Downsizing – the Future of Interventional Cardiology

2012 ◽  
Vol 7 (1) ◽  
pp. 28
Author(s):  
Giovanni Amoroso ◽  
Keyword(s):  
Contrast Agent ◽  
Vascular Complications ◽  
Cost Savings ◽  
Length Of Hospital Stay ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Transradial Approach ◽  
Technical Developments ◽  
Coronary Procedures ◽  
Angiographic Image

The concept of downsized catheters (i.e., using catheters smaller than 6 French) for invasive coronary procedures, such as diagnostic cardiac catheterisation and percutaneous coronary intervention, has been developing over the years, particularly as a result of the rise of the transradial approach. Recent advances have allowed the use of smaller and sheathless catheters, which confer a number of advantages – such as fewer vascular complications, reduced use of contrast agent and reduced haemostasis – thus increasing patient safety and comfort and allowing more rapid patient mobilisation. Reductions in patient complications, number and length of hospital stay, and amount of contrast agent used can also lead to cost savings. While the use of smaller catheters has been hindered in the past because of poor angiographic image quality, new automated contrast injectors have helped overcome this limitation. There is a need to make interventional cardiologists worldwide more aware of the benefits of downsizing, in the light of the latest technical developments and the increased use of transradial approach.

scholarly journals Comparison of In-Hospital Outcomes of ST Elevation Myocardial Infarction in Patients Undergoing Transradial and Transfemoral Primary Percutaneous Coronary Intervention

2019 ◽  
Vol 11 (2) ◽  
pp. 98-104
Author(s):  
Fahdia Afroz ◽  
Mir Jamal Uddin ◽  
Md Khalquzzaman ◽  
Mohammad Ullah ◽  
Mohammad Khalilur Rahman Siddiqui ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Transfemoral Approach ◽  
Transradial Approach ◽  
Group I ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Group Ii

Background: Primary percutaneous coronary intervention (PPCI) has been performed traditionally by using femoral approach. Transradial approach has become increasingly popular as it is likely to be less complicating, more comfortable and relatively cost effective having mortality and morbidity benefits. The aim of the study was to compare the in-hospital outcomes of transradial PPCI with that of transfemoral route. Methods: A total of 80 patients with ST elevation myocardial infarction (STEMI) who underwent PPCI were enrolled in the study. Patients were divided in two groups. Group-I: transradial PPCI; and Group-II: transfemoral PPCI. All patients were followed up during the period of hospital stay and adverse outcomes were observed and compared between the groups. Results: The result showed that bleeding took place in 2.5% patient of Group-I and 15% patients of Group- II. Vascular complications occurred in 2.5% and 12.5% patients of Group-I and Group-II, respectively. In Group-II, 7.5% patients died with none in Group-I. In Group-II, 37.5% patients experienced some sort of adverse outcomes whereas only 15% of the patients of Group-I did have such experiences (p<0.05). Bleeding and vascular complications were significantly more in Group-II (p<0.05). The mean hospital stay time was significantly lower in Group-I (p<0.001). Conclusions: Transradial PPCI is safer than transfemoral approach in respect of procedural and post procedural complications including bleeding, vascular complications and mortality. So, transradial approach may be an attractive alternative to conventional transfemoral approach and can be practiced routinely for PPCI. Cardiovasc. j. 2019; 11(2): 98-104

Abstract 1694: Reduced Incidence of Contrast Induced Nephropathy after Percutaneous Coronary Intervention with Routine Use of Visipaque in Unselected Patients

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jonas Eichhöfer ◽  
Joan Ivanov ◽  
Mark Osten ◽  
Karen Mackie ◽  
Vladimir Dzavik
Keyword(s):  
Contrast Agent ◽  
Propensity Scores ◽  
Multivariate Logistic Regression Analysis ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Contrast Induced Nephropathy ◽  
Data Registry ◽  
Period 2 ◽  
Cardiac Centre ◽  
Risk Patients

Objective: An observational study to determine if the routine use of Visipague contrast solution was associated with a decreased incidence of contrast-induced nephropathy (CIN) in patients following PCI at a large, tertiary cardiac centre. Methods: The Toronto General Hospital Interventional Cardiology Program maintains a prospective registry of all PCI procedures12951 consecutive patients undergoing PCI from a prospective data registry were assigned to either Period 1 (2000 – 03, various contrast agents were utilized) or Period 2 (2003– 06, only Visipaque was used). The contrast agent was changed systematically to the iso-osmolar agent, Visipaque. CIN was defined as an increase in plasma creatinine of >25% within 24 hours following PCI. Using propensity scores, 2502 consecutive patients undergoing PCI in Period 1, were randomly matched to 2502 patients in Period 2. Multivariate logistic regression analysis was used to identify the independent predictors of CIN. Results: The two well matched cohorts showed no significant differences in major pre-procedure clinical variables. Visipaque was associated with a lower rate of CIN after PCI (Period 1 = 14%, Period 2 = 7%, p<0.001). The multivariate independent predictors of CIN were: Visipaque (OR 0.437, p<0.001), contrast media volume per 10 ml (OR 1.015; p<0.0001), pre-procedure creatinine per 10mmol/L (OR 1.013; p=0.003), ACS (OR 2.861; p <0.001), PCI following thrombolysis (OR 1.952; p=0.022), peripheral vascular disease (OR 1.375; p=0.023), and age per decade over 40 (OR 1.143; p=0.001) Conclusions: After adjusting for significant predictors of CIN, a strategy of routine use of an iso-osmolar contrast agent (Visipaque) appeared to be associated with a lower risk of developing CIN after PCI, especially in higher risk patients. Contrast volume, ACS and age were the most powerful predictors of development of contrast nephropathy.

scholarly journals Central Vascular Complications Following Elective Catheterization Using Transradial Percutaneous Coronary Intervention

2017 ◽  
Vol 5 (1) ◽  
pp. 232470961769871 ◽  
Author(s):  
Julia Merkle ◽  
Christopher Hohmann ◽  
Anton Sabashnikov ◽  
Thorsten Wahlers ◽  
Jens Wippermann
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Artery Dissection ◽  
Case Presentation ◽  
Transradial Approach ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
The Right ◽  
Transradial Catheterization

Percutaneous coronary intervention is commonly used to treat coronary artery disease. Both transradial and transfemoral approaches are applied. In general, fewer complications are seen with the transradial approach compared to the transfemoral access, for which reason the transradial catheterization is frequently preferred. In this case presentation, we describe 2 cases of elective transradial coronary angiography both resulting in severe central vascular complications: perforation of the right subclavian artery with a mediastinal hematoma and dissection of the brachio-cephalic trunk and the aortic arch. Although the transradial access is generally considered safe, severe complications such as artery dissection or perforation can occur even in cases of elective procedures.

scholarly journals Expert Opinion: Transradial Coronary Artery Procedures: Tips for Success

2017 ◽  
Vol 12 (01) ◽  
pp. 18 ◽  
Author(s):  
Kully Sandhu ◽  
Robert Butler ◽  
James Nolan ◽  
◽  
◽  
...  
Keyword(s):  
Coronary Artery ◽  
Radiation Exposure ◽  
Femoral Artery ◽  
Patient Preference ◽  
Vascular Complications ◽  
Technological Advancement ◽  
Access Site ◽  
Early Ambulation ◽  
Transradial Approach ◽  
Coronary Procedures

Historically, the majority of coronary procedures have been performed via the femoral artery. However, since the inception of the transradial approach, a number of studies have confirmed that this technique is associated with a significant reduction in vascular complications, equivalent procedure times and radiation exposure to femoral procedures, the ability to perform complex coronary interventions, early ambulation and patient preference. Over the last decade, this has led to an exponential rise in the use of the transradial access site, with several potential technical challenges becoming increasingly recognised. However, with greater experience and technological advancement these potential obstacles may be overcome. The following review highlights the potential challenges and suggests several tips to assist transradial operators with recognising and overcoming these challenges.

Abstract P281: Impact of Transradial Approach on Quality of Care for Percutaneous Coronary Intervention: A Single Center Experience

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Chuntao Wu ◽  
Duanping Liao ◽  
Anne-Marie Dyer ◽  
Helen Chen ◽  
Ian C Gilchrist
Keyword(s):  
Quality Of Care ◽  
Lower Risk ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Transfemoral Approach ◽  
Transradial Approach ◽  
Risk Of Bleeding ◽  
The Difference

Background: Transradial cardiac catheterization has only been used in a small fraction of percutaneous coronary intervention (PCI) procedures in the United States, despite of the evidence that it may be associated with a lower risk of bleeding and mortality following PCI compared to the transfemoral approach. Objective: To evaluate the impact of the transradial approach on adverse outcomes following PCI and its potential of being a process to improve the quality of care for PCI in a single-center practice. Methods: We compared the risks of post-procedural adverse outcomes including in-hospital mortality, bleeding, and vascular complications between the 462 transradial and the 625 transfemoral cases who had undergone PCI procedures between January 2007 and March 2009. The difference in length of stay following PCI between the two entry approaches was also examined. Results: Compared to the transfemoral approach, the transradial cardiac catheterization was associated with significantly lower risk of bleeding (2.60% (12 of 462) vs. 6.08% (38 of 625); adjusted odds ratio (aOR)=0.34, 95% confidence interval (CI): 0.17-0.68, P=0.002) and vascular complications (0% vs. 1.44% (9 of 625), P=0.01). Although the trend was that the transradial approach was associated with lower risk of in-hospital mortality, the difference was not statistically significant (0.87% (4 of 462) vs. 2.24% (14 of 625); aOR=0.55, 95% CI: 0.14-2.10, P=0.38). Transradial patients were more likely to be discharged on the same day of procedure (14.2% vs. 2.2%, P<0.0001). Conclusion: The transradial approach is related to lower risk of bleeding and vascular complications. Introducing this approach to practice could improve the quality of care for PCI.

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