Comparison of radial, brachial, and femoral accesses using hemostatic devices for percutaneous coronary intervention
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ORIGINAL ARTICLE
Comparison of radial, brachial, and femoral accesses using hemostatic devices for percutaneous coronary intervention Masaya Otsuka1 • Nobuo Shiode1 • Yasuhisa Nakao1 • Yuki Ikegami1 • Yusuke Kobayashi1 • Arinori Takeuchi1 • Ayako Harima1 • Tadanao Higaki1 Kuniomi Oi1 • Kazuoki Dai1 • Tomoharu Kawase1 • Yasuharu Nakama1 • Kazuyoshi Suenari1 • Kenji Nishioka1 • Koyu Sakai1 • Yuji Shimatani1 • Yoshiko Masaoka1 • Ichiro Inoue1
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Received: 21 July 2016 / Accepted: 4 November 2016 Japanese Association of Cardiovascular Intervention and Therapeutics 2016
Abstract Some studies have suggested that radial access (RA) for percutaneous coronary intervention (PCI) reduces vascular complications and bleeding compared to femoral access (FA). The purpose of this study was to investigate the routine use of hemostatic devices and bleeding complications among RA, brachial access (BA), and FA. Between January 2015 and December 2015, 298 patients treated for PCI with RA were compared with 158 patients using BA and 206 patients using FA. The radial sheath was routinely removed with ADAPTY, the brachial sheath with BLEED SAFE, and the femoral sheath with Perclose ProGlide. In-hospital bleeding complications were investigated. Cardiogenic shock was most frequent in patients in the femoral group (RA 1.3%, BA 2.5%, FA 9.2%, p \ 0.0001). The rate of major bleeding was highest in the femoral group (RA 1.0%, BA 2.5%, FA 5.3%, p = 0.01). Blood transfusion rates were highest in the femoral group (RA 0.7%, BA 1.3%, FA 4.4%, p = 0.01). Retroperitoneal bleeding was observed in 1.9% of patients in the femoral group. Patients in the brachial group had large hematomas (RA 0.7%, BA 4.4%, FA 1.5%, p = 0.01). Pseudoaneurysm formation needing intervention occurred most frequently in the brachial group (RA 0%, BA 1.3%, FA 0%, p = 0.04). In conclusion, compared to the brachial and femoral approaches, the radial approach appears to be the safest technique to avoid local vascular bleeding complications. The brachial approach has the highest risk of large
& Masaya Otsuka [email protected] 1
Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-machi, Naka-ku, Hiroshima 730-8518, Japan
hematoma and pseudoaneurysm formation among the three groups. Keywords Radial access Brachial access Femoral access Percutaneous coronary intervention Hemostatic device Abbreviations PCI Percutaneous coronary intervention RA Radial access BA Brachial access FA Femoral access IABP Intraaortic balloon pump counterpulsation DAPT Dual antiplatelet therapy CABG Coronary artery bypass graft surgery BARC Bleeding Academic Research Consortium ARC Academic Research Consortium MI Myocardial infarction TLR Target lesion revascularization MACE Major adverse cardiac event NACE Net adverse clinical event CTO Chronic total occlusion PCPS Percutaneous cardiopulmonary support
Introduction Major bleeding complications are associated with an increased risk of post-percutaneous coronary intervention (PCI) morbidity and mortal
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