Acceptance and safety of femoral versus radial access for percutaneous coronary intervention (PCI): results from a large monitor-controlled German registry (QuIK)

Background In 2015 and 2018, European Society of Cardiology guidelines for percutaneous coronary intervention (PCI) favoring radial access over femoral access were published. These recommendations were based on randomized trials suggesting that patients treated radially experienced reduced bleeding complications and all-cause mortality. We aimed to assess acceptance and results of radial access in a real-world scenario by analyzing all PCI cases in the Quality Assurance in Invasive Cardiology (QuIK) registry. Methods The QuIK registry prospectively collects data on all diagnostic and interventional coronary procedures from 148 private practice cardiology centers in Germany. Major adverse cardiac and cerebrovascular events (MACE) were defined as myocardial infarction, stroke, or death during hospitalization. Results From 2012 to 2018, 189,917 patients underwent PCI via either access method. The rate of radial approach steadily increased from 13 to 49%. The groups did not differ significantly with respect to age or extent of coronary disease. Femoral approach was significantly more common in patients with ST elevation myocardial infarction and cardiogenic shock. Overall, there were significant differences in MACE (radial 0.12%; femoral 0.24%; p < 0.0009) and access site complications (radial 0.2%; femoral 0.8% (p < 0.0009). Conclusion Our data reveals an increase in use of radial access in recent years in Germany. The radial approach emerged as favorable regarding MACE in non-myocardial infarction patients, as well as favorable regarding access site complication regardless of indication for percutaneous intervention.

Trans-radial percutaneous intervention for thrombosed hemodialysis access: A single-center experience

Background: Traditionally, percutaneous transluminal angioplasty (PTA) is a first-line approach for stenosed dialysis accesses and has been performed through the non-thrombosed vein segment. For thrombosed accesses, thrombectomy (whether open or percutaneous) is a standard approach. The primary objective of our study is to determine the clinical and technical outcomes of the trans-radial approach of PTA among thrombosed dialysis accesses, in terms of safety and feasibility, technical and clinical aspects and factors influencing them, as well as assisted primary patency, secondary patency at 6 and 12 months. Methods: This is a single-center retrospective study that included 150 patients over 3 years. About 123 patients underwent successful percutaneous balloon angioplasty through the radial access. Results: We report an overall technical and clinical success rate of 82%, assisted primary patency rate of about 90.25% at 3 months, 82.93% at 6 months, 73.18% at 1 year, and secondary patency rate of 94% at 1 year. Twenty-seven patients were referred for surgical revisions/creation of a new fistula for reasons like inability to pass wire (6 patients), unfavorable anatomical variations like aneurysms at the proximal segments (5 patients), inability to cross the fistula (5 patients), and persistent fistula dysfunction with no flow after initial balloon dilatation (11 patients). Three patients had hematoma at the radial access site (2.5%) while two patients had the AV fistula segment rupture and were successfully treated conservatively. Conclusion: We conclude that PTA through the trans-radial approach to completely thrombosed hemodialysis accesses is a good alternative to transvenous access and has a very good assisted primary patency and secondary patency at 1 year without major complications.

Comparison of Radial and Femoral Approaches for Coronary Angiography with or without Percutaneous Coronary Intervention in Relation to Vascular Access Site Complications

<p>Background A major population health objective in New Zealand is to reduce the incidence and impact of cardiovascular disease. Cardiovascular disease (CVD) remains New Zealand's leading cause of death (41%). This high demand on health services indicates the need for improved therapies and treatment. Significant advances in percutaneous coronary intervention (PCI) offers many patients who would not typically be eligible for treatment, the chance for a better quality of life living with coronary artery disease (CAD). At present femoral access is primarily used for coronary angiography and or PCI procedures, however more recently there has been a gradual shift to using the radial access approach. Study objective The study's objective was to look at comparing the different access sites used for coronary angiography (CA) and/or percutaneous coronary intervention (PCI) and the significance of the rates of vascular access site complications. The research question considered was; "Is there a significant difference in the vascular access site complication rates when comparing radial to femoral approaches for coronary angiography?" Methodology and design A cohort study design used observational prospective data on radial approaches and compared this with historical retrospective data on femoral approaches. The secondary (comparative) data was extracted from historical records, from earlier research I had completed. The collection of the secondary data involved strict criteria so that the observational study participants had similar baseline characteristics to ensure validity of this study. One hundred participants were recruited for each (prospective and retrospective) database and then compared and analysed. Findings The use of a radial approach for CA and PCI has a significant decrease in combined vascular access site complications (haematoma, vasovagal and arterial bleed), (p value 0.001), OR 0.28 (0.13-0.62). Haematoma is the main vascular complication (p value 0.009), OR 0.29 (0.11-0.74). Conclusion This study, although small, can be used as a pilot study for a more detailed and bigger national study within New Zealand. From the results it is clear there is a significant decrease in the vascular site complication rates when a radial approach is undertaken for CA and/or PCI. Through education and clinical practice, the radial approach would ensure better patient safety, satisfaction and comfort which would help reduce the patients length of stay and increase patients treated with timely discharges. It could also help decrease the nurses' workload caring for the patient with the radial approach due to the lesser complication rates. More extensive use of radial approaches for CA and or PCI would ensure the above benefits for the patients, staff and the organisation.</p>

Comparison of Radial and Femoral Approaches for Coronary Angiography with or without Percutaneous Coronary Intervention in Relation to Vascular Access Site Complications

<p>Background A major population health objective in New Zealand is to reduce the incidence and impact of cardiovascular disease. Cardiovascular disease (CVD) remains New Zealand's leading cause of death (41%). This high demand on health services indicates the need for improved therapies and treatment. Significant advances in percutaneous coronary intervention (PCI) offers many patients who would not typically be eligible for treatment, the chance for a better quality of life living with coronary artery disease (CAD). At present femoral access is primarily used for coronary angiography and or PCI procedures, however more recently there has been a gradual shift to using the radial access approach. Study objective The study's objective was to look at comparing the different access sites used for coronary angiography (CA) and/or percutaneous coronary intervention (PCI) and the significance of the rates of vascular access site complications. The research question considered was; "Is there a significant difference in the vascular access site complication rates when comparing radial to femoral approaches for coronary angiography?" Methodology and design A cohort study design used observational prospective data on radial approaches and compared this with historical retrospective data on femoral approaches. The secondary (comparative) data was extracted from historical records, from earlier research I had completed. The collection of the secondary data involved strict criteria so that the observational study participants had similar baseline characteristics to ensure validity of this study. One hundred participants were recruited for each (prospective and retrospective) database and then compared and analysed. Findings The use of a radial approach for CA and PCI has a significant decrease in combined vascular access site complications (haematoma, vasovagal and arterial bleed), (p value 0.001), OR 0.28 (0.13-0.62). Haematoma is the main vascular complication (p value 0.009), OR 0.29 (0.11-0.74). Conclusion This study, although small, can be used as a pilot study for a more detailed and bigger national study within New Zealand. From the results it is clear there is a significant decrease in the vascular site complication rates when a radial approach is undertaken for CA and/or PCI. Through education and clinical practice, the radial approach would ensure better patient safety, satisfaction and comfort which would help reduce the patients length of stay and increase patients treated with timely discharges. It could also help decrease the nurses' workload caring for the patient with the radial approach due to the lesser complication rates. More extensive use of radial approaches for CA and or PCI would ensure the above benefits for the patients, staff and the organisation.</p>

FREQUENCY OF RADIAL ARTERY OCCLUSION IN PATIENTS UNDERGOING PERCUTANEOUS CARDIAC CATHETERIZATION BY RADIAL ACCESS

Objectives: To assess the frequency of radial artery occlusion (RAO) in patients undergoing percutaneous cardiac catheterization. Methodology: A descriptive cross sectional study was carried out at cardiology department Jinnah hospital, Lahore from April – October 2018. One hundred thirty one consecutive patients who had undergone percutaneous cardiac catheterization via the trans-radial approach were enrolled in the study. Post procedure patients were followed in the ward and after 24 hours, Allen’s test was used for checking the patency of the radial artery. Color Doppler USG was performed in the patients with absent radial artery and RAO was confirmed. Data was entered and analysed in SPSS version 21.0. Results: Out of 131 patients who had undergone for percutaneous cardiac catheterization 63.4% were male and 36.6% were female. Among these cases radial artery occlusion was detected in 52 (39.7%) patients. No statistically significant difference was found with effect modifiers like age, gender, duration of procedure and type of intervention statistically insignificant difference was observed (P>0.05). Conclusion: A considerable number of patients were observed with radial artery occlusion with trans-radial approach thought statistically insignificant difference was noted among all ages, gender or type of intervention suggesting a detailed evaluation of radial artery patency should be done before hospital discharge.

Use of Walrus balloon-guide catheter through sheathless radial approach for mechanical thrombectomy of right middle cerebral artery occlusion

The literature demonstrates a favorable first pass effect with balloon-guide catheter (BGC) for mechanical thrombectomy. An 8F BGC is routinely used with femoral access. We present the first video report of 8F BGC advanced through the radial artery using a sheathless technique (video 1). An approximately 70-year-old patient presented with left-sided hemiplegia, neglect, and dysarthria. A CT angiogram demonstrated right M1 occlusion, and the patient underwent urgent mechanical thrombectomy. Radial approach was preferred owing to patient history of anticoagulation. A 6F Sim Select intermediate catheter was used to minimize the step off as the 8F BGC was advanced into the radial artery over an 035 exchange-length Advantage Glidewire. A skin nick over the Glidewire Advantage facilitated the introduction of the 8F BGC into the radial artery. Standard mechanical thrombectomy using a combination of stent retriever and aspiration catheter (Solumbra technique) was performed, and thrombolysis in cerebral infarction 3 recanalization was achieved after a single pass. The National Institutes of Health Scale score improved from 12 to 4, with mild left facial droop, dysarthria, and decreased speech fluency. The patient was discharged from the hospital on postoperative day 2. Ultrasound should be used for immediate assessment of radial artery size and conversion to femoral access without delay if the radial artery is less than 2.5 mm.Video 1