Skip to main content

No Increased Risk of Neurologic Complications With Transradial PCI


STOKE-ON-TRENT, United Kingdom — Performing PCI via the radial artery does not increase the risk of neurological complications when compared with conventional transfemoral PCI, a new European analysis shows [1]. Researchers say the results are reassuring, given that more and more operators are beginning to switch over to the transradial approach for various procedures.
"This analysis of almost 350 000 PCI procedures has not found any increase in the risk of neurologic complications associated with transradial access via either the right (the predominant radial artery used) or left radial artery," writeDr Karim Ratib (University Hospital of North Staffordshire, Stoke-on-Trent, UK) and colleagues in their study, published online December 26, 2012 in the American Heart Journal. "The results are reassuring, as the data were collected over a transitional period in UK access-site practice, during which transradial access increased from 17.1% to 50.8% of all PCI cases."
To heart wire , Dr Sunil Rao (Duke University Medical Center, Durham, NC), who was not involved in the study but who is a proponent of transradial PCI, was also reassured by the data.
"There is concern by femoral operators that radial increases stroke risk because of catheter exchanges in the ascending aorta, and there is a belief among radial operators that it reduces stroke risk because of the routine anticoagulation given even for diagnostic cases," said Rao. "This study and others like theSCIPION trial reported in the American Heart Journal shows that the stroke risk is probably the same for radial and femoral, with the attendant benefits of radial on vascular complications."
The current study is a retrospective analysis of the British Cardiovascular Intervention Societydatabase between 2006 and 2010. During this time, there were 124 616 procedures performed via the radial artery and 223 476 procedures performed via the femoral artery. Patients treated with the transradial approach were younger, had less diabetes, and were more likely to have prior cerebrovascular disease and peripheral vascular disease. Patients treated with transfemoral access were more likely to have a history of previous CABG surgery and renal impairment.
Overall, there were 247 neurologic complications in patients treated via the femoral artery (0.11%) and 139 neurologic complications in the transradial group (0.11%). In a multivariate-adjusted risk model, transradial PCI was not associated with an increased risk of complications compared with conventional PCI. The strongest predictors of neurologic complications were the use of an intra-aortic balloon pump, prior cerebrovascular events, pre-PCI shock, and PCI for acute coronary syndrome (ACS).
The researchers did observe an increase in rate of neurologic complications over time, increasing from 0.08% to 0.14% during the five-year period. This increase, they explain, might be related to the shift in patients undergoing PCI, such as more ACS patients undergoing the procedure. The increase in neurologic complications, such as cerebral bleeding events, might be associated with the more intensive antithrombotic regime in this population.
"For other interventional communities that are also undergoing rapid evolution in access-site practice, our data suggest that there is no neurologic hazard associated with rapid adoption of transradial access," conclude Ratib et al.

Comments

Post a Comment

Popular posts from this blog

Early Surgery for Sigmoid Volvulus May be Safe and Effective

August 29, 2012 — Early elective surgery for sigmoid volvulus should be encouraged because it is associated with lower morbidity and mortality, as well as a lower incidence of recurrence, than conservative treatment, according to the findings of a retrospective study. Omid Yassaie, MBChB, from Tauranga Hospital in New Zealand, and colleagues presented their findings in an article published online August 24 in the ANZ Journal of Surgery. The authors remark that the optimal treatment of sigmoid volvulus and the long-term prognosis of patients after treatment are unclear. "Sigmoidoscopic treatment has gained favour as it is less invasive than surgery; however, a significant portion of patients return with recurrent volvulus," the authors write. "There is little, if any data in New Zealand or Australia on long-term follow-up of sigmoid volvulus." The authors analyzed 57 patients (from a total of 84 admissions for sigmoid volvulus) who were admitted to the Department o…
Post a Comment
Read more

Secondary Prevention: Clinical Approaches to Managing the Higher-Risk Patient with Heart Disease

INCIDENCE/PREVALENCE/BURDENS ASSOCIATED WITH CARDIOVASCULAR DISEASE (CVD) The prevention of an initial and recurrent cardiovascular event and other complications, such as diabetes and kidney failure [also known as end-stage renal disease (ESRD) or chronic kidney disease (CKD) stage 5] is an important goal in patients with a history of CVD. Each year, approximately 185,000 Americans suffer a recurrent stroke, approximately 470,000 will have a recurrent coronary attack, and an estimated 325,000 will suffer a recurrent myocardial infarction.[1] Secondary prevention strategies offer the opportunity to prevent further complications and improve outcomes by early detection and management of common comorbidities. The burden on public health and the costs associated with chronic illnesses such as CVD, CKD, and diabetes remain high. An estimated 82.6 million American adults (1 in 3) have 1 or more types of CVD.[1] Heart failure is the fastest-growing clinical cardiac disease entity in the Unit…
Post a Comment
Read more

Sexsomnia: Clinical Analysis of an Underdiagnosed Parasomnia

Introduction Sexsomnia, also known as sleep sex or somnambulistic sexual behavior, refers to unintentional sexual behaviors or activities during sleep. Sexsomnia is a relatively new diagnosis. The term was coined by Shapiro and colleagues in 2003,[1] but cases of this condition have been reported in the literature for the past 3 decades.[2,3] Sexual behavior during sleep automatism can range from explicit vocalizations to touching or sexual intercourse, and in some cases even sexual assault or rape. It is non-rapid eye movement (NREM) parasomnia characterized by abnormal transitions between sleep and wake states. The second edition of the International Classification of Sleep Disorders (ICSD-2) discusses somnambulistic sexual activity in the context of disorders of arousal from NREM sleep.[4] Most commonly, NREM parasomnias arise from slow-wave sleep (SWS). Because of a relative lack of cortical control, partial arousals from this deep state of sleep can lead to uninhibited manifesta…
Post a Comment
Read more