Document Detail

Lesion complexity and angiographic outcomes in radial access percutaneous coronary intervention.
MedLine Citation:
PMID:  18973507     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Percutaneous coronary intervention (PCI) is increasingly performed from the radial arterial (RA) access site. Few studies have examined the interaction between a default radial approach, lesion complexity, and angiographic outcome. This study investigates lesion complexity, arterial access route, and angiographic outcome in routine clinical practice by default radial operators. METHODS: All cases of PCI over a 12-month period (Jan 2005 to Jan 2006) at our regional cardiac center were prospectively entered into a database detailing arterial access route, target vessel and lesion characteristics, and lesion-specific angiographic outcome. Angiographic success was defined as residual stenosis <50% for balloon angioplasty alone or <20% for a stented lesion in the presence of TIMI 3 flow in the target vessel. All procedures carried out by default radial operators were selected for further retrospective analysis. Reasons for not completing a case via the radial route were recorded. Radial and femoral cases by default radial operators were evaluated on grounds of lesion complexity and angiographic outcome for each treated lesion. RESULTS: RA was the intended route in 91.5% of 1,324 procedures (91.5% of 2,239 lesions), and the final route in 90.1% of procedures (90.2% of lesions). There were 19 crossover procedures (30 lesions), all from radial to femoral access (FA). Crossovers were due to failed radial artery cannulation or sheath placement (9 procedures), inability to advance the guide catheter into the aortic root (7 procedures), and other guide catheter handling or support issues (3 procedures). Counting crossovers as failures, angiographic success rate was 96% among lesions for which RA was the primary intention. Complexity of cases was high (80.1% of RA lesions ACC/AHA type B2 or C). CONCLUSIONS: A default radial approach is compatible with successful treatment of a wide range of coronary lesions, with a low incidence of crossover to femoral access. When the radial approach fails, it is usually due to access problems rather than issues of guide catheter handling and support.
Elved Bryn Roberts; Sudhir Rathore; Andrew Beaumont; Albert E Alahmar; Mohammed Andron; Nicholas D Palmer; Raphael A Perry; Rodney H Stables
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2008-10-21
Journal Detail:
Title:  Journal of interventional cardiology     Volume:  21     ISSN:  1540-8183     ISO Abbreviation:  J Interv Cardiol     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-11-21     Completed Date:  2009-05-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8907826     Medline TA:  J Interv Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  555-61     Citation Subset:  IM    
Liverpool Cardiothoracic Center, Liverpool, United Kingdom.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary / adverse effects,  methods*,  statistics & numerical data
Cardiovascular Diseases / therapy*
Coronary Angiography
Databases, Factual
Femoral Artery*
Middle Aged
Radial Artery*
Treatment Outcome

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