Patient Versus Physician Variation in Use of Transradial Percutaneous Coronary Intervention

Shamim, Shariq; Tang, Fengming; Safley, David M.; Jones, Philip G.; Spertus, John A.; Baklanov, Dmitri

doi:10.1016/j.amjcard.2017.03.020

Cited by 3 publications

(1 citation statement)

References 21 publications

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“…In neurovascular centers across the USA in 2016, up to 4.5% of mechanical thrombectomies for acute ischemic stroke were performed via transradial access 6. This trend follows the lead of interventional cardiologists who reportedly pursue transradial access in 36% of their total angiographies and 28% of acute interventions in the USA, with up to 80% of cardiac cases performed via transradial access worldwide 7 8…”

Section: Introductionmentioning

confidence: 99%

Left transradial access for cerebral angiography

Barros

Bass

Osbun

et al. 2019

J NeuroIntervent Surg

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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.

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Section: Introductionmentioning

confidence: 99%

Left transradial access for cerebral angiography

Barros

Bass

Osbun

et al. 2019

J NeuroIntervent Surg

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Controversies in complex percutaneous coronary intervention: radial versus femoral

Gilchrist

Awuor

Davies

et al. 2017

Expert Review of Cardiovascular Therapy

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Evolution in the technology used in the cardiac catheterization laboratory has permitted a migration from the femoral to radial artery access for many interventional procedures while concurrently improving outcomes. As a disruptive technology, transradial access has been associated with several controversies including a dichotomous relationship with femoral access. Areas covered: Several different patient subsets along with perceived technical challenges in interventional cardiology are reviewed with regard to the issue of access site. Evolving technological improvements germane to transradial techniques are also discussed as garnered from the literature of recent clinical trials and reports. Expert commentary: Radial techniques have been enhanced by newer technology and the spread of knowledge. Fusion of radial techniques with those of the femoral approach is evolving into a unifying concept of using the access that is most appropriate for the patient. No one access technique can cover all clinical subsets of patients. There is a need for complimentary access skillsets for even the most advanced cardiovascular technology used in the cardiac catheterization laboratory if the patients' outcomes are to be idealized.

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Temporal trends in the practice of the transradial approach for percutaneous coronary intervention in a large tertiary center

Perl

Bental

Assali

et al. 2020

Coronary Artery Disease

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Objective The transradial approach (TRA) has increasingly been adopted for the use of percutaneous coronary interventions (PCI), with reported clinical benefits. Little is known regarding the change in outcomes over time. Patients and methods From our large single-center PCI registry, we have analyzed 15 429 patients in two periods – 2008–2012 (period 1) and 2013–2017 (period 2). We examined the proportions of use of TRA, the influence on in-hospital outcomes, and adjusted long-term effects. Results The rate of TRA rose from 15.9% in period 1 to 69.1% in period 2, including in specific situations such as acute coronary syndrome, chronic total occlusion, bifurcation, calcified lesions, and unprotected left main PCI. In-hospital rates of bleeding were lower for TRA versus transfemoral artery (1.8 vs. 5.1%, overall, P < 0.001), as were rates of additional bleeding events in the following 12 months (1.3 vs. 2.4%, P < 0.001). Following multivariate analysis, use of TRA was associated with a lower 30-day and 4-year rate of the composite outcomes of death, myocardial infarction, target vessel revascularization, or coronary artery bypass surgery [at 4 years, hazard ratio (HR) = 0.86; 95% confidence interval (CI): 0.77–0.96; P = 0.007, during period 1 and HR = 0.62; 95% CI 0.55–0.7; P < 0.0001 during period 2]. Interaction analysis showed a stronger effect at the latter period (HR = 0.69, 95% CI: 0.59–0.81, P < 0.001). Conclusion Over a decade of follow-up, TRA has gained acceptance for different PCI scenarios, including complex patients – a course which is associated with consistent short and long-term clinical benefits.

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Patient Versus Physician Variation in Use of Transradial Percutaneous Coronary Intervention

Cited by 3 publications

References 21 publications

Left transradial access for cerebral angiography

Left transradial access for cerebral angiography

Controversies in complex percutaneous coronary intervention: radial versus femoral

Temporal trends in the practice of the transradial approach for percutaneous coronary intervention in a large tertiary center

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