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Implementation of the Transradial Approach for Coronary Procedures is Not Associated with an Elevated Complication Rate and Elevated Radiation Patient Exposure.
MedLine Citation:
PMID:  20973820     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Background:  The transradial approach for coronary procedures is associated with a low complication rate, but specific training is considered mandatory. Methods:  Procedural characteristics (contrast dye: CD; fluoroscopy time: FT, patient radiation dose: RD) and local complication rates were prospectively assessed in 784 consecutive patients who underwent transradial coronary procedures. The study was divided into an implementation (2008-IP) and an evaluation period (2009-EP). Transradial (N = 624) and transfemoral (N = 842) procedural characteristics were compared in the EP. Results:  The amount of CD (mL) of transradial coronary angiography was similar between IP (75 [IQR 60-100]) and EP (70 [55-100]; P = 0.630). In contrast, FT (min) of transradial coronary angiography could be reduced from IP (4.4 [3.2-6.8]) to EP (4.1 [2.7-6.5]; P = 0.036), whereas RD (μGy * qcm) was similar (IP: 1623 [1042-3026]); EP (1576 [944-2530]; P = 0.149). Safety data showed a low complication rate: 0.2% access failure, 0.1% dissection, 0.7% vessel closure. Transfemoral procedures were followed by significantly more procedure- related transfusions (1.3% vs. 0%; P = 0.003). The comparison between transfemoral and transradial procedures demonstrated prolonged FT for transradial procedures (transfemoral 2.9 [1.7-5.5]; transradial 4.1 [2.7-6.5]; P = 0.002), whereas CD was similar (transfemoral 70 [55-100]; transradial 70 [55-100]; P = 0.248). The prolonged FT was restricted to coronary angiography but did not differ for PCI (transfemoral 9.7 [5.8-18.1]; transradial 8.9 [5.3-16.5]; P = 0.433). Conclusion:  A transradial program can be implemented with safety; therefore, the transradial approach should be preferred in suitable patients. Since spasm occurrence was the major determinant of procedural failure, further effort is need to develop better strategies for spasm prevention. (J Interven Cardiol 2011;24:56-64).
Authors:
Ralf Lehmann; Joachim R Ehrlich; Veronika Weber; Salvatore DE Rosa; M Nieves Bellera Gotarda; Volker Schächinger; Andreas M Zeiher; Stephan Fichtlscherer
Publication Detail:
Type:  Journal Article     Date:  2010-10-25
Journal Detail:
Title:  Journal of interventional cardiology     Volume:  24     ISSN:  1540-8183     ISO Abbreviation:  J Interv Cardiol     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-02-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8907826     Medline TA:  J Interv Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  56-64     Citation Subset:  IM    
Copyright Information:
©2010, Wiley Periodicals, Inc.
Affiliation:
From the Department of Cardiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, D-60590 Frankfurt, Germany.
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