Balanced Adoption of Radial Artery Access for Primary Percutaneous Coronary Intervention

Anderson, H. Vernon; Faxon, David P.

doi:10.1001/jamacardio.2017.2346

Cited by 2 publications

(1 citation statement)

References 10 publications

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“…Campelo-Parada et al demonstrated a significantly lower rate of long-term major adverse cardiac events (MACE) in patients undergoing PCI using TRA compared to those with transfemoral access (TFA) 5. Nonetheless, TFA still remains the most commonly used approach because of several potential drawbacks of TRA, e.g., higher frequency of crossover to alternative vascular access, longer procedure time, inability to insert mechanical circulatory support devices, and risk for potential arterial conduits for bypass graft surgery 6.…”

Section: Introductionmentioning

confidence: 99%

Extravascular compared to Intravascular Femoral Closure is Associated with Less Bleeding and Similar MACE after Percutaneous Coronary Intervention

et al. 2019

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Background: Various types of vascular closure devices (VCDs) are frequently utilized in patients undergoing percutaneous coronary intervention (PCI) in order to prevent arterial access site bleeding, which represents one of the most relevant complications associated with adverse clinical outcomes. This study aims to compare directly two mechanistically different types of femoral closure (FC) devices in patients undergoing PCI.Methods: This single-center, prospective, observational study includes consecutively patients either treated by the extravascular StarClose SE® (Abbott, Illinois, U.S.A.) or the intravascular AngioSeal™ FC (St. Jude Medical, Inc., St. Paul, MN, U.S.A.) after PCI. The primary endpoint was bleeding complications, the secondary endpoint was major adverse cardiac events (MACE) at 30 days of follow-up.Results: 200 patients in each group (StarClose SE® and AngioSeal™) were enrolled following PCI. The rates of overall and non-access site bleedings were significantly higher in the AngioSeal™ group (56%; 6%) compared to the StarClose SE® group (43.5%; 0.5%) (p = 0.012; 0.003). Additionally, complicated access site bleedings were also significantly higher in the AngioSeal™ group (p = 0.011). No significant differences of MACE were observed in both groups. However, there was a higher rate of unsuccessful implantation of the StarClose SE® (n=12, excluded from the study).Conclusions: In case of successful implantation, FC by the AngioSeal™ is associated with the higher rate of both access and non-access site bleedings, but similar rates of MACE at 30 days compared to the StarClose SE® device.

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Section: Introductionmentioning

confidence: 99%

Extravascular compared to Intravascular Femoral Closure is Associated with Less Bleeding and Similar MACE after Percutaneous Coronary Intervention

et al. 2019

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Comparison of Vascular Closure Devices Versus Manual Compression After Femoral Artery Puncture in Women

Gewalt

Helde

Ibrahim

et al. 2018

Circ: Cardiovascular Interventions

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Background: The value of vascular closure devices (VCD) in women undergoing transfemoral catheterization has not been sufficiently investigated. Methods and Results: This is a sex-specific analysis of 1395 women enrolled in a large-scale, randomized, multicenter trial, in which patients undergoing transfemoral diagnostic coronary angiography were randomly assigned in a 1:1:1 ratio to arteriotomy closure with an intravascular VCD, extravascular VCD, or manual compression (MC). Primary objective was to assess the safety and efficacy of 2 different VCD compared with MC regarding vascular access-site complications at 30 days. A secondary comparison was between 2 different types of contemporary VCD. Overall, women were at higher risk for vascular access-site complications compared with men (9.0% versus 6.4%; P =0.002). Vascular access-site complications were comparable in women assigned to VCD and MC (8.6% versus 9.8%; P =0.451). There was no interaction of treatment effect and sex ( P interaction =0.970). Time to hemostasis was significantly shortened with VCD compared with MC (1 [interquartile range, 0.5–2.0] minutes) versus 11 [interquartile range, 10–15] minutes; P <0.001); however, more women with VCD required repeat MC (2.4% versus 0.6%; P =0.018). The use of the intravascular compared with the extravascular VCD was associated with a numerical reduction in vascular access-site complications (6.6% versus 10.7%; P =0.027) and significant reductions in time to hemostasis and VCD failure. Conclusions: In women undergoing diagnostic coronary angiography via the common femoral artery, VCD and MC provided comparable safety, while time to hemostasis was reduced with VCD. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01389375.

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Balanced Adoption of Radial Artery Access for Primary Percutaneous Coronary Intervention

Abstract: This Viewpoint discusses the need for determining an optimal balance between femoral and radial artery access in primary percutaneous coronary intervention.

Cited by 2 publications

References 10 publications

Extravascular compared to Intravascular Femoral Closure is Associated with Less Bleeding and Similar MACE after Percutaneous Coronary Intervention

Extravascular compared to Intravascular Femoral Closure is Associated with Less Bleeding and Similar MACE after Percutaneous Coronary Intervention

Comparison of Vascular Closure Devices Versus Manual Compression After Femoral Artery Puncture in Women

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