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Heart and Vascular Health
Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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Scooped by Seth Bilazarian, MD
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Risk‐Treatment Paradox in Transradial Access for Angioplasty (PCI)

Risk‐Treatment Paradox in Transradial Access for Angioplasty (PCI) | Heart and Vascular Health | Scoop.it

Transradial arterial access significantly lowers the risk of access site complications compared to transfemoral arteriotomy. 

 We analyzed 17 509 patients who underwent PCI at 5 institutions. Transradial arterial access was used in 17.8% of patients. In those who underwent transfemoral access, 177 (1.2%) patients had access site complications. Using preprocedural clinical and demographic data, a prediction model for femoral arteriotomy complications was generated. The variables retained in the model:

- elevated age (P<0.001)

- female gender (P<0.001

- elevated troponin (P<0.001)

- decreased renal function or dialysis (P=0.002)

- emergent PCI (P=0.01)

- prior PCI (P=0.005)

- diabetes (P=0.008)

- peripheral artery disease (P=0.003).

Patients with higher predicted risk of complications via transfemoral access were less likely to receive transradial access (P<0.001). Similar results were seen in patients presenting with and without ST‐segment myocardial infarction and when adjusting for individual physician operator.

Conclusions Paradoxically, patients most likely to develop access site complications from transfemoral access, and therefore benefit from transradial access, were the least likely to receive transradial access.

Seth Bilazarian, MD's insight:

As the conclusion states: "Paradoxically, patients most likely to develop access site complications from transfemoral access, and therefore benefit from transradial access, were the least likely to receive transradial access."

Approaching heart catheterizations & angioplasty procedures from the wrist is slowly increasing in the US.  Cath labs that do not use  the radial approach in all ("Radial-first") rely on the femoral or groin approach.  In these labs, the most challenging patients that would benefit the most are not done from the wrist, because the radial approach is more challenging.  Older patients, smaller patients (women), and in circumstances when time is of the essence (like heart attacks called STEMIs)  don't get done by the radial approach so complications occur.  Unfortunately patients sometimes think they can just request this approach but if the cardiologist and/or cath lab  is not skilled in this technique using the femoral approach is still better.

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Scooped by Seth Bilazarian, MD
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Choosing wisely for interventionalists: top 5

Choosing wisely for interventionalists:  top 5 | Heart and Vascular Health | Scoop.it

FFR, BMS, complete angiography, complete revascularization, radial approach: best patient care, save healthcare dollars.

 

Calling all interventionalists: What five practices would you highlight to promote best patient care and save healthcare dollars? Here are 5 ideas from my community practice perspectives:

1. Use FFR liberally for intermediate lesions but not for severe ones
2. Use bare-metal stents if there's any doubt about the patient's insurance status
3. Do complete angiography before intervention
4. Don't send patients home without complete revascularization
5. Take up the radial approach

 

What's on your list?

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