<b>Switching from Femoral to Routine Radial Access Site for ST‐Elevation Myocardial Infarction:</b> A Single Center Experience

Rubartelli, Paolo; Bartolini, Davide; Bellotti, S; Iannone, Alessandro; Fontana, Vincenzo

doi:10.1111/joic.12157

Cited by 7 publications

(5 citation statements)

References 23 publications

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“…In a study from Montreal, Canada, in the crossover group, time to first device was longer of by 7.5 minutes and vascular access-related time of by 6.2 minutes, respectively [12]. On the other hand, Rubartelli et al [14] mentioned that crossover was associated with a much longer door-to-balloon median time 75 minutes vs. 43 minutes in comparison to successful transradial PCI in STEMI patients. Huded et al showed in their report that vascular crossovers do not compromise door-to-balloon time performance though [17].…”

Section: Resultsmentioning

confidence: 98%

“…In previous studies, various causes of vascular access crossover were reported. Rubartelii et al [14] pointed out failure in radial puncture, radial artery loop and other abnormalities, artery spasm, tortuosity of the brachiocephalic trunk, and suboptimal guiding catheter back-up. Also, a Canadian study [15] mentioned the same difficulties during transradial procedures.…”

Section: Resultsmentioning

confidence: 99%

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Predictors and periprocedural outcomes of access crossover during primary percutaneous coronary interventions — a contemporary report from the Polish ORPKI registry

Piątek

Kurzawski

et al. 2022

Kardiol Pol

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Background:The radial artery became preferable access for percutaneous coronary interventions (PCI). The latest European Society of Cardiology guidelines strongly recommended transradial access in patients with ST-segment elevation myocardial infarction (STEMI). Though, in a significant portion of the coronary artery, invasive procedure crossover to femoral is necessary.Aims: This study aimed to determine the ratio, risk factors, and periprocedural outcomes of crossover from radial to femoral access during PCI in a contemporary STEMI registry. Methods:Based on data from the Polish registry ORPKI, we analyzed 90245 patients with a diagnosis of STEMI that were intended to be treated invasively via transradial access between 2014 and 2019. Results:In 1484 (1.6 %) individuals, a switch to femoral access was necessary during the procedure. The most important independent predictors of vascular crossover were female sex, previous coronary artery bypass graft, class 3 and 4 of the Killip scale, left main disease, as well as any complications during coronary angiography. In that cohort, the risk of bleeding at the puncture site was over 20--fold higher. Major disparities in periprocedural outcomes (death during procedure, cardiac arrest during PCI, Thrombolysis In Myocardial Infarction (TIMI) after PCI, and no-reflow) between these groups resulted from disparities in initial characteristics, and they were not associated with crossover itself. Conclusions:Even though the risk of crossover to femoral is currently low, it appears to be indispensable to sustain operators' experience both in radial and femoral approaches to achieve the best outcomes in these patients.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Predictors and periprocedural outcomes of access crossover during primary percutaneous coronary interventions — a contemporary report from the Polish ORPKI registry

Piątek

Kurzawski

et al. 2022

Kardiol Pol

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“…Despite many rewards of the radial access as opposed to femoral one, radial approach requires a steep learning curve and associated with higher crossover rate to femoral approach owing to many physioanatomic disparities as but not limited to intense spasm, tortuous configuration, hypoplasia, loop, and lusoriasubclavian artery [28][29][30][31][32]. There is marked disparity in literature observing the percentage of crossover rate from radial to femoral access with a reported very low incidence at 1.2% to very high 18% [33][34][35], however, the average rate ranges between 4%-9%. In the current study I failed to get access to radial artery in 92 out of 1000 procedures "9.2%" that is high acceptable level as per international standard.…”

Section: Crossover Rate From Radial To Femoral Before and After Rurumentioning

confidence: 99%

Heparin-free distal radial artery approach to cardiac catheterisation and the small radial recurrent artery

Lim

Elghamry

2021

Br J Cardiol

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Aim: Our study aimed highlighting experience in reducing crossover rate from radial to femoral access to maintain coronary procedure safety and patients' satisfaction. Methods and results:A prospective, single center, single operator observational study included all comers for coronary procedures. The default access for coronary procedures was the right Radial artery, whenever failed, right Ulnar artery utilized then left Radial then left Ulnar "RURU". We studied 1000 procedures "964 patients" whom the default access was the radial artery. Radial access succeeded in 908 "90.8%" procedures and failed in 92 "9.2%" procedures necessitating crossover to other access site. One of the right ulnar, left radial or left ulnar succeeded in 51 out of 92 patients reducing the total crossover to femoral access to 4.1%. The remaining 41 procedures were obliged to crossover to femoral access. Radial artery spasm and vessel tortuosity were the commonest causes of crossover from radial to RURU/femoral artery "p=0.012 and 0.0017 respectively". Minor hematomas were the commonest immediate complication "p<0.022" with non significant prolongation of procedural time and radiation exposure. Conclusion:RURU approach has resulted in significant crossover rate reduction from radial to femoral access maintaining procedural safety and patient's satisfaction on expense of increased minor hematomas and non-significant increase of procedural time and radiation exposure.

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“…Real-world estimates of crossover rates to TFA have varied (4.6-10%), but operator experience consistently predicts rates of crossover. [4][5][6][7] Despite scientific statements outlining best TRA practices, 8 one specific challenge that may result in crossover is engaging the coronary arteries with a catheter in the presence of significant tortuosity in the brachiocephalic and thoracic aorta. Difficulty in torquing the catheter can result in prolonged procedure time, leading to radial artery vasospasm, increased exposure to radiation, and increased contrast use.…”

Section: Introductionmentioning

confidence: 99%

“…One reason is due to difficulties with performing TRA left heart catheterization (LHC) when unfavorable anatomy is encountered. Real‐world estimates of crossover rates to TFA have varied (4.6–10%), but operator experience consistently predicts rates of crossover 4‐7 …”

Section: Introductionmentioning

confidence: 99%

Right transradial coronary angiography in the setting of tortuous brachiocephalic/thoracic aorta (“elephant head”): Impact on fluoroscopy time and contrast use

Case

Yerasi

Forrestal

et al. 2021

Cathet Cardio Intervent

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Objectives: Assess the impact on fluoroscopy time and contrast use in patients with tortuous brachiocephalic/thoracic aortas undergoing right transradial coronary angiography (RTCA) and provide strategies to manage.Background: Unfavorable anatomy with severe brachiocephalic/thoracic tortuosity, referred to as an "elephant head," remains a significant obstacle for RTCA.Methods: We reviewed the coronary angiograms of patients who underwent RTCA and had tortuous aortas. Angiography was attempted first using a universal catheter (Tiger) and switched to a left coronary specific catheter (Judkins Left [JL]) if challenging. Fluoroscopy time, contrast volume, and greatest distance from the patient's midline to the catheter in the aorta were recorded.Results: Forty-nine patients (62.6 ± 12.0 years, 69.4% male) were included. Fifteen (30.6%) patients underwent successful angiography with a Tiger catheter; 34 (69.4%) patients required switching to JL catheter. The average distance of Tiger catheters to

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Switching from Femoral to Routine Radial Access Site for ST‐Elevation Myocardial Infarction: A Single Center Experience

Abstract: A progressive transition from TF to TR-pPCI could be implemented over a 4-year period without increasing overall treatment delay. The impact of operator experience on procedural results appeared to be modest and it did not differ in the study access groups.

Cited by 7 publications

References 23 publications

Predictors and periprocedural outcomes of access crossover during primary percutaneous coronary interventions — a contemporary report from the Polish ORPKI registry

Predictors and periprocedural outcomes of access crossover during primary percutaneous coronary interventions — a contemporary report from the Polish ORPKI registry

Heparin-free distal radial artery approach to cardiac catheterisation and the small radial recurrent artery

Right transradial coronary angiography in the setting of tortuous brachiocephalic/thoracic aorta (“elephant head”): Impact on fluoroscopy time and contrast use

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