Original title: Influence of access site choice on incidence of neurologic complications after percutaneous coronary intervention. Reference: Karim Ratib et al. Am Heart J 2012;0:1-8 Article in press.
Neurological complications post coronary angioplasty (PCA) are sporadic but they are associated with eight times increased mortality.
A transradial approach has multiple advantages over femoral but could theoretically have a higher incidence of cerebrovacular accident (CVA) because of the passage of catheters for subclavian artery and brachiocephalic trunk. This study included 370,238 patients from the angioplasty registry of the British Society of Interventional Cardiology (BCIS) conducted over a period of five years. From 2006 to 2010 the percentage of radial access increased from 17.1% to 50.8%, (p <0.0001).
The patients who received radial access were more often young men with a previous history of stroke, peripheral vascular disease or diagnosed with acute coronary syndrome and infusion of glycoprotein IIBIIIA but less diabetic. Those who received femoral acces showed more frequent renal failure, previous revascularization and those who had been in shock required Intraaortic balloon pump counterpulsation (IABP). After adjusting for all the variables we observed an identical (0.11%) incidence of stroke between the two accesses. If predictors resulted, use of IABP, previous history of stroke, shock and acute coronary syndrome presentation. During the 5 years, the incidence of stroke post PCA increased from 0.08% to 0.14% (p <0.001) but there was no difference between access sites.
Conclusion
In this large cohort of patients, the access site for angioplasty was not a predictor of periprocedural neurological events.
Editorial Comment:
With the limitations of being purely observational, this is the largest cohort that was dedicated specifically to finding differences between approaches. Bearing in mind the rapid femoral to radial change, it would be expected with a large number of surgeons at the beginning of the learning curve but, despite this, the incidence of stroke was identical. The increase in the overall incidence of stroke was observed post angioplasty but could be due to the increased complexity of patients treated.
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