Vascular complications and clinical outcome after coronary angioplasty with platelet IIb/IIIa receptor blockade. Comparison of transradial vs transfemoral arterial access

Choussat, Rémi; Black, Alexander; Bossi, Irene; Fajadet, Jean; Marco, Jean

doi:10.1053/euhj.1999.1945

Cited by 148 publications

(84 citation statements)

References 23 publications

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“…A principal vantagem dessa técnica sobre a femoral já foi previamente demonstrada por estudos randomizados 28 e meta-análises 29 . Se considerarmos pacientes em uso de anticoagulantes e esquemas potentes de antiagregação plaquetária, esse benefício fica ainda mais evidente 30 . Em nosso estudo, a técnica radial foi utilizada em apenas 5,3% dos procedimentos, e esses pacientes tiveram taxas de complicações vasculares significativamente menores que aqueles tratados pela via femoral.…”

Section: Discussionunclassified

Preditores e incidência de complicações vasculares após a realização de intervenções coronárias percutâneas: achados do Registro IC-FUC

Zanatta¹,

Cardoso²,

Mota³

et al. 2008

Rev. Bras. Cardiol. Invasiva

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Background: Vascular complications (VC) following percutaneous coronary intervention (PCI) are an important cause of morbidity and mortality. However, available data do not reflect current interventional cardiology practice. Objective: To determinate the incidence of VC and its predictors in a population treated with PCI in contemporary practice. Methods: Cross-sectional study with coronary stent implantation conducted from January/2000 to December/2007. Clinical and angiographic characteristics, as well as in-hospital evolution, were evaluated and recorded in a database. Exclusion criteria included in-hospital death and urgent heart surgery. VC were defined as major bleeding, vascular surgery or hematoma > 10 cm. Data were analyzed using SPSS 11.0 and the characteristics of patients with and without VC were compared using the Student's t test and chi-square test. Multiple Logistic Regression Analysis was performed to determinate the independent predictors of VC. Results: A total of 4,595 patients with 5,485 stents were included in this analysis. Mean age was 60.64 ± 10.65 years and 32% of the patients were female. The transfemoral approach was used in 95% of the PCIs and the transradial approach in 5%. Six French and 7 French introducers were used in 85% and 15% of the PCIs, respectively. A total of 162 (3.3%) patients experienced VC. The multivariate analysis determined that the only predictor for VC was the use of 7 French introducers (odds ratio = 3.05, 95% confidence interval = 1.2-7.8; p = 0.02).

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Section: Discussionunclassified

Preditores e incidência de complicações vasculares após a realização de intervenções coronárias percutâneas: achados do Registro IC-FUC

Zanatta¹,

Cardoso²,

Mota³

et al. 2008

Rev. Bras. Cardiol. Invasiva

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“…Some authors 4,6 have reported lower complication rates with the transradial approach as compared with that with the transfemoral approach, described by Seldinger. Despite the initial favorable results, the transradial approach has a learning curve that hinders its acceptance by most interventional cardiologists.…”

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confidence: 99%

“…The transradial artery approach for coronary angiography was reported for the first time by Campeau in 1989 1 , and, since then, several groups have reported their experiences related to both the diagnosis and treatment through angioplasty using that access [2][3][4][5][6][7] . Some authors 4,6 have reported lower complication rates with the transradial approach as compared with that with the transfemoral approach, described by Seldinger.…”

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confidence: 99%

Implante direto de stent através de cateter guia 5F por técnica transradial

Coelho¹,

Jacob²,

Filho³

et al. 2004

Arq. Bras. Cardiol.

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“…[5][6][7][8] Bleeding is reduced after PCI, even in patients treated with aggressive antithrombotic regimens, including abciximab. 5 Also observed with TRA are more rapid mobilization of the patient, shorter hospital stays, 6 and reduced costs. 7 Many patients appear to prefer TRA over TFA.…”

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confidence: 99%

Advantages and Concerns Regarding Transradial Cardiac Catheterization

Nibber

Whayne

2013

Angiology

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Yan et al evaluated the impact of the transradial approach (TRA) on the vasodilatory function of the radial artery when utilized for cardiac catheterization, including coronary angiography and percutaneous coronary intervention (PCI). 1 The right radial artery (RRA) baseline diameter and response to flow-mediated dilation (FMD) and nitroglycerine-mediated dilation (NMD) were measured on day 1 and at 3 months after the TRA procedures. The FMD of the RRA decreased from 11.5% before the procedure to 4.1% (P < .05) on day 1 postprocedure and remained decreased at 0.7% (P < .01) at 3 months after the procedure. The NMD of the RRA decreased from 17.6% before the procedure to 5.4% (P < .05) on day 1 postprocedure and to 6.3% (P < .05) 3 months afterward. As discussed by the authors, 1 catheterization procedures via TRA decrease the radial artery FMD and NMD, resulting in immediate and persistent blunting of vasodilatory function of the radial artery. Three months later, the FMD and NMD were still decreased compared to before the procedure. The TRA impairs not only endothelial-dependent vasodilation but also endothelialindependent (vascular smooth muscle dependent) vasodilation, indicated by the decrease in FMD and NMD, respectively. Therefore, the authors 1 concluded that patients catheterized by TRA should have radial artery structure and function evaluated before any plan to use the artery as a coronary artery bypass graft (CABG).Yan et al, 2 in an earlier study, showed that coronary procedures via TRA can lead to increased RRA intima-media thickness (IMT) and a decrease in RRA diameter early after the procedure. A subsequent significant recovery in IMT occurred but there was no return to baseline. 2 The mean IMT of the RRA increased from 0.25 + 0.12 mm before the procedure to 0.69 + 0.31 mm 1 day following the procedure (P < .01) and to 0.38 + 0.17 mm 1 month later (P < .05). The decrease in mean RRA diameter followed a similar pattern. There was no RRA stenosis or occlusion before the TRA procedures. However, the incidence of RRA stenosis was 15.7% 1 day following the procedure and 7.6% 1 month later (P < .05 compared to 1 day following the procedures). The incidence of RRA occlusion was 0%, 2.8%, and 1.7%, respectively. 2 Paraskevas et al commented in a subsequent editorial that the TRA is not always a benign procedure and can be associated with short-and long-term effects that may compromise the RRA luminal wall. 3 Furthermore, they emphasized that repetitive RRA catheterizations may exacerbate the procedural problems resulting in failure to recover from the injury. Paraskevas et al even suggested the potential importance of trials involving routine preprocedural use of statins, which might suppress vascular hyperplasia, improve arterial IMT, reduce high-sensitivity C-reactive protein levels, and maximally improve the function of the endothelium. 3 The TRA has also been evaluated in patients with previous CABG surgery. Han et al evaluated 124 consecutive patients with a history of CABG surgery who underwent graft...

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Vascular complications and clinical outcome after coronary angioplasty with platelet IIb/IIIa receptor blockade. Comparison of transradial vs transfemoral arterial access

Abstract: Coronary angioplasty in patients treated by abciximab using the transradial approach is efficacious with fewer major access site complications than with the transfemoral approach.

Cited by 148 publications

References 23 publications

Preditores e incidência de complicações vasculares após a realização de intervenções coronárias percutâneas: achados do Registro IC-FUC

Preditores e incidência de complicações vasculares após a realização de intervenções coronárias percutâneas: achados do Registro IC-FUC

Implante direto de stent através de cateter guia 5F por técnica transradial

Advantages and Concerns Regarding Transradial Cardiac Catheterization

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