Objective Comparative study on the feasibility,safety and outcome of transradial artery and transfemoral artery access for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(...Objective Comparative study on the feasibility,safety and outcome of transradial artery and transfemoral artery access for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(AMI).Methods Two hundred and eight patients with AMI episoded within 12 hours, male 159, female 49, age 58.9 ±11.9 (34～88)years, were randomly divided into transradial artery access for primary PCI (TRA pPCI) group of 106 cases and transfemoral artery access for PCI (TFA pPCI) group of 102 cases during Sept, 2000 to Aug, 2002. The protocols of the manipulation duration and the effect for TRA pPCI and TFA pPCI procedures were respectively compared, including the time of transradial artery puncture and the rate of puncture success at first time ; the time of guiding catheter engaging into target coronary ostium; the rate of patence in infarct related artery (IRA); total duration of manipulation and the successful rate.The incidence of complications such as bleeding, vessel injury,thrombi and embolism as well as the average stay of hospitalization between two groups was compared. The status and the incidance of vessel spasm were observed and the effect of medicine administration to prevent from and relieve the vascular spasm was evaluated. The time of Allen’s test before and after TRA pPCI , the inner diameter and the peak of blood velocity of the right and left radial artery were investigated with color Doppler vessel echography as well as the complications of radial artery were followed up 1 month after TRA pPCI procedure. Results Two cases in every TRA pPCI and TFA pPCI groups were crossed over each other because procedure of the transradial or transfemoral access was failure. One handred and six vessels (48 vessels in LAD,22 vessels in LCX and 36 vessels in RCA) associated with 28 vessels of total occlusion in TRA pPCI group and 102 vessels (51 vessels in LAD,18 veesles in LCX and 33 vessels in RCA) with 24 vessels in total occlusion in TFA pPCI group were angioplasticized . The successful rates of the first time puncture in access artery, the re patence IRA and pPCI were similar in TRA pPCI and TFA pPCI groups ( 93.4% vs 96.1% ;100% vs 100%; 96.2% vs 97.1% , P >0.05 ). There were no significant diffierence in the average time of puncture time of access artery ,engaging in target vessels of guiding catheters and the total procedure of PCI between the two groups ( 1.3 ±0.3s vs 1.2 ±0.3s ; 6.0 ±1.6min vs 5.8 ±0.9min ; 49.2 ±24.1min vs 46.5 ± 26.4min , P >0.05 ). The access artery complications such as bleeding ,hematoma and embolism as well the veneous thrombosis in TFA pPCI group were much more than those in TRA pPCI group(p< 0.01 ). Although slight artery spasm of 4.7% cases in TRA pPCI group was happened during the procedure of PCI , the procedure had being continued after administration of medicine to release the spasm. The time of Allen’s test ,diameter and the systolic velocity of blood in daul radial arteries were no significant change before and after pPCI.Conclusions The duration and effect by TRA pPCI for AMI with stable hemodynamics was similar to TFA pPCI. The complications such as of bleeding,vessel injury, thrombi and embolism by TRA pPCI were few, and it was unnecessary to discontinue the anticoagulation medicine. TRA pPCI might be selected as a access vessel for pPCI in AMI patients with stable hemodynamics.展开更多
Objective To compare hospital costs and clinical outcomes between transradial intervention （TRI） and transfemoral intervention （TFI） in elderly patients aged over 65 years. Methods We identified 1229 patients ag...Objective To compare hospital costs and clinical outcomes between transradial intervention （TRI） and transfemoral intervention （TFI） in elderly patients aged over 65 years. Methods We identified 1229 patients aged over 65 years who underwent percutaneous coronary intervention （PCI） in Fuwai Hospital, Beijing, China, between January 1 and December 31, 2010. Total hospital costs and in-hospital outcomes were compared between TRI and TFI. An inverse probability weighting （IPW） model was introduced to control potential biases. Results Patients who underwent TRI were younger, less often female, more likely to receive PCI for single-vessel lesions, and less likely to undergo the procedure for ostial lesions. TRI was associated with a cost saving of CNY7495 （95%CI： CNY4419-10 420）. Such differences were mainly driven by lower PCI-related costs. TRI patients had shorter length of stay （1.9 days, 95%CI： 1.1-2.7 days）, shorter post-procedural stay （0.7 days, 95%CI： 0.3-1.1 days）, and fewer major adverse cardiac events （adjusted odds ratio = 0.47, 95%CI： 0.31-0.73）. There was no statistical significance in the incidence of post-PCI bleeding between TRI and TFI （P〉0.05）. Such differences remained consistent in clinically relevant subgroups of acute myocardial infarction, acute coronary syndrome, and stable angina. Conclusion The use of TRI in patients aged over 65 years was associated with significantly reduced hospital costs and more favorable clinical outcomes.展开更多
Objective： To evaluate the efficacy and feasibility of the transradial approach for primary percutaneous coronary intervention （PCI） in patients with acute myocardial infarction（AMI）. Methods： 195 patients with ...Objective： To evaluate the efficacy and feasibility of the transradial approach for primary percutaneous coronary intervention （PCI） in patients with acute myocardial infarction（AMI）. Methods： 195 patients with acute myocardial infarction were randomly divided into two groups according to the different PCI operation pathways. 105 cases were assigned to the transfemoral artery group and 90 cases to the transradial artery group. We analyzed the data from the two groups, including the achievement ratio of paracentesis, cannulation time, the time from local anesthesia to the first time balloon inflation, the time of the total procedure, achievement ratio of PCI, incidence rate of vascular complications, total duration of hospitalization, and the six-month follow-up results in both groups. Results： Our results showed that the achier ement ratio of arteriopuncture, cannulafion time and the time from local anesthesia to the first time balloon inflation in the transradial and transfemoral groups were 98.9% vs. 100%, 3.15 ± 1.56min vs. 2.86 ± 0.97 min, and 18.56 ± 4.37 min vs. 17.75 ± 3.21 min, respectively. These differences between the two groups were not statistically significant. The total operating time was 29.75 ± 4.38 rain for the transradial group and 27.89 ± 3.95 min（P 〈 0.05） for the transfemoral group. The operation achievement ratio in the transradial group was 96.7%, and 96.2% in the transfemoral group. The incidence of puncture point complications was 2.2% in the transradial group and 11.4% in the transfemoral group, and this difference was significant. The duration of hospitalization was 10.56 ± 2.85 days for the transradial group and 13.78 ± 3.15 days（P 〈 0.05） for the transfemoral group. At the six-month follow-up, the rate of survival without cardiac event was 86.1% vs. 86.4% respectively in the transradial and transfemoral groups（P 〉 0.05）. Conclusion： The transradial approach was as effective as the transfemoral approach, and there were fewer puncture point complications as well as a shorter span of hospitalization in the transradial group. PCI via the transradial approach is safe, effective and feasible in patients with AMI.展开更多
Patients with chronic aortic dissections are at high risk of catheter-induced complications. We report a 41-year-old patient with a type B aortic dissection (Stanford) who underwent successful three-vessel percutaneou...Patients with chronic aortic dissections are at high risk of catheter-induced complications. We report a 41-year-old patient with a type B aortic dissection (Stanford) who underwent successful three-vessel percutaneous coronary intervention via the right radial artery approach following a non-ST elevation myocardial infarction. The patient remained asymptomatic at 6 mo follow-up. Trans-radial approach for coronary interventions can be used safely in patients with Stanford type B aortic dissection without increasing the risk of procedure-related complications in this high-risk group of patients.展开更多
Background: Complications post percutaneous coronary interventions (PCI) are more threatening than it was previously thought so that necessary measures should be taken to minimize those risks. Objective: To identify t...Background: Complications post percutaneous coronary interventions (PCI) are more threatening than it was previously thought so that necessary measures should be taken to minimize those risks. Objective: To identify the risk factors related to patient and procedure which could be used as predictors of complications after sheath removal post PCI. Methods: The study used a prospective non-experimental correlational descriptive. Design: The sample was chosen conveniently from three different hospitals and included 118 patients who were subjected to PCI. Results: Three models were used to predict complications. In the first model, none of the baseline variables were predictive of complications. In the second model, the only type of procedure (diagnostic, stent or balloon) was predictive of complications. In the third model, compression time was found to be a risk factor and a predictor of complications after sheath removal. Conclusion: Nurses and medical professionals are in a vital position to prevent, detect and manage PCI complications at the earliest possible opportunity. It is a must to assess and categorize patients in accordance with their risk level to develop post PCI and post sheath removal complications, in order to plan management strategies to decrease the health costs and the suffering.展开更多
Objective We conducted the present study in order to compare safety and efficacy of transradial intervention(TRI)and transfemoral intervention(TFI)in women undergoing percutaneous coronary intervention(PCI)in a large ...Objective We conducted the present study in order to compare safety and efficacy of transradial intervention(TRI)and transfemoral intervention(TFI)in women undergoing percutaneous coronary intervention(PCI)in a large heart center in China.Methods The study population consisted of a consecutive cohort of 5,067 women undergoing PCI in Fuwai Hospital,Beijing,China between 2006 and 2011(TRI:n=4,105,TFI:n=962).展开更多
Background Transradial coronary intervention has been widely used because of its effects in lowering the incidence of complications in vascular access site and improving patient satisfaction compared to the femoral ap...Background Transradial coronary intervention has been widely used because of its effects in lowering the incidence of complications in vascular access site and improving patient satisfaction compared to the femoral approach. This study aimed to investigate the safety and feasibility of transradial approach for primary percutaneous coronary intervention （PCI） in elderly patients with acute myocardial infarction （AMI）. Methods A total of 103 consecutive elderly patients Cage 〉65 years） who were diagnosed as having AMI were indicated for PCI. Among them, 57 patients received primary PCI via the transradial approach （transradial intervention, TRI group）, and 46 underwent primary PCI via the transfemoral approach （transfemoral intervention, TFI group）. The success rate of puncture, puncture time, cannulation time, repeffusion time, the total time for PCI, the success rate of PCI, the use rates of temporary pacemaker and intra-aortic balloon pump （IABP）, and the total length of hospital stay of the patients in the two groups were compared. After the procedure, vascular access site complications and major adverse cardiovascular events （MACE） in the two groups in one month were observed. Results The success rates of puncture （98.2% vs 100.0%） and PCI （96.5% vs 95.7%） for the patients in the TRI and TFI groups were not statistically significant （P〉0.05）. The puncture time （（2.4±1.1） vs （2.0±0.9） minutes）, cannulation time （（2.7±0.5） vs （2.6±0.5） minutes）, reperfusion time （（16.2±4.5） vs （15.4±3.6） minutes）, total time of the procedure （（44.1±6.8） vs （41.2±5.7） minutes）, use rates of temporary pacemaker （1.8% vs 2.2%） and IABP （0 vs 2.2%） in the two groups were not statistically significant （P〉0.05）, but the hospital stay of the TFI group was longer than that of the TRI group （（10.1±4.6） vs （7.2±2..6） days, P〈0.01）. A radial occlusion was observed in the TRI group, but no ischemic syndrome in hand. In the TFI group, 4 patients had hematosis, 1 had pseudoaneurysm, and 1 had major bleeding. Statistical significance in vascular access site complications was seen in the two groups （1.8 % vs 13.1%, P〈0.05）. Three patients died in the two groups respectively in one month, and there was no statistical significance in MACE in the two groups （5.3% vs 6.5%, P〉0.05）. Conclusion The transradial approach for primary PCI is safe and feasible for elderly patients with AMI.展开更多
Background A comparison of efficacy and safety between transradial and transfemoral approach for percutaneous coronary intervention （PCI） in bifurcations has not been done. This study evaluated feasibility of transr...Background A comparison of efficacy and safety between transradial and transfemoral approach for percutaneous coronary intervention （PCI） in bifurcations has not been done. This study evaluated feasibility of transradial PCI （TRI） and compared the immediate and followup results with transfemoral PCI （TFI） in bifurcations. Methods One hundred and thirty-four consecutive patients with bifurcations were treated with PCI in our hospital from April 2004 to October 2005. Of these, there were 60 patients （88 lesions） in TRI group and 74 patients （101 lesions） in TFI group. Bifurcations type was classified according to the Institut Cardiovasculaire Paris Sud Classification. Results TRI group had smaller stent diameter （（3.06±0.37） mm vs （3.18±0.35） mm, P=0.023） and postprocedural in-stent minimum lumen diameter （（2.62±0.37） mm vs （2.74±0.41） mm, P=0.029） than TFI, but there were not significant differences in in-stent subacute thrombosis rate （0% vs 1.0%, P=0.349）, target lesion revascularization （TLR） （0% vs 1.0%, P=0.349） following procedure and thrombosis （2.3% vs 1.0%, P=0.482）, in-stent restenosis （12.5% vs 10.9%, P=0.731）, in-segment restenosis （17.0% vs 14.9%, P=0.681）, TLR （10.2% vs 13.9%, P=0.446） and TLR-free cumulative survival rate （89.8% vs 86.1%, P=0.787） at seven months followup. No death was reported in the two groups. Conclusion Transradial intervention is feasible and appears to be as effective and safe as transfemoral PCI in treatment of true bifurcational lesions.展开更多
Objectives To evaluate the effectiveness and feasibility of transradial approach for primary, emergency percutaneous coronary intervention （PCI） in patients with acute myocardial infarction （AMI）. Methods One hund...Objectives To evaluate the effectiveness and feasibility of transradial approach for primary, emergency percutaneous coronary intervention （PCI） in patients with acute myocardial infarction （AMI）. Methods One hundred and ninety five patients with AMI undergone primary PCI were randomized into two groups using different catheter insertion pathways ： 105 cases by transfemoral approach and 90 cases by transradial approach. We compared data of different operating approaches in terms of success rate of access, cannulation time, the time from local anesthesia to the first balloon inflation, the total procedure time, success rate of PCI, access site complications, total duration of hospitalization, and the clinical outcomes at six-month follow-up. Results The success rate of artery puncture, cannulation time, and the time from local anesthesia to the first balloon inflation in the transradial and transfemoral groups were 98.9 % vs 100 % （P 〉0. 05）, 3.15 ± 1.56 minutes vs 2. 86 ± 0.97 minutes （P 〉0. 05）, and 18.56 ± 4. 37 minutes vs 17.75± 3.21 minutes （P 〉 0. 05 ）, respectively. Although the total procedure time was significantly shorter in the transfemoral group （27.89 ± 3.95 minutes） than in the transradial group （29.75 ±4. 38 minutes） （P 〈0. 05）, the overall PCI success rate was similar between the two groups （96.2 % vs 96. 7 % ）. Use of the transradial approach was associated with fewer access site complications （ 2. 2 % vs 11.4 %, P 〈 0. 05 ） and a shorter length of hospital stay （ 10. 6 days vs 13.8 days, P 〈 0. 05 ）. At six-month follow-up, the cumulative cardiac event-free survival rate was 86. 1% and 86. 4% （P 〉 0. 05 ）, respectively, in the transradial and transfemoral groups. Conclusions Transradial approach achieved similar effectiveness as transfemoral approach in emergency PCI. However, the use of the transradial approach decreased access complications and hospital stay. Primary PCI via transradial approach is safe, effective, and feasible in patients with AMI.展开更多
The use of intense anticoagulation and antiplatelet therapy in acute myocardial infarction （AMI）potentially increases the risk of bleeding complications during percutaneous coronary intervention （PCI） via the tran...The use of intense anticoagulation and antiplatelet therapy in acute myocardial infarction （AMI）potentially increases the risk of bleeding complications during percutaneous coronary intervention （PCI） via the transfemoral approach. Recently, the transradial access has been increasingly employed as an alternative means for diagnostic and interventional procedures. Low incidence of vascular access site bleeding complications suggests the transradial approach as a safe alternative to the femoral technique in AMI, particularly under an aggressive anticoagulation/antiplatelet regimen.Nevertheless, the safety and feasibility of employing the transradial approach for primary PCI in AMI has not been thoroughly investigated so far.展开更多
This paper describes the current status of percutaneous coronary intervention (PCI) for totally occluded coronary arteries. Chronic total occlusion is associated with 10%-20% of all PCI procedures. Results show that o...This paper describes the current status of percutaneous coronary intervention (PCI) for totally occluded coronary arteries. Chronic total occlusion is associated with 10%-20% of all PCI procedures. Results show that opening an occluded vessel, especially one supplying a considerable area of myocardium, may be beneficial for a patient's angina relief and heart function. We describe the devices used currently in re-canalization such as new wires, microcatheters (including Tonus and Cosair) and intravascular ultrasound guidance. Different techniques to improve the success rate and reduce complications are discussed in detail.展开更多
Background Transradial approach, which is now widely used in coronary angiography and intervention, may be advantageous with respect to the femoral access due to the lower incidence of vascular complications. Transuln...Background Transradial approach, which is now widely used in coronary angiography and intervention, may be advantageous with respect to the femoral access due to the lower incidence of vascular complications. Transulnar approach has been proposed for elective procedures in patients not suitable for transradial approach. The objective of this study was to evaluate the safety and efficacy of the transulnar approach versus the transradial approach for coronary angiography and intervention. Methods Two hundred and forty patients undergoing coronary angiography, followed or not by intervention, were randomized to transulnar （TUA） or transradial approach （TRA）. Doppler ultrasound assessments of the forearm vessels were scheduled for all patients before procedures, 1 day and 30 days after procedures. The primary end point was access site vascular complications during hospitalization and 30 days follow-up. Major adverse cardiac events （MACE） as secondary end point was recorded till 30 days follow-up. Results Successful puncture was achieved in 98.3% （118/120） of patients in the TUA group, and in 100% （120/120） of patients in the TRA group. Coronary angiographies were performed in 40 and 39 patients in TUA and TRA group. Intervention procedures were performed in 78 and 83 patients in TUA and TRA group, respectively. The incidence of artery stenosis 1 day and 30 days after procedures was 11.0% vs.12.3% and 5.1% vs. 6.6% in TUA and TRA group, respectively. Asymptomatic access site artery occlusion occurred in 5.1% vs.1.7% of patients 1 day and 30 days after transulnar angioplasty, and in 6.6% vs. 4.9% of patients 1 day and 30 days after transradial angioplasty. Minor bleeding was still observed at the moment of the ultrasound assessment in 5.9% and 5.7% of patients in TUA and TRA group, respectively （P=0.949）. No big forearm hematoma, and A-V fistula were observed in both groups. Freedom from MACE at 30 days follow-up was observed in all patients. Conclusions The transulnar approach is as safe and effective as the transradial approach for coronary angiography and intervention. It is an attractive opinion for experienced operators who are skilled in this technique, particularly in cases of anatomic variations of the radial artery, radial artery small-caliber or thin radial pulse.展开更多
文摘Objective Comparative study on the feasibility,safety and outcome of transradial artery and transfemoral artery access for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(AMI).Methods Two hundred and eight patients with AMI episoded within 12 hours, male 159, female 49, age 58.9 ±11.9 (34～88)years, were randomly divided into transradial artery access for primary PCI (TRA pPCI) group of 106 cases and transfemoral artery access for PCI (TFA pPCI) group of 102 cases during Sept, 2000 to Aug, 2002. The protocols of the manipulation duration and the effect for TRA pPCI and TFA pPCI procedures were respectively compared, including the time of transradial artery puncture and the rate of puncture success at first time ; the time of guiding catheter engaging into target coronary ostium; the rate of patence in infarct related artery (IRA); total duration of manipulation and the successful rate.The incidence of complications such as bleeding, vessel injury,thrombi and embolism as well as the average stay of hospitalization between two groups was compared. The status and the incidance of vessel spasm were observed and the effect of medicine administration to prevent from and relieve the vascular spasm was evaluated. The time of Allen’s test before and after TRA pPCI , the inner diameter and the peak of blood velocity of the right and left radial artery were investigated with color Doppler vessel echography as well as the complications of radial artery were followed up 1 month after TRA pPCI procedure. Results Two cases in every TRA pPCI and TFA pPCI groups were crossed over each other because procedure of the transradial or transfemoral access was failure. One handred and six vessels (48 vessels in LAD,22 vessels in LCX and 36 vessels in RCA) associated with 28 vessels of total occlusion in TRA pPCI group and 102 vessels (51 vessels in LAD,18 veesles in LCX and 33 vessels in RCA) with 24 vessels in total occlusion in TFA pPCI group were angioplasticized . The successful rates of the first time puncture in access artery, the re patence IRA and pPCI were similar in TRA pPCI and TFA pPCI groups ( 93.4% vs 96.1% ;100% vs 100%; 96.2% vs 97.1% , P >0.05 ). There were no significant diffierence in the average time of puncture time of access artery ,engaging in target vessels of guiding catheters and the total procedure of PCI between the two groups ( 1.3 ±0.3s vs 1.2 ±0.3s ; 6.0 ±1.6min vs 5.8 ±0.9min ; 49.2 ±24.1min vs 46.5 ± 26.4min , P >0.05 ). The access artery complications such as bleeding ,hematoma and embolism as well the veneous thrombosis in TFA pPCI group were much more than those in TRA pPCI group(p< 0.01 ). Although slight artery spasm of 4.7% cases in TRA pPCI group was happened during the procedure of PCI , the procedure had being continued after administration of medicine to release the spasm. The time of Allen’s test ,diameter and the systolic velocity of blood in daul radial arteries were no significant change before and after pPCI.Conclusions The duration and effect by TRA pPCI for AMI with stable hemodynamics was similar to TFA pPCI. The complications such as of bleeding,vessel injury, thrombi and embolism by TRA pPCI were few, and it was unnecessary to discontinue the anticoagulation medicine. TRA pPCI might be selected as a access vessel for pPCI in AMI patients with stable hemodynamics.
文摘Objective To compare hospital costs and clinical outcomes between transradial intervention （TRI） and transfemoral intervention （TFI） in elderly patients aged over 65 years. Methods We identified 1229 patients aged over 65 years who underwent percutaneous coronary intervention （PCI） in Fuwai Hospital, Beijing, China, between January 1 and December 31, 2010. Total hospital costs and in-hospital outcomes were compared between TRI and TFI. An inverse probability weighting （IPW） model was introduced to control potential biases. Results Patients who underwent TRI were younger, less often female, more likely to receive PCI for single-vessel lesions, and less likely to undergo the procedure for ostial lesions. TRI was associated with a cost saving of CNY7495 （95%CI： CNY4419-10 420）. Such differences were mainly driven by lower PCI-related costs. TRI patients had shorter length of stay （1.9 days, 95%CI： 1.1-2.7 days）, shorter post-procedural stay （0.7 days, 95%CI： 0.3-1.1 days）, and fewer major adverse cardiac events （adjusted odds ratio = 0.47, 95%CI： 0.31-0.73）. There was no statistical significance in the incidence of post-PCI bleeding between TRI and TFI （P〉0.05）. Such differences remained consistent in clinically relevant subgroups of acute myocardial infarction, acute coronary syndrome, and stable angina. Conclusion The use of TRI in patients aged over 65 years was associated with significantly reduced hospital costs and more favorable clinical outcomes.
基金support from the Editorial Department of the Journal of Nanjing Medical Univrsity
文摘Objective： To evaluate the efficacy and feasibility of the transradial approach for primary percutaneous coronary intervention （PCI） in patients with acute myocardial infarction（AMI）. Methods： 195 patients with acute myocardial infarction were randomly divided into two groups according to the different PCI operation pathways. 105 cases were assigned to the transfemoral artery group and 90 cases to the transradial artery group. We analyzed the data from the two groups, including the achievement ratio of paracentesis, cannulation time, the time from local anesthesia to the first time balloon inflation, the time of the total procedure, achievement ratio of PCI, incidence rate of vascular complications, total duration of hospitalization, and the six-month follow-up results in both groups. Results： Our results showed that the achier ement ratio of arteriopuncture, cannulafion time and the time from local anesthesia to the first time balloon inflation in the transradial and transfemoral groups were 98.9% vs. 100%, 3.15 ± 1.56min vs. 2.86 ± 0.97 min, and 18.56 ± 4.37 min vs. 17.75 ± 3.21 min, respectively. These differences between the two groups were not statistically significant. The total operating time was 29.75 ± 4.38 rain for the transradial group and 27.89 ± 3.95 min（P 〈 0.05） for the transfemoral group. The operation achievement ratio in the transradial group was 96.7%, and 96.2% in the transfemoral group. The incidence of puncture point complications was 2.2% in the transradial group and 11.4% in the transfemoral group, and this difference was significant. The duration of hospitalization was 10.56 ± 2.85 days for the transradial group and 13.78 ± 3.15 days（P 〈 0.05） for the transfemoral group. At the six-month follow-up, the rate of survival without cardiac event was 86.1% vs. 86.4% respectively in the transradial and transfemoral groups（P 〉 0.05）. Conclusion： The transradial approach was as effective as the transfemoral approach, and there were fewer puncture point complications as well as a shorter span of hospitalization in the transradial group. PCI via the transradial approach is safe, effective and feasible in patients with AMI.
文摘Patients with chronic aortic dissections are at high risk of catheter-induced complications. We report a 41-year-old patient with a type B aortic dissection (Stanford) who underwent successful three-vessel percutaneous coronary intervention via the right radial artery approach following a non-ST elevation myocardial infarction. The patient remained asymptomatic at 6 mo follow-up. Trans-radial approach for coronary interventions can be used safely in patients with Stanford type B aortic dissection without increasing the risk of procedure-related complications in this high-risk group of patients.
文摘Background: Complications post percutaneous coronary interventions (PCI) are more threatening than it was previously thought so that necessary measures should be taken to minimize those risks. Objective: To identify the risk factors related to patient and procedure which could be used as predictors of complications after sheath removal post PCI. Methods: The study used a prospective non-experimental correlational descriptive. Design: The sample was chosen conveniently from three different hospitals and included 118 patients who were subjected to PCI. Results: Three models were used to predict complications. In the first model, none of the baseline variables were predictive of complications. In the second model, the only type of procedure (diagnostic, stent or balloon) was predictive of complications. In the third model, compression time was found to be a risk factor and a predictor of complications after sheath removal. Conclusion: Nurses and medical professionals are in a vital position to prevent, detect and manage PCI complications at the earliest possible opportunity. It is a must to assess and categorize patients in accordance with their risk level to develop post PCI and post sheath removal complications, in order to plan management strategies to decrease the health costs and the suffering.
文摘Objective We conducted the present study in order to compare safety and efficacy of transradial intervention(TRI)and transfemoral intervention(TFI)in women undergoing percutaneous coronary intervention(PCI)in a large heart center in China.Methods The study population consisted of a consecutive cohort of 5,067 women undergoing PCI in Fuwai Hospital,Beijing,China between 2006 and 2011(TRI:n=4,105,TFI:n=962).
文摘Background Transradial coronary intervention has been widely used because of its effects in lowering the incidence of complications in vascular access site and improving patient satisfaction compared to the femoral approach. This study aimed to investigate the safety and feasibility of transradial approach for primary percutaneous coronary intervention （PCI） in elderly patients with acute myocardial infarction （AMI）. Methods A total of 103 consecutive elderly patients Cage 〉65 years） who were diagnosed as having AMI were indicated for PCI. Among them, 57 patients received primary PCI via the transradial approach （transradial intervention, TRI group）, and 46 underwent primary PCI via the transfemoral approach （transfemoral intervention, TFI group）. The success rate of puncture, puncture time, cannulation time, repeffusion time, the total time for PCI, the success rate of PCI, the use rates of temporary pacemaker and intra-aortic balloon pump （IABP）, and the total length of hospital stay of the patients in the two groups were compared. After the procedure, vascular access site complications and major adverse cardiovascular events （MACE） in the two groups in one month were observed. Results The success rates of puncture （98.2% vs 100.0%） and PCI （96.5% vs 95.7%） for the patients in the TRI and TFI groups were not statistically significant （P〉0.05）. The puncture time （（2.4±1.1） vs （2.0±0.9） minutes）, cannulation time （（2.7±0.5） vs （2.6±0.5） minutes）, reperfusion time （（16.2±4.5） vs （15.4±3.6） minutes）, total time of the procedure （（44.1±6.8） vs （41.2±5.7） minutes）, use rates of temporary pacemaker （1.8% vs 2.2%） and IABP （0 vs 2.2%） in the two groups were not statistically significant （P〉0.05）, but the hospital stay of the TFI group was longer than that of the TRI group （（10.1±4.6） vs （7.2±2..6） days, P〈0.01）. A radial occlusion was observed in the TRI group, but no ischemic syndrome in hand. In the TFI group, 4 patients had hematosis, 1 had pseudoaneurysm, and 1 had major bleeding. Statistical significance in vascular access site complications was seen in the two groups （1.8 % vs 13.1%, P〈0.05）. Three patients died in the two groups respectively in one month, and there was no statistical significance in MACE in the two groups （5.3% vs 6.5%, P〉0.05）. Conclusion The transradial approach for primary PCI is safe and feasible for elderly patients with AMI.
文摘Background A comparison of efficacy and safety between transradial and transfemoral approach for percutaneous coronary intervention （PCI） in bifurcations has not been done. This study evaluated feasibility of transradial PCI （TRI） and compared the immediate and followup results with transfemoral PCI （TFI） in bifurcations. Methods One hundred and thirty-four consecutive patients with bifurcations were treated with PCI in our hospital from April 2004 to October 2005. Of these, there were 60 patients （88 lesions） in TRI group and 74 patients （101 lesions） in TFI group. Bifurcations type was classified according to the Institut Cardiovasculaire Paris Sud Classification. Results TRI group had smaller stent diameter （（3.06±0.37） mm vs （3.18±0.35） mm, P=0.023） and postprocedural in-stent minimum lumen diameter （（2.62±0.37） mm vs （2.74±0.41） mm, P=0.029） than TFI, but there were not significant differences in in-stent subacute thrombosis rate （0% vs 1.0%, P=0.349）, target lesion revascularization （TLR） （0% vs 1.0%, P=0.349） following procedure and thrombosis （2.3% vs 1.0%, P=0.482）, in-stent restenosis （12.5% vs 10.9%, P=0.731）, in-segment restenosis （17.0% vs 14.9%, P=0.681）, TLR （10.2% vs 13.9%, P=0.446） and TLR-free cumulative survival rate （89.8% vs 86.1%, P=0.787） at seven months followup. No death was reported in the two groups. Conclusion Transradial intervention is feasible and appears to be as effective and safe as transfemoral PCI in treatment of true bifurcational lesions.
文摘Objectives To evaluate the effectiveness and feasibility of transradial approach for primary, emergency percutaneous coronary intervention （PCI） in patients with acute myocardial infarction （AMI）. Methods One hundred and ninety five patients with AMI undergone primary PCI were randomized into two groups using different catheter insertion pathways ： 105 cases by transfemoral approach and 90 cases by transradial approach. We compared data of different operating approaches in terms of success rate of access, cannulation time, the time from local anesthesia to the first balloon inflation, the total procedure time, success rate of PCI, access site complications, total duration of hospitalization, and the clinical outcomes at six-month follow-up. Results The success rate of artery puncture, cannulation time, and the time from local anesthesia to the first balloon inflation in the transradial and transfemoral groups were 98.9 % vs 100 % （P 〉0. 05）, 3.15 ± 1.56 minutes vs 2. 86 ± 0.97 minutes （P 〉0. 05）, and 18.56 ± 4. 37 minutes vs 17.75± 3.21 minutes （P 〉 0. 05 ）, respectively. Although the total procedure time was significantly shorter in the transfemoral group （27.89 ± 3.95 minutes） than in the transradial group （29.75 ±4. 38 minutes） （P 〈0. 05）, the overall PCI success rate was similar between the two groups （96.2 % vs 96. 7 % ）. Use of the transradial approach was associated with fewer access site complications （ 2. 2 % vs 11.4 %, P 〈 0. 05 ） and a shorter length of hospital stay （ 10. 6 days vs 13.8 days, P 〈 0. 05 ）. At six-month follow-up, the cumulative cardiac event-free survival rate was 86. 1% and 86. 4% （P 〉 0. 05 ）, respectively, in the transradial and transfemoral groups. Conclusions Transradial approach achieved similar effectiveness as transfemoral approach in emergency PCI. However, the use of the transradial approach decreased access complications and hospital stay. Primary PCI via transradial approach is safe, effective, and feasible in patients with AMI.
文摘The use of intense anticoagulation and antiplatelet therapy in acute myocardial infarction （AMI）potentially increases the risk of bleeding complications during percutaneous coronary intervention （PCI） via the transfemoral approach. Recently, the transradial access has been increasingly employed as an alternative means for diagnostic and interventional procedures. Low incidence of vascular access site bleeding complications suggests the transradial approach as a safe alternative to the femoral technique in AMI, particularly under an aggressive anticoagulation/antiplatelet regimen.Nevertheless, the safety and feasibility of employing the transradial approach for primary PCI in AMI has not been thoroughly investigated so far.
文摘This paper describes the current status of percutaneous coronary intervention (PCI) for totally occluded coronary arteries. Chronic total occlusion is associated with 10%-20% of all PCI procedures. Results show that opening an occluded vessel, especially one supplying a considerable area of myocardium, may be beneficial for a patient's angina relief and heart function. We describe the devices used currently in re-canalization such as new wires, microcatheters (including Tonus and Cosair) and intravascular ultrasound guidance. Different techniques to improve the success rate and reduce complications are discussed in detail.
文摘Background Transradial approach, which is now widely used in coronary angiography and intervention, may be advantageous with respect to the femoral access due to the lower incidence of vascular complications. Transulnar approach has been proposed for elective procedures in patients not suitable for transradial approach. The objective of this study was to evaluate the safety and efficacy of the transulnar approach versus the transradial approach for coronary angiography and intervention. Methods Two hundred and forty patients undergoing coronary angiography, followed or not by intervention, were randomized to transulnar （TUA） or transradial approach （TRA）. Doppler ultrasound assessments of the forearm vessels were scheduled for all patients before procedures, 1 day and 30 days after procedures. The primary end point was access site vascular complications during hospitalization and 30 days follow-up. Major adverse cardiac events （MACE） as secondary end point was recorded till 30 days follow-up. Results Successful puncture was achieved in 98.3% （118/120） of patients in the TUA group, and in 100% （120/120） of patients in the TRA group. Coronary angiographies were performed in 40 and 39 patients in TUA and TRA group. Intervention procedures were performed in 78 and 83 patients in TUA and TRA group, respectively. The incidence of artery stenosis 1 day and 30 days after procedures was 11.0% vs.12.3% and 5.1% vs. 6.6% in TUA and TRA group, respectively. Asymptomatic access site artery occlusion occurred in 5.1% vs.1.7% of patients 1 day and 30 days after transulnar angioplasty, and in 6.6% vs. 4.9% of patients 1 day and 30 days after transradial angioplasty. Minor bleeding was still observed at the moment of the ultrasound assessment in 5.9% and 5.7% of patients in TUA and TRA group, respectively （P=0.949）. No big forearm hematoma, and A-V fistula were observed in both groups. Freedom from MACE at 30 days follow-up was observed in all patients. Conclusions The transulnar approach is as safe and effective as the transradial approach for coronary angiography and intervention. It is an attractive opinion for experienced operators who are skilled in this technique, particularly in cases of anatomic variations of the radial artery, radial artery small-caliber or thin radial pulse.
