Risk of brain injury during diagnostic coronary angiography: Comparison between right and left radial approach

Pacchioni, Andrea; Versaci, Francesco; Mugnolo, Antonio; Penzo, Carlo; Nikas, Dimitrios; Saccà, Salvatore; Favero, Luca; Agostoni, P.; Garami, Zsolt; Prati, Francesco; Reimers, Bernhard

doi:10.1016/j.ijcard.2012.09.024

Cited by 41 publications

(23 citation statements)

References 40 publications

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“…7 In addition, catheter exchanges and manipulation within ascending aorta were shown to be associated with increased incidence of cerebral embolism. 28,29 Risk of cerebral embolism is especially valid for RRA route whereby manipulation in ascending aorta and brachiocephalic trunk exposes right common carotid artery to a higher risk of embolization compared to left radial or femoral routes, although most cerebral microembolisms are clinically silent and absolute risk of cerebrovascular event is low. 29,30 Therefore, single-catheter strategy might be more suited to right radial approach.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Handmade “Jacky‐Like Catheter” As a Single Multipurpose Catheter in Transradial Coronary Angiography: A Randomized Comparison With Conventional Two‐Catheter Strategy

Erden¹,

Gölcük

Bozyel

et al. 2016

J Interven Cardiology

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Handmade “Jacky‐Like Catheter” As a Single Multipurpose Catheter in Transradial Coronary Angiography: A Randomized Comparison With Conventional Two‐Catheter Strategy

Erden¹,

Gölcük

Bozyel

et al. 2016

J Interven Cardiology

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“…Catheter exchanges also cause transient or permanent functional changes in radial and brachial arteries . In addition, catheter exchanges and manipulation within ascending aorta were shown to be associated with increased incidence of cerebral embolism . Risk of cerebral embolism is especially valid for RRA route whereby manipulation in ascending aorta and brachiocephalic trunk expose right common carotid artery to a higher risk of embolization compared to left radial or femoral routes, although most cerebral microembolisms are clinically silent and absolute risk of cerebrovascular event is very low .…”

Section: Discussionmentioning

confidence: 99%

“…Risk of cerebral embolism is especially valid for RRA route whereby manipulation in ascending aorta and brachiocephalic trunk expose right common carotid artery to a higher risk of embolization compared to left radial or femoral routes, although most cerebral microembolisms are clinically silent and absolute risk of cerebrovascular event is very low. 15,16 Therefore two-catheter strategy might be more suited to left radial approach whereas single-catheter strategy is preferable in right radial approach. However, left radial approach has a disadvantage of requiring different table set-up and logistics.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Left Judkins Catheter as a Single Multipurpose Catheter in Transradial Coronary Angiography From Right Radial Artery: A Randomized Comparison With Conventional Two‐Catheter Strategy

Turan

Erkol

Daşlı

et al. 2016

J Interven Cardiology

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In TRA from RRA, JL3.5 catheter can be very effective when dedicated multipurpose catheter is not available. As a single multipurpose catheter, JL works perfectly in nearly half of procedures without prolonging procedure and fluoroscopy times. However insisting on a single-catheter approach with JL could unnecessarily increase fluoroscopy time and, hence, radiation exposure. (J Interven Cardiol 2016;29:257-264).

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“…Catheter ablation for AF is associated with a considerable risk of SCEs/SCLs detected on magnetic resonance imaging, as reported for RF ablation but recently also for CB‐A ablation . Real‐time monitoring of microembolic signals (MESs) in the cerebral arteries by transcranial doppler, as a surrogate for microembolization, have been described in other clinical settings than AF ablation, supporting the association with a risk of silent strokes . A recent study investigated the detection of MESs during the various procedural steps of CB‐A ablation .…”

Section: Discussionmentioning

confidence: 82%

Over‐the‐needle trans‐septal access using the cryoballoon delivery sheath and dilator in atrial fibrillation ablation

Ströker

Greef

Schwagten

et al. 2019

Pacing Clinical Electrophis

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Background:In the setting of second-generation cryoballoon (CB2) ablation, left atrial (LA) access is generally achieved using a standard sheath (SS) that is exchanged for the 15Fr cryoballoon delivery sheath (CBS) and dilator over a long wire (CBS over-the-wire technique, CBS-W). Our objective was to evaluate the direct use of the CBS to gain LA access, by advancing the latter over the trans-septal needle (CBS over-the-needle technique, CBS-N), under transesophageal echocardiographic (TEE) guidance. Methods: Consecutive patients who underwent CB2 ablation with the CBS-N technique were evaluated for feasibility of gaining LA access using TEE guidance and fluoroscopy views. Complications related to the LA access were compared with a matched CBS-W control group. Subanalysis (30 CBS-W vs 30 CBS-N patients) evaluated time-to-LA of the CBS: time from superior vena cava (with SS vs CBS) to LA insertion of the CBS, after exchange or directly, respectively.Results: LA access could be achieved in all 505 patients of the CBS-N group, without technique modification or additional equipment. Challenging interatrial septa were noted in 13% of these patients: previous atrial septal defect repair (1%), hypermobile (10%), aneurysmal (1%), and abnormally thickened/fibrotic (1%). Incidence of complications was similar to the CBS-W group. Subanalysis showed a shorter time-to-LA in the CBS-N versus CBS-W group, 72 ± 46 seconds versus 293 ± 180 seconds, P < .001. Conclusions:Our study showed that the CBS-N technique is feasible and safe under echocardiographic guidance. Without sheath exchange, it simplifies the CB2 procedure, is less costly, time sparing, and might reduce the risk of air embolism. K E Y W O R D S atrial fibrillation ablation, FlexCath sheath, second-generation cryoballoon, trans-septal access 1 INTRODUCTION Pulmonary vein (PV) isolation is currently an established treatment for symptomatic atrial fibrillation (AF). 1 In recent years, cryoballoon (CB) ablation has emerged as a valid alternative to traditional point-bypoint radiofrequency (RF) ablation, rendering the PV isolation proce-dure highly standardized and reproducible. 2,3 In the setting of secondgeneration cryoballoon (CB-A, Arctic Front Advance TM , Medtronic Inc., Minneapolis, MN, USA) ablation, left atrial (LA) access is generally achieved using a standard trans-septal (TS) sheath that is then exchanged for the 15-Fr cryoballoon delivery sheath (CBS) (FlexCath Advance TM , Medtronic Inc.) and its dilator over a long stiff wire (CBS 868

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Risk of brain injury during diagnostic coronary angiography: Comparison between right and left radial approach

Cited by 41 publications

References 40 publications

Effectiveness of Handmade “Jacky‐Like Catheter” As a Single Multipurpose Catheter in Transradial Coronary Angiography: A Randomized Comparison With Conventional Two‐Catheter Strategy

Effectiveness of Handmade “Jacky‐Like Catheter” As a Single Multipurpose Catheter in Transradial Coronary Angiography: A Randomized Comparison With Conventional Two‐Catheter Strategy

Effectiveness of Left Judkins Catheter as a Single Multipurpose Catheter in Transradial Coronary Angiography From Right Radial Artery: A Randomized Comparison With Conventional Two‐Catheter Strategy

Over‐the‐needle trans‐septal access using the cryoballoon delivery sheath and dilator in atrial fibrillation ablation

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