femoral Access ◽  
Access Site Complication ◽  
Wide Range

BackgroundCurrently, there are no large-scale studies in the neurointerventional literature comparing safety between transradial (TRA) and transfemoral (TFA) approaches for flow diversion procedures. This study aims to assess complication rates in a large multicenter registry for TRA versus TFA flow diversion.MethodsWe retrospectively analyzed flow diversion cases for cerebral aneurysms from 14 institutions from 2010 to 2019. Pooled analysis of proportions was calculated using weighted analysis with 95% CI to account for results from multiple centers. Access site complication rate and overall complication rate were compared between the two approaches.ResultsA total of 2,285 patients who underwent flow diversion were analyzed, with 134 (5.86%) treated with TRA and 2151 (94.14%) via TFA. The two groups shared similar patient and aneurysm characteristics. Crossover from TRA to TFA was documented in 12 (8.63%) patients. There were no access site complications in the TRA group. There was a significantly higher access site complication rate in the TFA cohort as compared with TRA (2.48%, 95% CI 2.40% to 2.57%, vs 0%; p=0.039). One death resulted from a femoral access site complication. The overall complications rate was also higher in the TFA group (9.02%, 95% CI 8.15% to 9.89%) compared with the TRA group (3.73%, 95% CI 3.13% to 4.28%; p=0.035).ConclusionTRA may be a safer approach for flow diversion to treat cerebral aneurysms at a wide range of locations. Both access site complication rate and overall complication rate were lower for TRA flow diversion compared with TFA in this large series.

Clinical and Procedural Predictors of Nurse Workload During and After Invasive Coronary Procedures: The Potential Benefit of a Systematic Radial Access

2005 ◽  
Vol 4 (3) ◽  
pp. 234-241 ◽  
Author(s):  
Giovanni Amoroso ◽  
Mascia Sarti ◽  
Rita Bellucci ◽  
Francesca Li Puma ◽  
Silvia D'Alessandro ◽  
...  
Keyword(s):  
Interventional Procedures ◽  
Access Site ◽  
Femoral Access ◽  
Access Site Complication ◽  
Radial Access ◽  
Ward Nurse ◽  
Nurse Workload ◽  
Procedural Time ◽  
Hospital Stays ◽  
Coronary Procedures

Background: Invasive coronary procedures are increasing in number and complexity over time. This trend translates in an increased need for economical and human resources, among which is nurse staffing the most affected. Aims: To identify possible predictors of nurse workload, during and after diagnostic and interventional procedures. Methods: Two hundred and sixty consecutive patients were included: 52 and 208 patients underwent femoral and radial access, respectively. Nurse workload was calculated with a self-developed model. Results: Cathlab nurse workload was 103 [63–156] min. Independent predictors of increased Cathlab nurse workload were: femoral access, failed radial access and cross-over, interventional procedures, procedural time, urgent procedures. Cathlab nurse workload was 174 [134–218] and 86 [58–126] min, for femoral and radial access, respectively ( p < 0.001). Among the overall population, 174/260 patients (44 females, mean age 66 ± 11 years) were hospitalised at our Center after the procedure. Fifty-six and 118 patients had femoral and radial access, respectively. Ward nurse workload was 457 [226–954] min. Independent predictors of increased Ward nurse workload were: access-site complication, length of in-hospital stay, admission to CCU, interventional procedures. Ward nurse workload was 386 [226–652] and 720 [314–1375] min, respectively for radial and femoral access ( p < 0.001). Conclusions: A systematic radial access is an effective strategy for reducing nurse workload, both during, by simplifying nurse tasks in the CathLab, and after coronary invasive procedures, by preventing access-site complications, shortening in-hospital stays, and reducing admissions to CCU.

A Cost-effectiveness Analysis of Aspirin versus Oral Anticoagulants after Acute Myocardial Infarction in Italy

1998 ◽  
Vol 80 (12) ◽  
pp. 887-893 ◽  
Author(s):  
Jacopo Gianetti ◽  
Gianfranco Gensini ◽  
Raffaele De Caterina
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Cost Effectiveness ◽  
Interventional Procedures ◽  
Cost Allocation ◽  
Oral Anticoagulants ◽  
The United States ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
Artery Disease

SummaryAims. The recent publication of two large trials of secondary prevention of coronary artery disease with oral anticoagulants (WARIS and ASPECT) has caused a revival of the interest for this antithrombotic therapy in a clinical setting where the use of aspirin is common medical practice. Despite this, the preferential use of aspirin has been supported by an American cost-effectiveness analysis (JAMA 1995; 273: 965). Methods and Results. Using the same parameters used in that analysis and incidence of events from the Antiplatelet Trialists Collaboration and the ASPECT study, we re-evaluated the economic odds in favor of aspirin or oral anticoagulants in the Italian Health System, which differs significantly in cost allocation from the United States system and is, conversely, similar to other European settings. Recalculated costs associated with each therapy were 2,150 ECU/ patient/year for oral anticoagulants and 2,187 ECU/patient/year for aspirin. In our analysis, the higher costs of oral anticoagulants versus aspirin due to a moderate excess of bleeding (about 10 ECU/ patient/year) and the monitoring of therapy (168 ECU/ patient/year) are more than offset by an alleged savings for recurrent ischemic syndromes and interventional procedures (249 ECU/ patient/year). Conclusions. Preference of aspirin vs. oral anticoagulants in a pharmaco-economical perspective is highly dependent on the geographical situation whereupon calculations are based. On a pure cost-effectiveness basis, and in the absence of data of direct comparisons between aspirin alone versus I.N.R.-adjusted oral anticoagulants, the latter are not more expensive than aspirin in Italy and, by cost comparisons, in other European countries in the setting of post-myocardial infarction.

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