P6519Transulnar approach vs. left radial access in STEMI patients: experiences from a single high volume center
| Autor: | Danica Petkoska, Aleksandar Jovkovski, B. Zafirovska Taleska, Ivan Vasilev, D. Kitanovski, Sasko Kedev |
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| Rok vydání: | 2019 |
| Předmět: | |
| Zdroj: | European Heart Journal. 40 |
| ISSN: | 1522-9645 0195-668X |
| DOI: | 10.1093/eurheartj/ehz746.1109 |
| Popis: | Background Transulnar and left radial artery approach are alternative wrist access sites from right TRA for coronary diagnostic and interventional procedures. Using wrist approach in all STEMI patients can decrease access site bleeding and vascular complications, improve patient outcomes and reduce MACCE, allowing rapid ambulation. Purpose To compare the results of the two most common wrist access crossover sites from right TRA in a large single center registry of consecutive STEMI PPCI patients. Methods From March 2011 until December 2017, 5048 consecutive STEMI patients that underwent catheterization were included in a single center prospective registry. Right radial access was used in 97% (4891) of patients. From the total number of STEMI patients, Transulnar approach was used in 95 (1.9%) patients. LRA was used in 43 (0.8%), TFA in 8 (0.1%) and TBA in 11 (0.2%). We compared two groups of patients with TUA and LRA by analyzing access site complications, procedural characteristics, procedural and fluoroscopy time. Results All procedures were successfully performed through TUA and LRA. Procedural time was slightly longer in STEMI patients with LRA transfer (41±16 vs. 38±16 min), but there was no significant difference between patients with TUA and LRA transfer in terms of fluoroscopy time (10±9.3 vs. 10±6.8 min), procedural success and vascular complications. Patients with TUA had significantly smaller number of anomalies 1% vs. 14% in LRA and were less prone to high degree spasm 1% vs. 4,6%. Both access sites had similar number of patients with multiple access site punctures 7.3% vs. 6.9%. Hand ischemia was not observed in any patient on day 1 after procedure and on 1 month follow-up. None of the patients showed nerve injury. Minor access site hematomas were similar with 2% EASY type 1 hematoma present in both groups. TUA vs. LRA STEMI STEMI (n=5048) LRA TUA P value ACCESS 43 (0,8%) 95 (1,9%) Anomalies 7 (14%) 1 (1%) P3 3 (6,9%) 7 (7,3%) NA High grade spasm 2 (4.6%) 1 (1%) P TUA vs.LRA STEMI Conclusion Both transulnar and left radial access are safe and feasible alternatives to the default right radial approach, decreasing the need of TFA crossover in STEMI patients. |
| Databáze: | OpenAIRE |
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