Abstract:ObjectivesLittle is known about local access-site complications and upper extremity dysfunction after transradial percutaneous coronary procedures (TR-PCP). This systematic review study aimed to summarise the current knowledge on the incidences of access-site complications and upper extremity dysfunction after TR-PCP.MethodsTwo independent, trained investigators searched MEDLINE, EMBASE and CENTRAL for eligible studies published before 1 January 2015. Also, they hand-searched the conference proceedings of the … Show more
“…There has never been such an extended and all-round study grasping all facets forming upper extremity function after transradial PCI. The highly sensitive binary score, composed by hand specialists, is a first attempt to measure the overall function of the upper extremity after transradial PCI [9] . We think that it may have been too sensitive and overestimated the actual and clinically relevant upper extremity dysfunction.…”
Section: Discussionmentioning
confidence: 99%
“…After local anaesthesia of the wrist with a subcutaneous injection of 2 % lidocaine, the radial artery was punctured with an introducer needle (Terumo Medical Corporation, Tokyo, Japan) using a modified Seldinger technique [12,13] . After introduction of the wire, the introducer needle was removed and a 6F introducer sheath (Terumo) was inserted [9] . Heparin, 100IU/KG and a mixture of verapamil, 5 mg, nitroglycerin, 200 μg, and 10 ml of saline solution were administered.…”
“…However, the precise effects of transradial procedures on the upper extremities function are unknown. The few published studies lack clear definitions of outcomes and systematic protocols and report inconsistent relationships between access-site complications and upper extremity function [6][7][8][9] . Several important factors combined contribute to the normal function of the upper extremities, including intact anatomy, blood supply and lymphatic drainage, muscle strength, range of motion, coordination and sensibility.…”
Section: Introductionmentioning
confidence: 99%
“…Upper extremity function has been defined as "The physiological capacity in which the patient can use an anatomically intact upper limb in everyday activities" [9] . Procedural complications may be the source of Upper Extremity Dysfunction (UED).…”
Aims: To examine the short-term effects of transradial percutaneous coronary interventions on the upper extremities function.
Method and results:This is an interim analysis of the Effects of trAnsRadial perCUtaneouS coronary intervention on upper extremity function (ARCUS) study. Out of 191 patients evaluated at 2 weeks after they had undergone a transradial percutaneous coronary intervention, 120 (62.8 % ) had manifestations of upper extremity dysfunction on the side of the intervention. The main abnormalities were a decrease in sensibility, a ≥ 15 % increase in the Disabilities of the Hand and Shoulder questionnaire score and a ≥ 2 cm increase in hand and forearm volumes. Radial artery occlusions occurred in 12 patients in the upper extremity dysfunction versus 1 patient in the no upper extremity dysfunction group (p = 0.03). Patients with upper extremity dysfunction were significantly more likely to have a family history of heart disease (50 % vs. 26.8 % ; p = 0.002). In addition, there was a trend (p = 0.07) toward a greater proportion of previous smokers in the group with upper extremity dysfunction than in the other group. Conclusions: Upper extremity dysfunction after transradial percutaneous coronary intervention is a medical concern. However, our original score may be overly sensitive and overestimate the rate of upper extremity dysfunction. Further analyses are needed, as well as perhaps a modification of the primary endpoint.
“…There has never been such an extended and all-round study grasping all facets forming upper extremity function after transradial PCI. The highly sensitive binary score, composed by hand specialists, is a first attempt to measure the overall function of the upper extremity after transradial PCI [9] . We think that it may have been too sensitive and overestimated the actual and clinically relevant upper extremity dysfunction.…”
Section: Discussionmentioning
confidence: 99%
“…After local anaesthesia of the wrist with a subcutaneous injection of 2 % lidocaine, the radial artery was punctured with an introducer needle (Terumo Medical Corporation, Tokyo, Japan) using a modified Seldinger technique [12,13] . After introduction of the wire, the introducer needle was removed and a 6F introducer sheath (Terumo) was inserted [9] . Heparin, 100IU/KG and a mixture of verapamil, 5 mg, nitroglycerin, 200 μg, and 10 ml of saline solution were administered.…”
“…However, the precise effects of transradial procedures on the upper extremities function are unknown. The few published studies lack clear definitions of outcomes and systematic protocols and report inconsistent relationships between access-site complications and upper extremity function [6][7][8][9] . Several important factors combined contribute to the normal function of the upper extremities, including intact anatomy, blood supply and lymphatic drainage, muscle strength, range of motion, coordination and sensibility.…”
Section: Introductionmentioning
confidence: 99%
“…Upper extremity function has been defined as "The physiological capacity in which the patient can use an anatomically intact upper limb in everyday activities" [9] . Procedural complications may be the source of Upper Extremity Dysfunction (UED).…”
Aims: To examine the short-term effects of transradial percutaneous coronary interventions on the upper extremities function.
Method and results:This is an interim analysis of the Effects of trAnsRadial perCUtaneouS coronary intervention on upper extremity function (ARCUS) study. Out of 191 patients evaluated at 2 weeks after they had undergone a transradial percutaneous coronary intervention, 120 (62.8 % ) had manifestations of upper extremity dysfunction on the side of the intervention. The main abnormalities were a decrease in sensibility, a ≥ 15 % increase in the Disabilities of the Hand and Shoulder questionnaire score and a ≥ 2 cm increase in hand and forearm volumes. Radial artery occlusions occurred in 12 patients in the upper extremity dysfunction versus 1 patient in the no upper extremity dysfunction group (p = 0.03). Patients with upper extremity dysfunction were significantly more likely to have a family history of heart disease (50 % vs. 26.8 % ; p = 0.002). In addition, there was a trend (p = 0.07) toward a greater proportion of previous smokers in the group with upper extremity dysfunction than in the other group. Conclusions: Upper extremity dysfunction after transradial percutaneous coronary intervention is a medical concern. However, our original score may be overly sensitive and overestimate the rate of upper extremity dysfunction. Further analyses are needed, as well as perhaps a modification of the primary endpoint.
“…Myocardial infarction (MI) and PCI-related bleeding have been strongly associated with early and late mortality [5–9]. The use of radial access has been demonstrated to be feasible in the ACS setting and, compared with femoral access, a reduction in vascular complications and bleeding has been suggested [10, 11]. Whether this evident reduction in access-site bleeding may also have a positive impact on prevention of further cardiovascular events remains to be defined.…”
AimThis study sought to assess whether radial artery access improves clinical outcomes in patients presenting with acute myocardial infarction compared with femoral artery access.MethodsThis is a single-centre, prospective observational registry of all STEMI and NSTEMI patients who underwent coronary angiography and/or primary PCI in the period January 2010 to December 2013. Primary endpoint was 30-day all-cause mortality. Choice of access was left to the discretion of the cardiologist. Differences in the risk of death at 30 days between patients undergoing transradial intervention versus transfemoral intervention was assessed on an intention-to-treat comparison.ResultsRetrospective analysis of prospectively collected data was performed in 3580 patients with an acute coronary syndrome who underwent coronary angiography, of which 1310 had radial artery access. PCI was performed in 77 % of the patients. Before propensity score matching, patients who underwent transradial intervention and those intended to undergo transfemoral approach differed significantly in intra-aortic balloon pump use (1.7 % vs. 6.7 %, p < 0.001), and Killip class (Killip 1: 10.8 % vs. 17.3 %, p < 0.001). 30-day mortality rates were 1.7 % in the transradial group and 4.6 % in the transfemoral group (p < 0.001). After matching on the propensity score, the hazard ratio for 30-day mortality in the transradial group was 0.56 (95 % CI: 0.29–1.07, p = 0.08).ConclusionThis registry-based study showed that radial access is associated with improved outcome in patients with an acute coronary syndrome. However, this difference was no longer significant after multivariate and propensity score adjustment for differences in baseline characteristics.
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