scholarly journals Radial Access for Neurointerventions

2020 ◽  
Vol 3 ◽  
Author(s):  
Roger Barranco Pons ◽  
Isabel Rodriguez Caamaño ◽  
Marta de Dios Lascuevas
Keyword(s):  
Patient Experience ◽  
Lower Incidence ◽  
Cost Reduction ◽  
Large Body ◽  
Vascular Complications ◽  
Standard Approach ◽  
Cardiac Intervention ◽  
Radial Access ◽  
Technical Details ◽  
General Technical

Transradial access (TRA) has become the standard approach for cardiac intervention, with a large body of evidence demonstrating a lower incidence of vascular complications, better patient experience and cost reduction. There has been increasing interest in using TRA both for diagnostic neuroangiography and for interventional neurovascular procedures. This aim of this article is to discuss the advantages and limitations of TRA for neurointerventions. General technical details, such as pre-procedure recommendations, prevention of spasm and occlusion, haemostasis protocols and distal TRA puncture, are also described, along with the specific technical details of TRA for aneurysm embolisation, stroke thrombectomy and other neurovascular interventions. TRA provides additional tools to the neurointerventionist and – with appropriate training – the whole spectrum of intervention procedures can be achieved using this approach.

P5611Feasibility of distal radial access for carotid interventions: the RADCAR-DISTAL pilot study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Z Ruzsa ◽  
S Nardai ◽  
B Nemes ◽  
V Orias ◽  
E Vegh ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Ultrasound Guidance ◽  
Vascular Complications ◽  
Patient Comfort ◽  
X Ray ◽  
Radial Access ◽  
Procedural Success ◽  
Sheathless Guiding Catheter ◽  
Major Adverse Events ◽  
Guiding Catheter

Abstract Aims The aim of our study was to demonstrate the feasibility and safety of the distal transradial approach (DTRA) for carotid artery stenting (CAS). Methods and results We included 209 consecutive patients (151 Trans-Radial Access (TRA) and 58 DTRA) treated in a single center by CAS with cerebral protection between 2016 and 2018. DTRA punctures were performed by ultrasound guidance, and the carotid artery cannulations were done using a 6.5 F coronary sheathless guiding catheter. The groups showed similar demographic profile regarding age, gender and comorbidities, however the proportion of symptomatic patients was significantly higher in the DTRA cohort (DTRA: 75,86% vs. TRA: 46.36% p<0.001). Procedural success rate was similarly high in both groups, while the overall complication rate was very low, with no major adverse events and only a few vascular complications. The cannulation times were similar, while the overall procedure length was slightly higher in the DTRA group. The cumulative X-ray dose was similarly low regardless the access used. Conclusion DTRA is a safe and effective alternative of conventional trans-radial approach for CAS, with a potential to further improve the patient comfort.

P3745Differences in short-term outcome between early- and new-generation TAVR devices

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Veulemans ◽  
K Klein ◽  
O Maier ◽  
G Wolff ◽  
A Polzin ◽  
...  
Keyword(s):  
Aortic Regurgitation ◽  
Lower Incidence ◽  
Academic Research ◽  
Pacemaker Implantation ◽  
Vascular Complications ◽  
Permanent Pacemaker ◽  
Bleeding Events ◽  
Term Outcome ◽  
Pacemaker Therapy ◽  
New Generation

Abstract Background For transcatheter aortic valve replacement (TAVR) morbidity- and outcome relevant factors like paravalvular aortic regurgitation, vascular access complications and the need for permanent pacemaker implantation remain key challenges. New-generation devices for TAVR have been optimized to improve clinical outcome. Purpose We aimed to address safety and effectiveness of new-generation TAVR devices compared with earlier generations in a single centre study. Methods We compared 30 days outcome of the new-generation repositionable MER (n=614) and MEP (n=90) and the balloon-expandable ES3 (n=414) valve with the last-generation self-expandable MCV (n=270) and the balloon-expandable SXT (n=103) in patients treated with TAVR between 2009 and 2018. TAVR endpoints and adverse events were defined according to the Valve Academic Research Consortium-2. Results Logistic EuroSCORE I as predictor for risk stratification and 30-day mortality was comparable between both cohorts (27.3%±2.9 new vs 23.0%±1.4 early; p=n.s.). Compared to early-generation devices (MCV/SXT), new-generation devices (MER/MEP/ES3) had significantly higher primary device success (98.9% new vs 96.8% early; p=0.0089), lower incidence of new renal replacement therapy (2.6% new vs 6.2% early; p=0.0028), new permanent pacemaker therapy for conduction disturbances (12.8% new vs 17.0% early; p=0.0394), and disabling bleeding (1.4% new vs 4.0% early; p=0.0040). No difference could be observed concerning incidence of moderate-to-severe paravalvular leakage (4.2% new vs 5.0% early; p=n.s.), stroke (3.3% new vs 2.1% early; p=n.s.), major vascular complications (2.8% new vs 3.5% early; p=n.s.) and 30-day mortality (2.7% new vs 4.4% early; p=n.s). Conclusion Data from the retrospective analysis indicate higher primary device success and lower incidence of renal replacement, pacemaker therapy and disabling bleeding events in new-generation devices, although praised “hot-item” advantages like paravalvular leackage/aortic regurgitation, vascular complications and mortality remain unacknowledged.

Left transradial access for cerebral angiography

2019 ◽  
Vol 12 (4) ◽  
pp. 427-430 ◽  
Author(s):  
Guilherme Barros ◽  
David I Bass ◽  
Joshua W Osbun ◽  
Stephanie H Chen ◽  
Marie-Christine Brunet ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cerebral Angiography ◽  
Vascular Complications ◽  
Cerebral Aneurysms ◽  
Retrospective Chart Review ◽  
Interventional Cardiology ◽  
Distal Catheter ◽  
Radial Access ◽  
Transradial Access ◽  
Clinical Scenarios

IntroductionTransradial access is increasingly used among neurointerventionalists as an alternative to the transfemoral route. Currently available data, building on the interventional cardiology experience, primarily focus on right radial access. However, there are clinical scenarios when left-sided access may be indicated. The purpose of this study was to evaluate the technical feasibility of left transradial access to cerebral angiography across three institutions.MethodsA retrospective chart review was performed for patients who underwent cerebral angiography accessed via the left radial artery at three institutions between January 2018 and July 2019. The outcome variables studied were successful catheterization, vascular complications, and fluoroscopic time.ResultsNineteen patients underwent a total of 25 cerebral angiograms via left transradial access for cerebral aneurysms (n=15), basilar occlusion (n=1), carotid stenosis (n=1), arteriovenous malformation (n=1), and cervical neurofibroma (n=1). There were 12 diagnostic angiograms and 13 interventional angiograms. The left transradial approach was chosen due to left vertebrobasilar pathology (n=22), right subclavian stenosis (n=2), and previous right arm amputation (n=1). There was one instance of radial artery spasm, which resolved after catheter removal, and one conversion to transfemoral access in an interventional case due to lack of distal catheter support. There were no procedural complications.ConclusionsLeft transradial access in diagnostic and interventional cerebral angiography is a technically feasible, safe, and an effective alternative when indicated, and may be preferable for situations in which pathology locations or anatomic limitations preclude right-sided radial access.

Lower incidence of vascular complications during pregnancy in women treated with low dose aspirin in in-vitro-fertilisation (IVF)

2008 ◽  
Vol 90 ◽  
pp. S211
Author(s):  
M.J. Lambers ◽  
E. Groeneveld ◽  
D.A. Hoozemans ◽  
R. Schats ◽  
C.B. Lambalk ◽  
...  
Keyword(s):  
Lower Incidence ◽  
Low Dose ◽  
Vascular Complications ◽  
In Vitro Fertilisation ◽  
Dose Aspirin ◽  
Low Dose Aspirin

scholarly journals Standard Versus Ultrasound-Guided Cannulation of the Femoral Artery in Patients Undergoing Invasive Procedures: A Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 9 (3) ◽  
pp. 677 ◽  
Author(s):  
Sabato Sorrentino ◽  
Phong Nguyen ◽  
Nadia Salerno ◽  
Alberto Polimeni ◽  
Jolanda Sabatino ◽  
...  
Keyword(s):  
Success Rate ◽  
Major Bleeding ◽  
Femoral Artery ◽  
Meta Analysis ◽  
Vascular Complications ◽  
Standard Approach ◽  
Access Time ◽  
Continuous Variables ◽  
Ultrasound Guided ◽  
Access Site

Background: It is unclear whether or not ultrasound-guided cannulation (UGC) of the femoral artery is superior to the standard approach (SA) in reducing vascular complications and improving access success. Objective: We sought to compare procedural and clinical outcomes of femoral UGC versus SA in patients undergoing percutaneous cardiovascular intervention (PCvI). Methods: We searched EMBASE, MEDLINE, Scopus and web sources for randomized trials comparing UGC versus SA. We estimated risk ratio (RR) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) for categorical and continuous variables, respectively. Primary efficacy endpoint was the success rate at the first attempt, while secondary efficacy endpoints were access time and number of attempts. Primary safety endpoints were the rates of vascular complications, while secondary endpoints were major bleeding, as well as access site hematoma, venepuncture, pseudoaneurysms and retroperitoneal hematoma. This meta-analysis has been registered on Centre for Open Science (OSF) (osf.io/fy82e). Results: Seven trials were included, randomizing 3180 patients to UGC (n = 1564) or SA (n = 1616). Efficacy between UGC and SA was the main metric assessed in most of the trials, in which one third of the enrolled patients underwent interventional procedures. The success rate of the first attempt was significantly higher with UGC compared to SA, (82.0% vs. 58.7%; RR: 1.36; 95% CI: 1.17 to 1.57; p < 0.0001; I2 = 88%). Time to access and number of attempts were significantly reduced with UGC compared to SA (SMD: −0.19; 95% CI: −0.28 to −0.10; p < 0.0001; I2 = 22%) and (SMD: −0.40; 95% CI: −0.58 to −0.21; p < 0.0001; I2 = 82%), respectively. Compared with SA, use of UGC was associated with a significant reduction in vascular complications (1.3% vs. 3.0%; RR: 0.48; CI 95%: 0.25 to 0.91; p = 0.02; I2 = 0%) and access-site hematoma (1.2% vs. 3.3%; RR: 0.41; CI 95%: 0.20 to 0.83; p = 0.01; I2 = 27%), but there were non-significant differences in major bleeding (0.7% vs. 1.4%; RR: 0.57; CI 95%: 0.24 to 1.32; p = 0.19; I2 = 0%). Rates of venepuncture were lower with UGC (3.6% vs. 12.1%; RR: 0.32; CI 95%: 0.20 to 0.52; p < 0.00001; I2 = 55%). Conclusion: This study, which included all available data to date, demonstrated that, compared to a standard approach, ultrasound-guided cannulation of the femoral artery is associated with lower access-related complications and higher efficacy rates. These results could be of great clinical relevance especially in the femoral cannulation of high risk patients.

Abstract 119: Prospective Assessment Of The Risk-Treatment Paradox In The Use Of Radial Access For Cardiac Catheterization

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Ian C Gilchrist ◽  
Sunil V Rao ◽  
Caroline O Robinson ◽  
Samir B Pancholy ◽  
P. Holder Nevins ◽  
...  
Keyword(s):  
Linear Regression ◽  
Linear Regression Analysis ◽  
Vascular Complications ◽  
High Volume ◽  
Control Beliefs ◽  
Linear Regression Models ◽  
Radial Access ◽  
Case Vignettes ◽  
Risk Treatment ◽  
Risk For Bleeding

Background: Radial access (TRA) is associated with reduced access site bleeding, vascular complications, and in some settings, reduced mortality. The uptake of TRA in the US has been limited and prior studies have demonstrated a “risk-treatment” paradox wherein the patients at highest risk for bleeding are least likely to undergo TRA. The reasons for this risk-treatment paradox are unclear. Methods: Four case scenarios were developed that varied with respect to a patient’s risk of bleeding, complexity of coronary artery disease, and level of radial proficiency required to complete the procedure. The case vignettes were presented to 201 US interventional cardiologists with varying self-reported rates of TRA use who were surveyed as to their likelihood of using TRA for each case, which was measured on a 6-point Likert-type scale, with a range between 1 (“not at all likely”) to 6 (“very likely”). We then applied the theory of planned behavior (TPB), a framework utilizing behavioral constructs [attitudes (beliefs about TRA outcomes), normative beliefs (perceptions of how other physicians judge TRA use) and control beliefs (awareness of factors that facilitate or impede TRA use)], to determine predictors of TRA use. For each of the 4 patient case vignettes, multiple linear regression analysis was performed between the likelihood to use TRA and each of the TPB domains and additional factors.. Results: The most significant predictor of TRA use across all vignettes was the attitude domain (beliefs about TRA outcomes) which showed to have the strongest interaction in all 4 linear regression models . In the three case scenarios representing increasing risk for bleeding and vascular complications, a reverse gradation of utilization of TRA could be seen in both the low (n=65) and high volume operators (n=136). Both groups showed a greater likelihood of using TRA in patients at lowest risk for bleeding (Table). Conclusions: This study demonstrates that one of the underlying reasons for the risk-treatment paradox in the use of TRA is related to the perception of its benefit. More education on the benefits of bleeding avoidance strategies like TRA may lead to wider application of TRA to patients most likely to benefit.

scholarly journals Radial Access for Coronary Angiography Carries Fewer Complications Compared with Femoral Access: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 10 (10) ◽  
pp. 2163
Author(s):  
Gani Bajraktari ◽  
Zarife Rexhaj ◽  
Shpend Elezi ◽  
Fjolla Zhubi-Bakija ◽  
Artan Bajraktari ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Clinical Outcome ◽  
Major Bleeding ◽  
Clinical Presentation ◽  
Meta Analysis ◽  
Vascular Complications ◽  
Controlled Trials ◽  
Femoral Access ◽  
Randomized Controlled ◽  
Radial Access

Background and Aim: In patients undergoing diagnostic coronary angiography (CA) and percutaneous coronary interventions (PCI), the benefits associated with radial access compared with the femoral access approach remain controversial. The aim of this meta-analysis was to compare the short-term evidence-based clinical outcome of the two approaches. Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) comparing radial versus femoral access for CA and PCI. We identified 34 RCTs with 29,352 patients who underwent CA and/or PCI and compared 14,819 patients randomized for radial access with 14,533 who underwent procedures using femoral access. The follow-up period for clinical outcome was 30 days in all studies. Data were pooled by meta-analysis using a fixed-effect or a random-effect model, as appropriate. Risk ratios (RRs) were used for efficacy and safety outcomes.Results: Compared with femoral access, the radial access was associated with significantly lower risk for all-cause mortality (RR: 0.74; 95% confidence interval (CI): 0.61 to 0.88; p = 0.001), major bleeding (RR: 0.53; 95% CI:0.43 to 0.65; p ˂ 0.00001), major adverse cardiovascular events (MACE)(RR: 0.82; 95% CI: 0.74 to 0.91; p = 0.0002), and major vascular complications (RR: 0.37; 95% CI: 0.29 to 0.48; p ˂ 0.00001). These results were consistent irrespective of the clinical presentation of ACS or STEMI. Conclusions: Radial access in patients undergoing CA with or without PCI is associated with lower mortality, MACE, major bleeding and vascular complications, irrespective of clinical presentation, ACS or STEMI, compared with femoral access.

Description of Technique and Short-Term Outcomes of Radial Artery Access for Vascular Disease

2020 ◽  
Vol 54 (4) ◽  
pp. 319-324
Author(s):  
Ali Khalifeh ◽  
Besher Tolaymat ◽  
Joseph Noggle ◽  
Richa Kalsi ◽  
Christine Owen ◽  
...  
Keyword(s):  
Radial Artery ◽  
Endovascular Procedures ◽  
Perioperative Complications ◽  
Vascular Complications ◽  
Retrospective Chart Review ◽  
Patient Comfort ◽  
Complication Rates ◽  
Arterial Access ◽  
Radial Access ◽  
Manual Pressure

Objectives: Radial artery access is widely utilized in coronary angiography with reported lower rates of vascular complications and better patient comfort. There is limited data in the literature regarding radial access in peripheral endovascular procedures. We hypothesize that radial access is safe and feasible for peripheral endovascular procedures. Methods: A retrospective chart review was performed for all patients who underwent angiography using radial artery access between August 2013 and December 2017. Patient demographics and perioperative data were recorded and analyzed. Patient Selection: The operating surgeon screened patients presenting for elective angiography for possible radial artery access. Ultrasound guidance was used in all cases. Upon cannulation, the sheath was infused with an antispasmodic cocktail, and the patients were systemically anticoagulated. Results: Forty-seven out of 52 patients successfully completed their procedure (90% success rate). The patients were mostly female (60%), elderly (mean age of 71 years), and had several comorbidities. Preoperative diagnoses were variable. Procedures were both diagnostic (58%) and interventional (42%) with maximum sheath size used being 7F and median fluoroscopy time of 7.5 minutes. Only 2 patients experienced perioperative complications, and both of these were minor hematomas that resolved with manual pressure. Conclusions: Transradial arterial access for peripheral vascular angiography and interventions is safe and feasible. With low complication rates and increased patient comfort, transradial access serves as an excellent alternative to transfemoral access for a variety of endovascular procedures.

P6519Transulnar approach vs. left radial access in STEMI patients: experiences from a single high volume center

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B Zafirovska Taleska ◽  
D Petkoska ◽  
A Jovkovski ◽  
I Vasilev ◽  
D Kitanovski ◽  
...  
Keyword(s):  
Vascular Complications ◽  
High Volume ◽  
Fluoroscopy Time ◽  
P Value ◽  
Single Center ◽  
Access Site ◽  
St Segment Elevation ◽  
Radial Access ◽  
Number Of Patients ◽  
Significant Difference

Abstract Background Transulnar and left radial artery approach are alternative wrist access sites from right TRA for coronary diagnostic and interventional procedures. Using wrist approach in all STEMI patients can decrease access site bleeding and vascular complications, improve patient outcomes and reduce MACCE, allowing rapid ambulation. Purpose To compare the results of the two most common wrist access crossover sites from right TRA in a large single center registry of consecutive STEMI PPCI patients. Methods From March 2011 until December 2017, 5048 consecutive STEMI patients that underwent catheterization were included in a single center prospective registry. Right radial access was used in 97% (4891) of patients. From the total number of STEMI patients, Transulnar approach was used in 95 (1.9%) patients. LRA was used in 43 (0.8%), TFA in 8 (0.1%) and TBA in 11 (0.2%). We compared two groups of patients with TUA and LRA by analyzing access site complications, procedural characteristics, procedural and fluoroscopy time. Results All procedures were successfully performed through TUA and LRA. Procedural time was slightly longer in STEMI patients with LRA transfer (41±16 vs. 38±16 min), but there was no significant difference between patients with TUA and LRA transfer in terms of fluoroscopy time (10±9.3 vs. 10±6.8 min), procedural success and vascular complications. Patients with TUA had significantly smaller number of anomalies 1% vs. 14% in LRA and were less prone to high degree spasm 1% vs. 4,6%. Both access sites had similar number of patients with multiple access site punctures 7.3% vs. 6.9%. Hand ischemia was not observed in any patient on day 1 after procedure and on 1 month follow-up. None of the patients showed nerve injury. Minor access site hematomas were similar with 2% EASY type 1 hematoma present in both groups. TUA vs. LRA STEMI STEMI (n=5048) LRA TUA P value ACCESS 43 (0,8%) 95 (1,9%) Anomalies 7 (14%) 1 (1%) P<0,0001 Multiple punctures >3 3 (6,9%) 7 (7,3%) NA High grade spasm 2 (4.6%) 1 (1%) P<0.0001 Procedure time 41±16 min 38±16.4 min 0.0250 Fluoroscopy time 10±6.8 10±9.3 NA STEMI = ST segment elevation myocardial infarction; LRA = Left Radial Access; TUA = Transulnar Access. TUA vs.LRA STEMI Conclusion Both transulnar and left radial access are safe and feasible alternatives to the default right radial approach, decreasing the need of TFA crossover in STEMI patients.

scholarly journals The Role of HbA1C for Diagnosis of Type-2 Diabetes Mellitus - A Review

2016 ◽  
Vol 11 (1) ◽  
pp. 30-32
Author(s):  
Shahana Zabeen ◽  
Sultana Rehana Akhter
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Large Body ◽  
Vascular Complications ◽  
Glucose Levels ◽  
Blood Glucose Levels

For many years, the diagnosis of diabetes has been made through the laboratory- based measurement of fasting or random blood glucose levels or using OGTT. In the case of diabetes, the major outcome of interest is long term micro vascular complications for which a large body of data has been accumulated leading to the endorsement of HbA1C for diagnosis in many countries worldwide, with some variations in cut-offs and testing strategies.Faridpur Med. Coll. J. Jan 2016;11(1): 30-32

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