Access-Site Crossover in Patients With Acute Coronary Syndrome Undergoing Invasive Management

Gragnano, Felice; Branca, Mattia; Frigoli, Enrico; Leonardi, Sergio; Vranckx, Pascal; Maio, Dario Di; Monda, Emanuele; Fimiani, Luigi; Fioretti, Vincenzo; Chianese, Salvatore; Esposito, Fabrizio; Franzese, Michele; Scalise, Martina; D’Angelo, Claudio; Scalise, Renato Francesco Maria; Blasi, Gabriele De; Andò, Giuseppe; Esposito, Giovanni; Calabrò, Paolo; Windecker, Stephan; Pedrazzini, Giovanni; Valgimigli, Marco

doi:10.1016/j.jcin.2020.11.042

Cited by 26 publications

(18 citation statements)

References 19 publications

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“…Beyond characteristics of vessel lesion, pre-procedural and intra-procedural operations of PCI may also influence outcomes of ISR, because various stenting strategies may have different extent impairments to vessels. Therefore, access sites of PCI might also affect the outcomes of ISR for it increasing incidences of adverse events of angiography [ 47 ] .…”

Section: Discussionmentioning

confidence: 99%

A prediction model based on platelet parameters, lipid levels, and angiographic characteristics to predict in-stent restenosis in coronary artery disease patients implanted with drug-eluting stents

et al. 2021

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Background The present study was aimed to establish a prediction model for in-stent restenosis (ISR) in subjects who had undergone percutaneous coronary intervention (PCI) with drug-eluting stents (DESs). Materials and methods A retrospective cohort study was conducted. From September 2010 to September 2013, we included 968 subjects who had received coronary follow-up angiography after primary PCI. The logistic regression analysis, receiver operator characteristic (ROC) analysis, nomogram analysis, Hosmer–Lemeshow χ2 statistic, and calibration curve were applied to build and evaluate the prediction model. Results Fifty-six patients (5.79%) occurred ISR. The platelet distribution width (PDW), total cholesterol (TC), systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and lesion vessels had significant differences between ISR and non-ISR groups (all P < 0.05). And these variables were independently associated with ISR (all P < 0.05). Furthermore, they were identified as predictors (all AUC > 0.5 and P < 0.05) to establish a prediction model. The prediction model showed a good value of area under curve (AUC) (95%CI): 0.72 (0.64–0.80), and its optimized cut-off was 6.39 with 71% sensitivity and 65% specificity to predict ISR. Conclusion The incidence of ISR is 5.79% in CAD patients with DES implantation in the Xinjiang population, China. The prediction model based on PDW, SBP, TC, LDL-C, and lesion vessels was an effective model to predict ISR in CAD patients with DESs implantation.

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Section: Discussionmentioning

confidence: 99%

A prediction model based on platelet parameters, lipid levels, and angiographic characteristics to predict in-stent restenosis in coronary artery disease patients implanted with drug-eluting stents

et al. 2021

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“…Dilation was then performed with the short dilator with no skin incision being required in any of the cases. The SHGC with the long dilator inserted could be advanced into the aorta in all cases, with a low cross-over rate to femoral access when compared to other studies [ 1 , 14 ]. There are a number of design features of the SHGC that may contribute its deliverability.…”

Section: Discussionmentioning

confidence: 91%

First Experience Using the Sheathless Hyperion Guiding Catheter System Designed for Direct Insertion

Borrie

Fairley

Harding

2022

Journal of Interventional Cardiology

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Background. Use of sheathless guiding catheters for transradial PCI has the potential to reduce radial trauma and allow use of larger catheters to facilitate complex PCI. The new sheathless Hyperion guide catheter (SHGC) system allows direct insertion of the SHGC using a 20G needle or IV cannula, a 0.025″ Silverway wire, and a dilator. We report the first clinical experience. Methods. We prospectively evaluated outcomes in consecutive patients undergoing PCI using radial access and the SHGC catheter at our institution between June 2020 and June 2021. There were no exclusion criteria. Results. The study included 120 patients, mean age 67 ± 12.6 years, 79.2% male. Insertion of a SHGC was attempted in 128 radial arteries and was successful in all cases. The SHGC was inserted directly in 74 (57.8%), following initial sheath removal in 24 (20.5%) and through the initial sheath in 30 (26.2%). Coronary artery engagement with a SHGC was successful in 126 (98.4%). A total of 150 lesions were treated, the majority being complex: 16.1% chronic total occlusions, 37.1% calcified, 30.6% bifurcation, and 43.5% long lesions. Angiographic success was achieved in 149 (99.2%) lesions. Periprocedural myocardial infarction occurred in 5 (4.2%) patients. There was no in-hospital urgent revascularisation or death and no major bleeding or vascular complications. Occlusion occurred in 2 (1.6%) radial arteries. Conclusion. This first clinical experience with the SHGC demonstrates that direct insertion is safe and effective and that the use of the SHGC allows complex interventions to be undertaken transradially with a high success rate.

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“…Accessing site crossover have been also associated with an increased risk of procedural failure and revascularization [ 34 , 35 ]. The previous procedure was started via transradial approach in most of patients in our study.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for revascularization and in-stent restenosis in patients with triple-vessel disease after second-generation drug-eluting stent implantation: a retrospective analysis

Zeng

Yan

2021

BMC Cardiovasc Disord

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Objectives Coronary artery disease (CAD) is a common cardiac disease with high morbidity and mortality, and triple-vessel disease (TVD) is a severe type of CAD. This study investigated risk factors for revascularization and in-stent restenosis (ISR) in TVD patients who underwent second-generation drug-eluting stent implantation. Methods A retrospective clinical study was conducted, and 246 triple-vessel disease (TVD) patients with 373 vessels after second-generation drug-eluting stent (DES) implantation who received follow-up coronary angiography (CAG) were consequently enrolled. According to the follow-up angiography, patients were categorized into the revascularization group and nonrevascularization group as well as the in-stent restenosis (ISR) group and non-ISR group. Univariate and multivariate logistic regression analyses were used to identify risk factors for revascularization and ISR. Receiver operating characteristic (ROC) curve with area under the curve (AUC) analysis was performed to assess the predictive power of these risk factors. Results In the median follow-up period of 28.0 (14.0, 56.0) months, 142 TVD patients (57.7%) with 168 vessels underwent revascularization, and ISR occurred in 43 TVD patients (17.5%) with 47 vessels after second-generation DES implantation. Compared to the nonrevascularization group, the revascularization group presented with an increased rate of current smoking and higher levels of TC, LDL-C, HDL-C, non-HDL-c, ApoB, neutrophils, and Hs-CRP as well as a longer follow-up of months but with a lower level of HDL-C. In addition, patients in the ISR group had an older age, longer follow-up (months) and elevated rates of current smoking and stage 4–5 chronic kidney disease (CKD4-5). In multivariate analysis, current smoking and higher non-HDL-c were independent risk factors for revascularization. In addition, older age, current smoking and CKD4-5 were considered independent risk factors for ISR. Importantly, the receiver operating characteristic curve showed that non-HDL-C and age displayed predictive power for revascularization and ISR, respectively. Conclusion Current smoking is an independent risk factor for both revascularization and in-stent restenosis. Higher non-HDL-c is independently related to revascularization; moreover, increased age and CKD4-5 are potential risk factors for ISR in TVD patients after second-generation drug-eluting stent implantation.

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Access-Site Crossover in Patients With Acute Coronary Syndrome Undergoing Invasive Management

Cited by 26 publications

References 19 publications

A prediction model based on platelet parameters, lipid levels, and angiographic characteristics to predict in-stent restenosis in coronary artery disease patients implanted with drug-eluting stents

A prediction model based on platelet parameters, lipid levels, and angiographic characteristics to predict in-stent restenosis in coronary artery disease patients implanted with drug-eluting stents

First Experience Using the Sheathless Hyperion Guiding Catheter System Designed for Direct Insertion

Risk factors for revascularization and in-stent restenosis in patients with triple-vessel disease after second-generation drug-eluting stent implantation: a retrospective analysis

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