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Comparison of radial, brachial, and femoral accesses using hemostatic devices for percutaneous coronary intervention

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Abstract

Some studies have suggested that radial access (RA) for percutaneous coronary intervention (PCI) reduces vascular complications and bleeding compared to femoral access (FA). The purpose of this study was to investigate the routine use of hemostatic devices and bleeding complications among RA, brachial access (BA), and FA. Between January 2015 and December 2015, 298 patients treated for PCI with RA were compared with 158 patients using BA and 206 patients using FA. The radial sheath was routinely removed with ADAPTY, the brachial sheath with BLEED SAFE, and the femoral sheath with Perclose ProGlide. In-hospital bleeding complications were investigated. Cardiogenic shock was most frequent in patients in the femoral group (RA 1.3%, BA 2.5%, FA 9.2%, p < 0.0001). The rate of major bleeding was highest in the femoral group (RA 1.0%, BA 2.5%, FA 5.3%, p = 0.01). Blood transfusion rates were highest in the femoral group (RA 0.7%, BA 1.3%, FA 4.4%, p = 0.01). Retroperitoneal bleeding was observed in 1.9% of patients in the femoral group. Patients in the brachial group had large hematomas (RA 0.7%, BA 4.4%, FA 1.5%, p = 0.01). Pseudoaneurysm formation needing intervention occurred most frequently in the brachial group (RA 0%, BA 1.3%, FA 0%, p = 0.04). In conclusion, compared to the brachial and femoral approaches, the radial approach appears to be the safest technique to avoid local vascular bleeding complications. The brachial approach has the highest risk of large hematoma and pseudoaneurysm formation among the three groups.

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Abbreviations

PCI:

Percutaneous coronary intervention

RA:

Radial access

BA:

Brachial access

FA:

Femoral access

IABP:

Intraaortic balloon pump counterpulsation

DAPT:

Dual antiplatelet therapy

CABG:

Coronary artery bypass graft surgery

BARC:

Bleeding Academic Research Consortium

ARC:

Academic Research Consortium

MI:

Myocardial infarction

TLR:

Target lesion revascularization

MACE:

Major adverse cardiac event

NACE:

Net adverse clinical event

CTO:

Chronic total occlusion

PCPS:

Percutaneous cardiopulmonary support

References

  1. Kugelmass AD, Cohen DJ, Brown PP, Simon AW, Becker ER, Culler SD. Hospital resources consumed in treating complications associated with percutaneous coronary interventions. Am J Cardiol. 2006;97:322–7.

    Article  PubMed  Google Scholar 

  2. Kinnaird TD, Stabile E, Mintz GS, Lee CW, Canos DA, Gevorkian N, et al. Incidence, predictors, and prognostic implications of bleeding and blood transfusion following percutaneous coronary interventions. Am J Cardiol. 2003;92:930–5.

    Article  PubMed  Google Scholar 

  3. Kiemeneij F, Laarman GJ, Odekerken D, Slagboom T, van der Wieken R. A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: the access study. J Am Coll Cardiol. 1997;29:1269–75.

    Article  CAS  PubMed  Google Scholar 

  4. Cooper CJ, El-Shiekh RA, Cohen DJ, Blaesing L, Burket MW, Basu A, et al. Effect of transradial access on quality of life and cost of cardiac catheterization: a randomized comparison. Am Heart J. 1999;138:430–6.

    Article  CAS  PubMed  Google Scholar 

  5. Valgimigli M, Gagnor A, Calabro P, Frigoli E, Leonardi S, Zaro T, et al. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet. 2015;385:2465–76.

    Article  PubMed  Google Scholar 

  6. Romagnoli E, Biondi-Zoccai G, Sciahbasi A, Politi L, Rigattieri S, Pendenza G, et al. Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study. J Am Coll Cardiol. 2012;60:2481–9.

    Article  PubMed  Google Scholar 

  7. Jolly SS, Yusuf S, Cairns J, Niemela K, Xavier D, Widimsky P, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011;377:1409–20.

    Article  PubMed  Google Scholar 

  8. Mann T, Cowper PA, Peterson ED, Cubeddu G, Bowen J, Giron L, et al. Transradial coronary stenting: comparison with femoral access closed with an arterial suture device. Catheter Cardiovasc Interv. 2000;49:150–6.

    Article  CAS  PubMed  Google Scholar 

  9. Brueck M, Bandorski D, Kramer W, Wieczorek M, Holtgen R, Tillmanns H. A randomized comparison of transradial versus transfemoral approach for coronary angiography and angioplasty. JACC Cardiovasc Interv. 2009;2:1047–54.

    Article  PubMed  Google Scholar 

  10. Ryan TJ, Faxon DP, Gunnar RM, Kennedy JW, King SB 3rd, Loop FD, et al. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty). Circulation. 1988;78:486–502.

    Article  CAS  PubMed  Google Scholar 

  11. Ochiai M, Sakai H, Takeshita S, Yonashiro T, Ozumi K, Maruyama Y, et al. Efficacy of a new hemostatic device, Adapty, after transradial coronary angiography and intervention. J Invasive Cardiol. 2000;12:618–22.

    CAS  PubMed  Google Scholar 

  12. Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123:2736–47.

    Article  PubMed  Google Scholar 

  13. Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, et al. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation. 2007;115:2344–51.

    Article  PubMed  Google Scholar 

  14. Agostoni P, Biondi-Zoccai GG, de Benedictis ML, Rigattieri S, Turri M, Anselmi M, et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; Systematic overview and meta-analysis of randomized trials. J Am Coll Cardiol. 2004;44:349–56.

    Article  PubMed  Google Scholar 

  15. Bertrand OF, Belisle P, Joyal D, Costerousse O, Rao SV, Jolly SS, et al. Comparison of transradial and femoral approaches for percutaneous coronary interventions: a systematic review and hierarchical Bayesian meta-analysis. Am Heart J. 2012;163:632–48.

    Article  PubMed  Google Scholar 

  16. Jolly SS, Amlani S, Hamon M, Yusuf S, Mehta SR. Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials. Am Heart J. 2009;157:132–40.

    Article  PubMed  Google Scholar 

  17. Parviz Y, Rowe R, Vijayan S, Iqbal J, Morton AC, Grech ED, et al. Percutaneous brachial artery access for coronary artery procedures: feasible and safe in the current era. Cardiovasc Revasc Med. 2015;16:447–9.

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank Editage (http://www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-machi, Naka-ku, Hiroshima, 730-8518, Japan

    Masaya Otsuka, Nobuo Shiode, Yasuhisa Nakao, Yuki Ikegami, Yusuke Kobayashi, Arinori Takeuchi, Ayako Harima, Tadanao Higaki, Kuniomi Oi, Kazuoki Dai, Tomoharu Kawase, Yasuharu Nakama, Kazuyoshi Suenari, Kenji Nishioka, Koyu Sakai, Yuji Shimatani, Yoshiko Masaoka & Ichiro Inoue

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  1. Masaya Otsuka
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  2. Nobuo Shiode
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  3. Yasuhisa Nakao
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  4. Yuki Ikegami
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  5. Yusuke Kobayashi
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  15. Koyu Sakai
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  16. Yuji Shimatani
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  17. Yoshiko Masaoka
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  18. Ichiro Inoue
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Corresponding author

Correspondence to Masaya Otsuka.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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There is no study sponsor.

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All authors have nothing to disclose.

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Otsuka, M., Shiode, N., Nakao, Y. et al. Comparison of radial, brachial, and femoral accesses using hemostatic devices for percutaneous coronary intervention. Cardiovasc Interv and Ther 33, 62–69 (2018). https://doi.org/10.1007/s12928-016-0439-4

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  • DOI: https://doi.org/10.1007/s12928-016-0439-4

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