Transradial cardiac catheterization in patients with coronary bypass grafts: Feasibility analysis and comparison with transfemoral approach

Sanmartín, Marcelo; Cuevas, Diogenes; Moxica, Joaquin; Valdés, Manuel; Esparza, José; Baz, José Antonio; Mantilla, Ramón; Íñiguez, Andrés

doi:10.1002/ccd.20633

Cited by 43 publications

(22 citation statements)

References 10 publications

(8 reference statements)

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“…32 In patients with ITA grafts, the radial approach for angiography facilitates selective engagement of the ITA compared with the femoral approach. 49 Targeting stenoses with substantial functional relevance is one of the basic aspects of planning PCI. 1,30 Patients who have previously undergone CABG surgery typically present with multiple stenoses in the arterial tree, so targeting those stenoses that put a large area of myocardium in jeopardy is a key issue when planning revascularization to improve both symptoms and prognosis.…”

Section: Challenges Of Repeat Cabg Surgerymentioning

confidence: 99%

Secondary revascularization after CABG surgery

Escaned

2012

Nat Rev Cardiol

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CABG surgery is an effective way to improve symptoms and prognosis in patients with advanced coronary atherosclerotic disease. Despite multiple improvements in surgical technique and patient treatment, graft failure after CABG surgery occurs in a time-dependent fashion, particularly in the second decade after the intervention, in a substantial number of patients because of atherosclerotic progression and saphenous-vein graft (SVG) disease. Until 2010, repeat revascularization by either percutaneous coronary intervention (PCI) or surgical techniques was performed in these high-risk patients in the absence of specific recommendations in clinical practice guidelines, and within a culture of inadequate communication between cardiac surgeons and interventional cardiologists. Indeed, some of the specific technologies developed to reduce procedural risk, such as embolic protection devices for SVG interventions, are largely underused. Additionally, the implementation of secondary prevention, which reduces the need for reintervention in these patients, is still suboptimal. In this Review, graft failure after CABG surgery is examined as a clinical problem from the perspective of holistic patient management. Issues such as the substrate and epidemiology of graft failure, the choice of revascularization modality, the specific problems inherent in repeat CABG surgery and PCI, and the importance of secondary prevention are discussed.

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Section: Challenges Of Repeat Cabg Surgerymentioning

confidence: 99%

Secondary revascularization after CABG surgery

Escaned

2012

Nat Rev Cardiol

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“…There were a total of 1,370 patients across these studies with 583 undergone CABG angiography via transradial access and 787 undergone CABG angiography via transfemoral access. Six of these studies were observational and one was a randomized control trial (9)(10)(11)(12)(13)(14)(15). Study quality and bias analysis are depicted in tables 1,2.…”

Section: Resultsmentioning

confidence: 99%

“…There have been a few observational studies and a single randomized trial conducted to help evaluate transradial access for angiography in those having previously undergone CABG [9][10][11][12][13][14][15]. The aim of this study was to provide a pooled analysis of all currently available studies in order to better characterize the utility of transradial access for PCI in those with a history of CABG.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Transradial and Transfemoral Access for Coronary Bypass Graft Angiography

Loomba¹,

Saurabh²,

Navdeep³

et al. 2017

Ann Circ

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Introduction: Transradial access has been shown to be safe and effective in the setting of percutaneous coronary intervention (PCI) and even being benefi cial in regards to vascular complications and perceived quality of life after the intervention. However, data is limited in patients having previously undergone coronary artery bypass grafting (CABG) where procedural complexity can be increased. Methods:Studies comparing transradial and transfemoral access for PCI in patients having undergone CABG were identifi ed. Data for similar endpoints was extracted for subsequent meta-analysis. Bias and heterogeneity were also assessed. Conclusions:Transradial access for PCI in patients with prior CABG is safe, with fewer vascular complications, and offers an effective and potentially favorable alternative to transfemoral access. Condensed abstract:Transradial access has been demonstrated to offer benefi ts in comparison to transfemoral access for percutaneous coronary intervention (PCI). This advantage has not been fully elucidated for PCI of coronary artery bypass grafts (CABG). A meta-analysis was conducted to study the two access options and found that transradial access for PCI of CABG grafts is safe and may in fact be associated with fewer vascular complications.

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“…Coronary angiography in patients with CABG not only lasts longer, but also leads to higher irradiation and nephrotoxicity than coronary angiography in patients without CABG . In addition, the CABG population is certainly more fragile and at a higher risk of complications related to more comorbidities, such as polyvascular diseases, elderly, overweight, and kidney failure.…”

Section: Discussionmentioning

confidence: 99%

“…Locating a CABG during coronary angiography may be difficult, particularly for venous or radial artery grafts because of the variability in proximal anastomosis location. These procedures last longer and therefore lead to higher levels of radiation exposure, and are more nephrotoxic, in patients with a higher risk of complications (generally elderly, overweight, suffering from polyvascular disease, renal failure, and so on). A cardiac computed tomography (CT) scan system allows for reconstruction in three dimensions (3D) of any structure of interest.…”

Section: Introductionmentioning

confidence: 99%

Value of Image Fusion in Coronary Angiography for the Detection of Coronary Artery Bypass Grafts

Plessis

Fresse

Cahouch

et al. 2016

JAHA

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BackgroundCoronary angiography is more complex in patients with coronary artery bypass grafts (CABG). Image fusion is a new technology that allows the overlay of a computed tomography (CT) three‐dimension (3D) model with fluoroscopic images in real time.Methods and ResultsThis single‐center prospective study included 66 previous CABG patients undergoing coronary and bypass graft angiography. Image fusion coronary angiographies (fusion group, 20 patients) were compared to conventional coronary angiographies (control group, 46 patients). The fusion group included patients for whom a previous chest CT scan with contrast was available. For patients in this group, aorta and CABG were reconstructed in 3D from CT acquisitions and merged in real time with fluoroscopic images. The following parameters were compared: time needed to localize the CABG; procedure duration; air kerma (AK); dose area product (DAP); and volume of contrast media injected. Results are expressed as median. There were no significant differences between the 2 groups in patient demographics and procedure characteristics (access site, number of bypass to be found, and interventional cardiologist's experience). The time to localize CABG was significantly shorter in the fusion group (7.3 versus 12.4 minutes; P=0.002), as well as the procedure duration (20.6 versus 25.6 minutes; P=0.002), AK (610 versus 814 mGy; P=0.02), DAP (4390 versus 5922.5 cGy·cm2; P=0.02), and volume of iodinated contrast media (85 versus 116 cc; P=0.002).Conclusions3D image fusion improves the CABG detection in coronary angiography and reduces the time necessary to localize CABG, total procedure time duration, radiation exposure, and volume of contrast media.

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Transradial cardiac catheterization in patients with coronary bypass grafts: Feasibility analysis and comparison with transfemoral approach

Cited by 43 publications

References 10 publications

Secondary revascularization after CABG surgery

Secondary revascularization after CABG surgery

Comparison of Transradial and Transfemoral Access for Coronary Bypass Graft Angiography

Value of Image Fusion in Coronary Angiography for the Detection of Coronary Artery Bypass Grafts

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