Características operacionais das intervenções coronárias percutâneas em centro que prioriza a utilização do acesso radial

Abstract

background:The radial approach has demonstrated superior benefits to the femoral approach in reducing vascular complications and bleeding events associated to percutaneous coronary interventions. However, because this is a more complex procedure, it requires a learning curve to get all of the advantages of the technique. The aim of this study was to present the characteristics of the procedures of a center that prioritizes the use of radial approach. Methods: Prospective registry of patients undergoing percutaneous coronary intervention (PCI) using the radial or ulnar access where angiographic success, technical failure, ischemic adverse events and severe bleeding rates were assessed. A pre-specified analysis of the group undergoing PCI for the right coronary artery was performed, comparing patients using Judkins right catheter (JR) or Amplatz catheters. Results: Between April 2010 and May 2012, 1,117 patients underwent PCI, 1,040 (93.1%) by the radial approach and 50 (4.5%) by the ulnar approach. Sedation was performed in 58.5% of the patients, the crossover rate was 1.2%, and angiographic success was 96.2%. Extra backup catheters were used in 99.1% of PCIs for the left coronary artery, JR in 69.4% and Amplatz in 27.1% of the PCIs for the right coronary artery. When the JR and Amplatz were compared, longer procedure duration, longer fluoroscopy time, larger number of catheters, more frequent lesion predilation and higher number of implanted stents were observed in the group using Amplatz catheters as well as lower angiographic success rates. Conclusions: The use of radial access in PCI showed a high success rate and a low rate of major cardiac

Comparação entre os Tempos de Procedimento e Fluoroscopia e o Volume de Contraste das Vias de Acesso Radial e Femoral em Pacientes Submetidos a Cateterismo Cardíaco

“…3,6 The learning curve is closely related to the technical improvement of the operating physician, which should minimize patient exposure during the procedure. 8,12,13 In this study, the total exam time was longer in the group with femoral access, possibly due to the need to exchange catheters. 13 When the procedure is performed via radial route, the operating physician usually employs only one pre-shaped catheter, versus three for the femoral route.…”

“…This suggests that the operating physician was in line with the global trend, using the radial route technique. 3,7 The use of this route began approximately 20 years ago, 8 and some authors consider it as a default strategy for cardiac procedures in a catheterization laboratory, 9 since the technique presents lower bleeding and vascular complication rates, brings more comfort for the patient, and allows for a shorter hospital stay with lower costs when compared with the femoral route. 2,7,10,11 Nonetheless, the femoral route remains the most used technique in hemodynamic laboratories for diagnostic cardiac catheterizations and percutaneous coronary interventions, both on national and international scenarios.…”

Intervenção percutânea por via radial e tempo de permanência hospitalar

“…However, the development of interventional cardiology, the improvement of techniques and medications, and the tendency for elective PCI to progress to a shorter hospital stay. Many hemodynamic services, including in Brazil, use the radial access route, 16,33 but lack studies that show the time of hospital stay post-procedure.…”

Complicações da intervenção coronária percutânea: inferência dos diagnósticos de enfermagem

“…Mostraram ter menor gravidade angiográfica, utilizaram stents de maior diâmetro e apresentaram mais distúrbios de fluxo transitórios durante a ICP. O sucesso do procedimento foi semelhante às eletivas, assim como a ocorrência de complicações [17]. Outras publicações confirmaram que a ICP ad hoc é tão segura quanto às eletivas [17].…”