Accession Site Does Not Influence the Risk of Stroke after Diagnostic Coronary Angiography or Intervention: Results from a Large Prospective Registry

<b><i>Introduction:</i></b> Periprocedural stroke represents a rare but serious complication of cardiac catheterization. Pooled data from randomized trials evaluating the risk of stroke following cardiac catheterization via transradial versus transfemoral access showed no difference. On the other hand, a significant difference in stroke rates favoring transradial access was found in a recent meta-analysis of observational studies. Our aim was to determine if there is a difference in stroke risk after transradial versus transfemoral catheterization within a contemporary real-world registry. <b><i>Methods:</i></b> Data from 14,139 patients included in a single-center prospective registry between 2009 and 2016 were used to determine the odds of periprocedural transient ischemic attack (TIA) and stroke for radial versus femoral catheterization via multivariate logistic regression with Firth’s correction. <b><i>Results:</i></b> A total of 10,931 patients underwent transradial and 3,208 underwent transfemoral catheterization. Periprocedural TIA/stroke occurred in 41 (0.29%) patients. Age was the only significant predictor of TIA/stroke in multivariate analysis, with each additional year representing an odds ratio (OR) = 1.09 (CI 1.05–1.13, <i>p</i> &#x3c; 0.000). The choice of accession site had no impact on the risk of periprocedural TIA/stroke (OR = 0.81; CI 0.38–1.72, <i>p</i> = 0.577). <b><i>Conclusion:</i></b> Observational data from a large prospective registry indicate that accession site has no influence on the risk of periprocedural TIA/stroke after cardiac catheterization.

Femoral artery pseudoaneurysm, an avoidable complication of femoral catheterization for hemodialysis

DOI: http://dx.doi.org/10.3126/jaim.v2i2.8779 Journal of Advances in Internal Medicine 2013;02(02):65-66

Study of the Influence of Upper Extremities Variation on Transradial Success

Background. To investigate whether the presence of arterial anomalies in upper limb arteries can influence the success rate of transradial coronary angiography. Methods. retrograde transarterial sheath injection was done in patients with transradial coronary angiography. Arterial anomalies in the upper limb are evaluated in these patients. There are ten brachial (5.4%), 7 radial (4/2%), 5 subclavian (3%), and 3 brachiocephalic arteries (1.8%). There also were 4 loops in ulnar artery (2.4%) and one in radial (0.6%). Except cannulation time (), there were associations between anomalies and other times () and contrast volume used (). Anomalies did not have any effect on procedural success rate and just in one patient because of subclavian loop,procedure changed to femoral approach (). Discussion. Patients without upper extremities anomalies in comparison with patients with anomalies had significantly shorter periods for angiographic time, catheterization time, and fluoroscopic time. We recommend femoral catheterization instead of radial catheterization in patients with upper extremities anomalies.