ND
Uploaded byNorthPoint Domain
1,186 views

Seoul Radial Artery Access 2009 1

This document summarizes several studies comparing transradial versus transfemoral access for percutaneous coronary interventions (PCI). The studies show that transradial access is associated with lower rates of access site complications and bleeding, shorter hospital stays, lower costs, and improved patient satisfaction compared to transfemoral access. Meta-analyses demonstrate transradial access reduces major bleeding, access site complications, and mortality compared to transfemoral access.

Howard A. Cohen, MD, FACC, FSCAI Director, Division of Cardiac Intervention Co-Director, Cardiac Catheterization Laboratories Lenox Hill Heart & Vascular Institute LENOX HILL HOSPITAL TRANSRADIAL COURSE New York, NY October 23-24, 2009
DISCLOSURE Vascular Solutions – Grant support
Why Do Transradial Access? Improve outcomes Improve procedural success? Short-term Long-term Decrease complications? Decrease costs? Improve patient satisfaction?
Why Do Transradial Access? Background Transradial access originally initiated because of bleeding associated with PCI/Stenting Radial artery is superficial Radial artery is easily compressible No critical structures in proximity Most patients have dual arterial supply to hand
TRANSRADIAL PTCA The Access Trial 900 patients randomized to radial, brachial or femoral access 1993-1995 6 F guiding catheters Heparin 5000u Stents 5.5% (Palmaz-Schatz) Primary EP’s access and PTCA related Secondary EP’s QCA, procedural and fluoro times, equipment consumption and LOS Kiemeneij et al. J Am Coll Cardiol 1997:1269-75
TRANSRADIAL PTCA The Access Trial Kiemeneij et al. J Am Coll Cardiol 1997; 29:1269-75 Radial N=300 Brachial N=300 Femoral N=300 p value Successful access 93.0% 95.7% 99.7% 0.001 PTCA Success 91.7% 90.7% 90.7% ns Access Compl 0% 2.3% 2.0% 0.035 Time 40±24 39±25 38±24 ns
TRANSRADIAL CATHETERIZTION Stenting in ACS: A Comparison of Radial vs Femoral Access Sites Mann et al. J Am Coll Cardiol 1998; 32:572-76 RADIAL n=68 FEMORAL n=77 p value 1° Success 65 (96%) 74 (96%) ns D/MI/CABG 0 0 ns Access site Comp 0 3 (4%) p<0.01
TRANSRADIAL CATHETERIZTION Stenting in ACS: A Comparison of Radial vs Femoral Access Sites Mann et al. J Am Coll Cardiol 1998;323:572-76 RADIAL FEMORAL p Value Post op LOS 1.4 2.3 p<0.01 Hospital LOS 3.0 4.5 p<0.01 Total Charges 20,476 23,389 p<0.01
TRANSRADIAL APPROACH in AMI Prospective Consecutive PTCA in Two Centers Study Center A Study Center B RA (n=180) FA-P (n=889) RA(n=87) FA-M(n=58) Age 60  14 63  16 59  14 60  12 Male 80% 76% 91% 84% Primary 75.6% 85.8% 79.3% 75.9% Rescue 24.4% 14.2% 20.7% 24.1% Anterior 43.9% 47.6% 70.1% 60.3% Louvard et al: Cath and CV Interventions 55:206-211, 2002
TRANSRADIAL APPROACH in AMI Prospective Consecutive PTCA in Two Centers Study Center A Study Center B RA (n=180) FA-P (n=889) RA(n=87) FA-M(n=58) RA to FA(%) 2 4 Access(%) 2 2 Spasm (%) 0 2 Success (%) 98 97 96 98 Stent (%) 89 91 83 81 Time 45  42 43  32 67  25 68±21 Access NA NA 25  9 23  9 FBI NA NA 50  14 50  18 Louvard et al: Cath and CV Interventions 55:206-211, 2002
TRANSRADIAL APPROACH in AMI Prospective Consecutive PTCA in Two Centers Study Center A Study Center B RA (n=180) FA-P (n-889) p RA(n=87) FA-M(n=58) p Local Comp 0 2 NS 0 10 <0.01 v repair 0 0 NS 0 3 NS M bleed 0 2 NS 0 7 <0.05 Louvard et al: Cath and CV Interventions 55:206-211, 2002
EFFECT of TRANSRADIAL ACCESS on QUALITY OF LIFE AND COST A RANDOMIZED COMPARISON Femoral Radial p Value (n=99) (n=101) Procedure Outcome Success 98 99 ns Crossover 1 2 ns Sheath Insertion (min) 5.1  0.6 8  0.8 <0.01 Cath time(min) 16.4  1 18.6  0.9 ns Hemostasis time(min) 26.5  2.3 4.7  0.6 <0.001 Total Procedure (min) 47.6  2.7 31.4  1.7 <0.001 Hospital stay (hours) 10.4(8.3,22.7) 3.6(3.0,4.6) <0.001 Complications ns Cooper et al. Am Heart J 138:430-436,1999
EFFECT of TRANSRADIAL ACCESS on QUALITY OF LIFE AND COST A RANDOMIZED COMPARISON Femoral Radial p Value (n=99) (n=101) Other Outcomes Costs ($) 2229 2010 <0.001 Patient preference ++++ <0.001 Cooper et al. Am Heart J 138:430-436,1999
RANDOMIZED COMPARISON OF TRANSRADIAL AND TRANFEMORAL APPROACHES IN OCTAGENARIANS Louvard et al Am J Cardiol 92:17L, 2003 RADIAL P VALUE FEMORAL Crossover 11.7 NS 9.5 Angio Duration(min) 18.1  10.8 NS 16.4  10.8 Xray Duration(min) 6.1  4.8 0.001 4.4  3.4 PCI Success (%) 96.8 NS 94.7 PCI Duration(min) 27.6  18.2 NS 33.3  23.2 Xray Duration(min) 9.9  8.3 NS 10.7  10.2 Primary EP (%) 1.4 0.08 5.9(58.5% FCD) Hematoma >3cm(%) 2.2 0.004 11.4
TRANSRADIAL CATHETERIZATION Learning Curve Spaulding et al. Cathet Cardiovasc Diagn 39:365-70, 1996 <80 PATIENTS >80 PATEINTS Access Failure 14% 2% Access Time 10.2±12.9 m ±2.8±2.5 Procedure Time 25.7±12.9 m 17.4±4,7
Meta-Analysis of transfemoral vs transradial access for coronary procedures Twelve randomized trials 3224 patients Failure, access complication, MACE Agostononi et al. J Am Coll Cardiol 2004;44:349-56
TRANRADIAL VS TRANSFEMORAL ACCESS Agostononi et al. J Am Coll Cardiol 2004;44:349-56
TRANRADIAL VS TRANSFEMORAL ACCESS Agostononi et al. J Am Coll Cardiol 2004;44:349-56 MACE
TRANRADIAL VS TRANSFEMORAL ACCESS Agostononi et al. J Am Coll Cardiol 2004;44:349-56 ENTRY SITE COMPLICATIONS
TRANRADIAL VS TRANSFEMORAL ACCESS Agostononi et al. J Am Coll Cardiol 2004;44:349-56 RISK OF PROCEDURAL FAILURE
TRANRADIAL VS TRANSFEMORAL ACCESS Conclusions TRA is as safe as TFA TRA eliminates access site complications Lower overall procedure success rate Agostononi et al. J Am Coll Cardiol 2004;44:349-56
BLEEDING AND PCI OUTCOMES Access site hematoma requiring blood transfusion predicts mortality in patients undergoing PCI: Data from the NHLBI Dynamic Registry 6652 Patients between 1997 and 2002 In hospital mortality among patients with HRT was 9 times higher than patients without HRT and by one year patients with HRT were 4.5 times more likely to die Yatskaar L et al. Catheter Cardiovasc Interv 2007;69:961-6
BLEEDING AND OUTCOMES WITH PCI IN ACS J Am Coll Cardiol 2007;49:1362-8
BLEEDING AND OUTCOMES WITH PCI IN ACS Manoukian, S. V. et al. J Am Coll Cardiol 2007;49:1362-1368 INDEPENDENT PREDICTORS OF MAJOR BLEEDING
BLEEDING AND OUTCOMES WITH PCI IN ACS Manoukian, S. V. et al. J Am Coll Cardiol 2007;49:1362-1368 INDEPENDENT PREDICTORS OF MORTALITY
Radial Artery Access Improving Outcomes and Decreasing Costs Manoukian, S. V. et al. J Am Coll Cardiol 2007;49:1362-1368 MORTALITY AND MAJOR BLEEDING
Radial Artery Access Improving Outcomes and Decreasing Costs Types of Major Bleeding by Treatment Group Manoukian, S. V. et al. J Am Coll Cardiol 2007;49:1362-1368
BLEEDING AND OUTCOMES WITH PCI IN ACS Nikolsky, E. et al. J Am Coll Cardiol Intv 2009;2:624-632
Nikolsky, E. et al. J Am Coll Cardiol Intv 2009;2:624-632 Kaplan-Meier Estimates of Adverse Events at 1 Year BLEEDING AND OUTCOMES WITH PCI IN ACS
PCI COMPLICATIONS AND GUIDE CATHETER SIZE BIGGER IS NOT BETTER Evaluation association between guide catheter size and complications of PCI 103,070 consecutive patients 6F (n=64,335), 7F(n=32,676), 8F(n=6,059) Univariate and multivariate logistic regression modeling to calculate unadjusted and adjusted odds for complications Grossman, P. M. et al. J Am Coll Cardiol Intv 2009;2:636-644
. Grossman, P. M. et al. J Am Coll Cardiol Intv 2009;2:636-644 8F GUIDE USE
Grossman, P. M. et al. J Am Coll Cardiol Intv 2009;2:636-644 IN HOSPITAL OUTCOMES 8F VS 6F GUIDES
Grossman, P. M. et al. J Am Coll Cardiol Intv 2009;2:636-644 S STANDARDIZED MORTALITY RATE BASED ON GUIDE SIZE
Grossman, P. M. et al. J Am Coll Cardiol Intv 2009;2:636-644 TEMPORAL USE OF 6,7 AND 8F GUIDES
Radial Artery Access Improving Outcomes and Decreasing Costs “… hospital savings were due primarily to a reduction in major bleeding.”
Association of the Arterial Access Site at Angioplasty with Transfusion and Mortality: the MORTAL Study (Mortality Benefit of Reduced Transfusion After Percutaneous Coronary Intervention via the Arm or Leg) Objective – To determine the association of arterial access site (radial or femoral) with transfusion and mortality in unselected patients Study Design: Retrospective, non-randomized analysis of three prospectively collated registries of 32,822 patients in British Columbia The association between access site, transfusion and outcomes assessed by logistic regression, propensity score matching and probit regression Chase A J et al. Heart 2008;95:1019-1025
MORTAL STUDY Chase et al. Heart ;94:1019-1025,2008
MORTAL STUDY Chase et al. Heart ;94:1019-1025,2008 Predictors of 1-Year Mortality in the Mortal Study
MORTAL STUDY Chase et al. Heart ;94:1019-1025,2008
MORTAL STUDY 914 Matched Patients p=0.96 Chase et al. Heart ;94:1019-1025,2008 Trans No Trans ARR NNT RR 95% CI 30 Day Mortality 7.7% 2% 5.7 18 3.9 1.89-8.0 1 Year Mortality 19.3% 5.7% 12.5 7.4 3.38 2.22-5.14
 
Rao, S. V. et al. J Am Coll Cardiol Intv 2008;1:379-386 Proportion of PCI Cases Performed Via TRA
TRENDS IN TRANSRADIAL PCI Rao et al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383
UNADJUSTED OUTCOMES Rao et al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383
UNADJUSTED RATES OF BLEEDING & VASCULAR COMPLICATIONS IN KEY SUB-GROUPS Rao et al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383
Effect of Age, Gender,and Indication on Association of r-PCI Success and Bleeding Complications Rao et al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383
Unadjusted and Adjusted Association Between PCI and Primary Outcomes (f PCI as Reference) Rao et al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383 Outcome Unadjusted Odds Ratio (95% CI) Adjusted Odds Ratio (95% CI) Procedural Success 1.09 (0.97-1.23) 0.92 (1.02-1.12) Any Bleeding Comp 0.38 (0.26-.0.54) 0.42 (0.31-0.56)
CONCLUSIONS Radial PCI….is infrequently used…but is associated with a rate of procedural success similar to the femoral approach with lower rates of bleeding and vascular complications These findings were present even among patients at high risk for PCI-related complications such as elderly patients, women and patients with ACS. These data, in the context of prior clinical trials, suggest that wider adoption of radial PCI in clinical practice may improve the safety of PCI Rao et al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383
PREVAIL STUDY Prospective observational study involving nine centers and 1052 patients All consecutive patients who underwent an invasive procedure Arterial access site and technique employed was made by individual practitioner according to usual practice Multivariate analysis adjusted with propensity score Pristipino et al. Heart :2009;95:476-82
PREVAIL STUDY Pristipino et al. Heart :2009;95:476-82 Overall (1052) Femoral (543) Radial (509) P Value Male gender 71% 66% 75% <0.002 Prior radial 9% 4% 14% <0.0001 Prior PCI 20% 17% 24% <0.01 Chronic SAP 35% 28% 42% <0.0001 ACS 31% 35% 28% <0.01 Sheath size F 5.9 6.1 5.7 <0.0001 Heparin IU 4950 4270 5650 <0.0001 GP II IIIa RA 12% 8% 15% <0.002
Major Improvement of PCI Outcomes with Radial Artery Access from the Prevail Study Pristipino et al. Heart :2009;95:476-82
Major Improvement of PCI Outcomes with Radial Artery Access from the Prevail Study Pristipino et al. Heart :2009;95:476-82 Stable ACS
Major Improvement of PCI Outcomes with Radial Artery Access from the Prevail Study Pristipino et al. Heart :2009;95:476-82 Adjusted Multivariate Analysis
PREVAIL STUDY 86% Reduction in clinical and procedural adjusted risk of in-hospital death or infarction/reinfarction in patients undergoing PCI by the radial approach (based on intention-to-treat) Confirmed by multivariate analysis and propensity adjustment Highest baseline risk patients (ACS,STEMI) contributed mostly to the outcome benefit by the radial approach suggests that baseline bias is less relevant in this study
BLEEDING/TRANSFUSION AND ADVERSE OUTCOMES IN PCI Potential Mechanisms Hemodynamic compromise Induction of hyperadrenergic state Induction of inflammatory state Cessation of anti-thrombotic/anti-platelet agents Altered characteristics of older banked blood such as reduced O2 delivery, NO depletion, or stimulation of vasoconstriction
TRANS RADIAL CATHETERIZATION Complications Radial artery occlusion 1-5% (heparin dose and hemodynamic monitoring) of no consequence Severe hematoma - very rare Compartment syndrome - very rare –unsuspected guidewire perforation Hand ischemia (should not occur with normal Allen Test)
Why Do Transradial Access? Improve outcomes - Yes Improve procedural success - Yes Short-term Long-term Decrease complications – Yes Primarily access site bleeding Decrease transfusion requirement Decrease costs - Yes Improve patient satisfaction - Yes Radial Artery Access Improving Outcomes in PCI
TRANSRADIAL ACCESS Dr. L. Yogi Berra “ Just remember, it’s not over ‘til it’s over” The PCI is not over with the successful delivery of the stent The successful PCI is over when the patient leaves the hospital with a good angiographic result and no early or late complication
TRANSRADIAL ACCESS Just remember, “it’s not over until the fat lady (your patient) sings” But is she singing your praises or the “blues” The “black and blues” Try radial access. Try it you’ll like it! Your patients will love it!!!
THANK YOU

More Related Content

PDF
Patel TM 201111
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPT
Hahalis G - AIMRADIAL 2013 - Ulnar catheterization
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPT
Pancholy S - AIMRADIAL 2013 - Radiation exposure
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPT
Jolly SS et al
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPT
Benamer H
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPTX
Gilchrist IC - AIMRADIAL 2014 - Acute kidney injury
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPT
Fu Q - AIMRADIAL 2014 - Left vs right radial approach
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPT
Koutouzis M - AIMRADIAL 2015 - Transradial and negative Allen test
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Patel TM 201111
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Hahalis G - AIMRADIAL 2013 - Ulnar catheterization
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Pancholy S - AIMRADIAL 2013 - Radiation exposure
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Jolly SS et al
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Benamer H
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Gilchrist IC - AIMRADIAL 2014 - Acute kidney injury
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Fu Q - AIMRADIAL 2014 - Left vs right radial approach
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Koutouzis M - AIMRADIAL 2015 - Transradial and negative Allen test
byInternational Chair on Interventional Cardiology and Transradial Approach
 

What's hot

PPTX
Applegate RJ - AIMRADIAL 2013 - Learning curve
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPT
Nolan J - AIMRADIAL 2014 - Heparin is better
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPT
De Andrade PB - AIMRADIAL 2015 - Angio-Seal vs radial approach
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPTX
Pancholy SB - AIMRADIAL 2014 Endovascular - Renal denervation
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PDF
Pancholy SB 2014
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPT
Sciahbasi A - AIMRADIAL 2013 - Heparin vs bivalirudin
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPT
Role of CRT and CRTD in CHF
byTaiwan Heart Rhythm Society
 
PPTX
Montalescot G - AIMRADIAL 2013 - Prasugrel and radial
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPT
Valgimigli M 2015 MATRIX trial transradial
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PDF
Rao SV - AIMRADIAL 2013 - Bivalirudin and radial
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPT
Stein cimt for shape 11-05
bySociety for Heart Attack Prevention and Eradication
 
PDF
Mann T 201111
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPTX
Ikari Y - AIMRADIAL 2014 - Radial and IABP
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PDF
Medtronic international the future of cardiac resynchronisation therapy
bydrucsamal
 
PPT
Espessamento medio intimal carótidal trials
byJorge Garcia
 
PPTX
Gabric ID - AIMRADIAL 2014 - Primary PCI and left radial approach
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPT
Samir rafla real life outcome of atrial fibrillation ablation-cardio alex 2014
byAlexandria University, Egypt
 
PPT
Endovenous or surgical treatment of cvi
byuvcd
 
PPTX
Ludwig J 20150319
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPTX
Coronary CTA: The test of choice for obstructive CAD.
bycardiositeindia
 
Applegate RJ - AIMRADIAL 2013 - Learning curve
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Nolan J - AIMRADIAL 2014 - Heparin is better
byInternational Chair on Interventional Cardiology and Transradial Approach
 
De Andrade PB - AIMRADIAL 2015 - Angio-Seal vs radial approach
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Pancholy SB - AIMRADIAL 2014 Endovascular - Renal denervation
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Pancholy SB 2014
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Sciahbasi A - AIMRADIAL 2013 - Heparin vs bivalirudin
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Role of CRT and CRTD in CHF
byTaiwan Heart Rhythm Society
 
Montalescot G - AIMRADIAL 2013 - Prasugrel and radial
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Valgimigli M 2015 MATRIX trial transradial
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Rao SV - AIMRADIAL 2013 - Bivalirudin and radial
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Stein cimt for shape 11-05
bySociety for Heart Attack Prevention and Eradication
 
Mann T 201111
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Ikari Y - AIMRADIAL 2014 - Radial and IABP
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Medtronic international the future of cardiac resynchronisation therapy
bydrucsamal
 
Espessamento medio intimal carótidal trials
byJorge Garcia
 
Gabric ID - AIMRADIAL 2014 - Primary PCI and left radial approach
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Samir rafla real life outcome of atrial fibrillation ablation-cardio alex 2014
byAlexandria University, Egypt
 
Endovenous or surgical treatment of cvi
byuvcd
 
Ludwig J 20150319
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Coronary CTA: The test of choice for obstructive CAD.
bycardiositeindia
 

Similar to Seoul Radial Artery Access 2009 1

PPTX
Radial access interventions pros,cons and evidense
byAhmed Kamel
 
PPTX
Percutaneous radial intervention dr gaurav chaudhary
bygauravchaudharydr
 
PDF
Cohen MG 201305
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PDF
Nolan J - AIMRADIAL 2013 - Radial centers do better
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPT
Nolan J - AIMRADIAL 2015 - Radialists and femoral access
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPTX
PCI & AimRadial 2018 | Safety and Feasibility of Trans-radial Access for Non-...
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPT
Nolan J - AIMRADIAL 2014 - Radialists and femoral access
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PDF
Yeh RW - Femoral vs radial: evidence - 201507
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PDF
Cafri C
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPTX
Ruzsa Z - AIMRADIAL 2013 - Carotid artery stenting
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PDF
Holmes DR
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPTX
04 aimradial2016 fri2 A Roy / Y Louvard
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPTX
04 aimradial2016 thu2 B Zafirovska
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PDF
Leon MB - Current perspectives
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PDF
Moses JW - Transradial and transfemoral approach
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPTX
03 Mamas aimradial20170921 Radialists and femoral
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PPT
12 Valgimigli aimradial20170921 MATRIX program
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PDF
Acceso Radial en el paciente con Síndrome Coronario Agudo. Ventajas e inconv...
byCardioTeca
 
PDF
Fischman AM - AIMRADIAL 2013 - Peripheral interventions
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PDF
Rao SV 201111
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Radial access interventions pros,cons and evidense
byAhmed Kamel
 
Percutaneous radial intervention dr gaurav chaudhary
bygauravchaudharydr
 
Cohen MG 201305
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Nolan J - AIMRADIAL 2013 - Radial centers do better
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Nolan J - AIMRADIAL 2015 - Radialists and femoral access
byInternational Chair on Interventional Cardiology and Transradial Approach
 
PCI & AimRadial 2018 | Safety and Feasibility of Trans-radial Access for Non-...
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Nolan J - AIMRADIAL 2014 - Radialists and femoral access
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Yeh RW - Femoral vs radial: evidence - 201507
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Cafri C
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Ruzsa Z - AIMRADIAL 2013 - Carotid artery stenting
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Holmes DR
byInternational Chair on Interventional Cardiology and Transradial Approach
 
04 aimradial2016 fri2 A Roy / Y Louvard
byInternational Chair on Interventional Cardiology and Transradial Approach
 
04 aimradial2016 thu2 B Zafirovska
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Leon MB - Current perspectives
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Moses JW - Transradial and transfemoral approach
byInternational Chair on Interventional Cardiology and Transradial Approach
 
03 Mamas aimradial20170921 Radialists and femoral
byInternational Chair on Interventional Cardiology and Transradial Approach
 
12 Valgimigli aimradial20170921 MATRIX program
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Acceso Radial en el paciente con Síndrome Coronario Agudo. Ventajas e inconv...
byCardioTeca
 
Fischman AM - AIMRADIAL 2013 - Peripheral interventions
byInternational Chair on Interventional Cardiology and Transradial Approach
 
Rao SV 201111
byInternational Chair on Interventional Cardiology and Transradial Approach
 

Recently uploaded

PDF
Hyaluronic Acid Role in Combination Therapy: Advances & Application
byReza Aminnejad
 
PDF
Olaparib Tablet For breast and ovarian cancers
byLetsMeds
 
PPTX
Cardiomyopathies; Hypertophic, Dilated cardiomyopathy, Broken heart syndrome.
byAjoke Onigbanjo
 
PPTX
Anatomy of General Connective Tissue.pptx
byMathew Joseph
 
PPTX
GLP-1 Medicines From Metabolic Agents to Multi System Therapeutics
byArchitMehta11
 
PPTX
Schizophrenia in detail for Students..pptx
byDr.Prakashkumar More
 
PPTX
Craniopharyngioma: A Comprehensive Overview
byArchitMehta11
 
PPTX
Endocrine Management of Adult Gender-Incongruent Persons in India
byArchitMehta11
 
PDF
Osteoarthritis.pdf
byGhaidaa Al-Sarayreh
 
PPTX
PHOBIA IN DETAILS FOR MEDICAL AND NURSING STUDENTS.pptx
byDr.Prakashkumar More
 
PPTX
AI_ECG_Interpretation_Presentation_by_Huseini_Kamara.pptx
bystudyrighthuseini
 
PPTX
2025 Diabetes Management: Technology, Pharmacotherapy & Individualized Care
byArchitMehta11
 
DOCX
My Lord I wish not to face day of Christmas ever again.
byAbdul Haye Amin
 
PDF
S.D. Medical College, Multi-Speciality Hospital and Cancer Research Centre.
byLordShivaPublicSchoo
 
PPTX
2025-FMF conf..pptx familial Mediterranean Fever
byAzzaMostafa7
 
PDF
Necrotizing fasciitis: Lethal soft tissue infection
byDrKetanVagholkar
 
PDF
Benign Bone Tumors basics explained well
byWaris Ali
 
PDF
Diuretics (mechanism of action, Uses and Clinical Consequences)
byMedicoseAcademics
 
PPTX
When the Brain Talks to the Machine.pptx
byZaynabAtwi
 
PPT
Making Connections to Improve Patient Care in Obesity, Metabolism, and Liver ...
byPVI, PeerView Institute for Medical Education
 
Hyaluronic Acid Role in Combination Therapy: Advances & Application
byReza Aminnejad
 
Olaparib Tablet For breast and ovarian cancers
byLetsMeds
 
Cardiomyopathies; Hypertophic, Dilated cardiomyopathy, Broken heart syndrome.
byAjoke Onigbanjo
 
Anatomy of General Connective Tissue.pptx
byMathew Joseph
 
GLP-1 Medicines From Metabolic Agents to Multi System Therapeutics
byArchitMehta11
 
Schizophrenia in detail for Students..pptx
byDr.Prakashkumar More
 
Craniopharyngioma: A Comprehensive Overview
byArchitMehta11
 
Endocrine Management of Adult Gender-Incongruent Persons in India
byArchitMehta11
 
Osteoarthritis.pdf
byGhaidaa Al-Sarayreh
 
PHOBIA IN DETAILS FOR MEDICAL AND NURSING STUDENTS.pptx
byDr.Prakashkumar More
 
AI_ECG_Interpretation_Presentation_by_Huseini_Kamara.pptx
bystudyrighthuseini
 
2025 Diabetes Management: Technology, Pharmacotherapy & Individualized Care
byArchitMehta11
 
My Lord I wish not to face day of Christmas ever again.
byAbdul Haye Amin
 
S.D. Medical College, Multi-Speciality Hospital and Cancer Research Centre.
byLordShivaPublicSchoo
 
2025-FMF conf..pptx familial Mediterranean Fever
byAzzaMostafa7
 
Necrotizing fasciitis: Lethal soft tissue infection
byDrKetanVagholkar
 
Benign Bone Tumors basics explained well
byWaris Ali
 
Diuretics (mechanism of action, Uses and Clinical Consequences)
byMedicoseAcademics
 
When the Brain Talks to the Machine.pptx
byZaynabAtwi
 
Making Connections to Improve Patient Care in Obesity, Metabolism, and Liver ...
byPVI, PeerView Institute for Medical Education
 

Seoul Radial Artery Access 2009 1

  • 1.
    Howard A. Cohen,MD, FACC, FSCAI Director, Division of Cardiac Intervention Co-Director, Cardiac Catheterization Laboratories Lenox Hill Heart & Vascular Institute LENOX HILL HOSPITAL TRANSRADIAL COURSE New York, NY October 23-24, 2009
  • 2.
  • 3.
    Why Do TransradialAccess? Improve outcomes Improve procedural success? Short-term Long-term Decrease complications? Decrease costs? Improve patient satisfaction?
  • 4.
    Why Do TransradialAccess? Background Transradial access originally initiated because of bleeding associated with PCI/Stenting Radial artery is superficial Radial artery is easily compressible No critical structures in proximity Most patients have dual arterial supply to hand
  • 5.
    TRANSRADIAL PTCA TheAccess Trial 900 patients randomized to radial, brachial or femoral access 1993-1995 6 F guiding catheters Heparin 5000u Stents 5.5% (Palmaz-Schatz) Primary EP’s access and PTCA related Secondary EP’s QCA, procedural and fluoro times, equipment consumption and LOS Kiemeneij et al. J Am Coll Cardiol 1997:1269-75
  • 6.
    TRANSRADIAL PTCA TheAccess Trial Kiemeneij et al. J Am Coll Cardiol 1997; 29:1269-75 Radial N=300 Brachial N=300 Femoral N=300 p value Successful access 93.0% 95.7% 99.7% 0.001 PTCA Success 91.7% 90.7% 90.7% ns Access Compl 0% 2.3% 2.0% 0.035 Time 40±24 39±25 38±24 ns
  • 7.
    TRANSRADIAL CATHETERIZTION Stentingin ACS: A Comparison of Radial vs Femoral Access Sites Mann et al. J Am Coll Cardiol 1998; 32:572-76 RADIAL n=68 FEMORAL n=77 p value 1° Success 65 (96%) 74 (96%) ns D/MI/CABG 0 0 ns Access site Comp 0 3 (4%) p<0.01
  • 8.
    TRANSRADIAL CATHETERIZTION Stentingin ACS: A Comparison of Radial vs Femoral Access Sites Mann et al. J Am Coll Cardiol 1998;323:572-76 RADIAL FEMORAL p Value Post op LOS 1.4 2.3 p<0.01 Hospital LOS 3.0 4.5 p<0.01 Total Charges 20,476 23,389 p<0.01
  • 9.
    TRANSRADIAL APPROACH inAMI Prospective Consecutive PTCA in Two Centers Study Center A Study Center B RA (n=180) FA-P (n=889) RA(n=87) FA-M(n=58) Age 60  14 63  16 59  14 60  12 Male 80% 76% 91% 84% Primary 75.6% 85.8% 79.3% 75.9% Rescue 24.4% 14.2% 20.7% 24.1% Anterior 43.9% 47.6% 70.1% 60.3% Louvard et al: Cath and CV Interventions 55:206-211, 2002
  • 10.
    TRANSRADIAL APPROACH inAMI Prospective Consecutive PTCA in Two Centers Study Center A Study Center B RA (n=180) FA-P (n=889) RA(n=87) FA-M(n=58) RA to FA(%) 2 4 Access(%) 2 2 Spasm (%) 0 2 Success (%) 98 97 96 98 Stent (%) 89 91 83 81 Time 45  42 43  32 67  25 68±21 Access NA NA 25  9 23  9 FBI NA NA 50  14 50  18 Louvard et al: Cath and CV Interventions 55:206-211, 2002
  • 11.
    TRANSRADIAL APPROACH inAMI Prospective Consecutive PTCA in Two Centers Study Center A Study Center B RA (n=180) FA-P (n-889) p RA(n=87) FA-M(n=58) p Local Comp 0 2 NS 0 10 <0.01 v repair 0 0 NS 0 3 NS M bleed 0 2 NS 0 7 <0.05 Louvard et al: Cath and CV Interventions 55:206-211, 2002
  • 12.
    EFFECT of TRANSRADIALACCESS on QUALITY OF LIFE AND COST A RANDOMIZED COMPARISON Femoral Radial p Value (n=99) (n=101) Procedure Outcome Success 98 99 ns Crossover 1 2 ns Sheath Insertion (min) 5.1  0.6 8  0.8 <0.01 Cath time(min) 16.4  1 18.6  0.9 ns Hemostasis time(min) 26.5  2.3 4.7  0.6 <0.001 Total Procedure (min) 47.6  2.7 31.4  1.7 <0.001 Hospital stay (hours) 10.4(8.3,22.7) 3.6(3.0,4.6) <0.001 Complications ns Cooper et al. Am Heart J 138:430-436,1999
  • 13.
    EFFECT of TRANSRADIALACCESS on QUALITY OF LIFE AND COST A RANDOMIZED COMPARISON Femoral Radial p Value (n=99) (n=101) Other Outcomes Costs ($) 2229 2010 <0.001 Patient preference ++++ <0.001 Cooper et al. Am Heart J 138:430-436,1999
  • 14.
    RANDOMIZED COMPARISON OFTRANSRADIAL AND TRANFEMORAL APPROACHES IN OCTAGENARIANS Louvard et al Am J Cardiol 92:17L, 2003 RADIAL P VALUE FEMORAL Crossover 11.7 NS 9.5 Angio Duration(min) 18.1  10.8 NS 16.4  10.8 Xray Duration(min) 6.1  4.8 0.001 4.4  3.4 PCI Success (%) 96.8 NS 94.7 PCI Duration(min) 27.6  18.2 NS 33.3  23.2 Xray Duration(min) 9.9  8.3 NS 10.7  10.2 Primary EP (%) 1.4 0.08 5.9(58.5% FCD) Hematoma >3cm(%) 2.2 0.004 11.4
  • 15.
    TRANSRADIAL CATHETERIZATION LearningCurve Spaulding et al. Cathet Cardiovasc Diagn 39:365-70, 1996 <80 PATIENTS >80 PATEINTS Access Failure 14% 2% Access Time 10.2±12.9 m ±2.8±2.5 Procedure Time 25.7±12.9 m 17.4±4,7
  • 16.
    Meta-Analysis of transfemoralvs transradial access for coronary procedures Twelve randomized trials 3224 patients Failure, access complication, MACE Agostononi et al. J Am Coll Cardiol 2004;44:349-56
  • 17.
    TRANRADIAL VS TRANSFEMORALACCESS Agostononi et al. J Am Coll Cardiol 2004;44:349-56
  • 18.
    TRANRADIAL VS TRANSFEMORALACCESS Agostononi et al. J Am Coll Cardiol 2004;44:349-56 MACE
  • 19.
    TRANRADIAL VS TRANSFEMORALACCESS Agostononi et al. J Am Coll Cardiol 2004;44:349-56 ENTRY SITE COMPLICATIONS
  • 20.
    TRANRADIAL VS TRANSFEMORALACCESS Agostononi et al. J Am Coll Cardiol 2004;44:349-56 RISK OF PROCEDURAL FAILURE
  • 21.
    TRANRADIAL VS TRANSFEMORALACCESS Conclusions TRA is as safe as TFA TRA eliminates access site complications Lower overall procedure success rate Agostononi et al. J Am Coll Cardiol 2004;44:349-56
  • 22.
    BLEEDING AND PCIOUTCOMES Access site hematoma requiring blood transfusion predicts mortality in patients undergoing PCI: Data from the NHLBI Dynamic Registry 6652 Patients between 1997 and 2002 In hospital mortality among patients with HRT was 9 times higher than patients without HRT and by one year patients with HRT were 4.5 times more likely to die Yatskaar L et al. Catheter Cardiovasc Interv 2007;69:961-6
  • 23.
    BLEEDING AND OUTCOMESWITH PCI IN ACS J Am Coll Cardiol 2007;49:1362-8
  • 24.
    BLEEDING AND OUTCOMESWITH PCI IN ACS Manoukian, S. V. et al. J Am Coll Cardiol 2007;49:1362-1368 INDEPENDENT PREDICTORS OF MAJOR BLEEDING
  • 25.
    BLEEDING AND OUTCOMESWITH PCI IN ACS Manoukian, S. V. et al. J Am Coll Cardiol 2007;49:1362-1368 INDEPENDENT PREDICTORS OF MORTALITY
  • 26.
    Radial Artery AccessImproving Outcomes and Decreasing Costs Manoukian, S. V. et al. J Am Coll Cardiol 2007;49:1362-1368 MORTALITY AND MAJOR BLEEDING
  • 27.
    Radial Artery AccessImproving Outcomes and Decreasing Costs Types of Major Bleeding by Treatment Group Manoukian, S. V. et al. J Am Coll Cardiol 2007;49:1362-1368
  • 28.
    BLEEDING AND OUTCOMESWITH PCI IN ACS Nikolsky, E. et al. J Am Coll Cardiol Intv 2009;2:624-632
  • 29.
    Nikolsky, E. etal. J Am Coll Cardiol Intv 2009;2:624-632 Kaplan-Meier Estimates of Adverse Events at 1 Year BLEEDING AND OUTCOMES WITH PCI IN ACS
  • 30.
    PCI COMPLICATIONS AND GUIDE CATHETER SIZE BIGGER IS NOT BETTER Evaluation association between guide catheter size and complications of PCI 103,070 consecutive patients 6F (n=64,335), 7F(n=32,676), 8F(n=6,059) Univariate and multivariate logistic regression modeling to calculate unadjusted and adjusted odds for complications Grossman, P. M. et al. J Am Coll Cardiol Intv 2009;2:636-644
  • 31.
    . Grossman, P.M. et al. J Am Coll Cardiol Intv 2009;2:636-644 8F GUIDE USE
  • 32.
    Grossman, P. M.et al. J Am Coll Cardiol Intv 2009;2:636-644 IN HOSPITAL OUTCOMES 8F VS 6F GUIDES
  • 33.
    Grossman, P. M.et al. J Am Coll Cardiol Intv 2009;2:636-644 S STANDARDIZED MORTALITY RATE BASED ON GUIDE SIZE
  • 34.
    Grossman, P. M.et al. J Am Coll Cardiol Intv 2009;2:636-644 TEMPORAL USE OF 6,7 AND 8F GUIDES
  • 35.
    Radial Artery AccessImproving Outcomes and Decreasing Costs “… hospital savings were due primarily to a reduction in major bleeding.”
  • 36.
    Association of theArterial Access Site at Angioplasty with Transfusion and Mortality: the MORTAL Study (Mortality Benefit of Reduced Transfusion After Percutaneous Coronary Intervention via the Arm or Leg) Objective – To determine the association of arterial access site (radial or femoral) with transfusion and mortality in unselected patients Study Design: Retrospective, non-randomized analysis of three prospectively collated registries of 32,822 patients in British Columbia The association between access site, transfusion and outcomes assessed by logistic regression, propensity score matching and probit regression Chase A J et al. Heart 2008;95:1019-1025
  • 37.
    MORTAL STUDY Chaseet al. Heart ;94:1019-1025,2008
  • 38.
    MORTAL STUDY Chaseet al. Heart ;94:1019-1025,2008 Predictors of 1-Year Mortality in the Mortal Study
  • 39.
    MORTAL STUDY Chaseet al. Heart ;94:1019-1025,2008
  • 40.
    MORTAL STUDY 914Matched Patients p=0.96 Chase et al. Heart ;94:1019-1025,2008 Trans No Trans ARR NNT RR 95% CI 30 Day Mortality 7.7% 2% 5.7 18 3.9 1.89-8.0 1 Year Mortality 19.3% 5.7% 12.5 7.4 3.38 2.22-5.14
  • 41.
  • 42.
    Rao, S. V.et al. J Am Coll Cardiol Intv 2008;1:379-386 Proportion of PCI Cases Performed Via TRA
  • 43.
    TRENDS IN TRANSRADIALPCI Rao et al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383
  • 44.
    UNADJUSTED OUTCOMES Raoet al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383
  • 45.
    UNADJUSTED RATES OFBLEEDING & VASCULAR COMPLICATIONS IN KEY SUB-GROUPS Rao et al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383
  • 46.
    Effect of Age,Gender,and Indication on Association of r-PCI Success and Bleeding Complications Rao et al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383
  • 47.
    Unadjusted and AdjustedAssociation Between PCI and Primary Outcomes (f PCI as Reference) Rao et al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383 Outcome Unadjusted Odds Ratio (95% CI) Adjusted Odds Ratio (95% CI) Procedural Success 1.09 (0.97-1.23) 0.92 (1.02-1.12) Any Bleeding Comp 0.38 (0.26-.0.54) 0.42 (0.31-0.56)
  • 48.
    CONCLUSIONS Radial PCI….isinfrequently used…but is associated with a rate of procedural success similar to the femoral approach with lower rates of bleeding and vascular complications These findings were present even among patients at high risk for PCI-related complications such as elderly patients, women and patients with ACS. These data, in the context of prior clinical trials, suggest that wider adoption of radial PCI in clinical practice may improve the safety of PCI Rao et al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383
  • 49.
    PREVAIL STUDY Prospectiveobservational study involving nine centers and 1052 patients All consecutive patients who underwent an invasive procedure Arterial access site and technique employed was made by individual practitioner according to usual practice Multivariate analysis adjusted with propensity score Pristipino et al. Heart :2009;95:476-82
  • 50.
    PREVAIL STUDY Pristipinoet al. Heart :2009;95:476-82 Overall (1052) Femoral (543) Radial (509) P Value Male gender 71% 66% 75% <0.002 Prior radial 9% 4% 14% <0.0001 Prior PCI 20% 17% 24% <0.01 Chronic SAP 35% 28% 42% <0.0001 ACS 31% 35% 28% <0.01 Sheath size F 5.9 6.1 5.7 <0.0001 Heparin IU 4950 4270 5650 <0.0001 GP II IIIa RA 12% 8% 15% <0.002
  • 51.
    Major Improvement ofPCI Outcomes with Radial Artery Access from the Prevail Study Pristipino et al. Heart :2009;95:476-82
  • 52.
    Major Improvement ofPCI Outcomes with Radial Artery Access from the Prevail Study Pristipino et al. Heart :2009;95:476-82 Stable ACS
  • 53.
    Major Improvement ofPCI Outcomes with Radial Artery Access from the Prevail Study Pristipino et al. Heart :2009;95:476-82 Adjusted Multivariate Analysis
  • 54.
    PREVAIL STUDY 86%Reduction in clinical and procedural adjusted risk of in-hospital death or infarction/reinfarction in patients undergoing PCI by the radial approach (based on intention-to-treat) Confirmed by multivariate analysis and propensity adjustment Highest baseline risk patients (ACS,STEMI) contributed mostly to the outcome benefit by the radial approach suggests that baseline bias is less relevant in this study
  • 55.
    BLEEDING/TRANSFUSION AND ADVERSEOUTCOMES IN PCI Potential Mechanisms Hemodynamic compromise Induction of hyperadrenergic state Induction of inflammatory state Cessation of anti-thrombotic/anti-platelet agents Altered characteristics of older banked blood such as reduced O2 delivery, NO depletion, or stimulation of vasoconstriction
  • 56.
    TRANS RADIAL CATHETERIZATIONComplications Radial artery occlusion 1-5% (heparin dose and hemodynamic monitoring) of no consequence Severe hematoma - very rare Compartment syndrome - very rare –unsuspected guidewire perforation Hand ischemia (should not occur with normal Allen Test)
  • 57.
    Why Do TransradialAccess? Improve outcomes - Yes Improve procedural success - Yes Short-term Long-term Decrease complications – Yes Primarily access site bleeding Decrease transfusion requirement Decrease costs - Yes Improve patient satisfaction - Yes Radial Artery Access Improving Outcomes in PCI
  • 58.
    TRANSRADIAL ACCESS Dr.L. Yogi Berra “ Just remember, it’s not over ‘til it’s over” The PCI is not over with the successful delivery of the stent The successful PCI is over when the patient leaves the hospital with a good angiographic result and no early or late complication
  • 59.
    TRANSRADIAL ACCESS Justremember, “it’s not over until the fat lady (your patient) sings” But is she singing your praises or the “blues” The “black and blues” Try radial access. Try it you’ll like it! Your patients will love it!!!
  • 60.