Periprocedural stroke, unrelated to the access site?

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.

SOLACI.ORG

More articles by this author

Radial Patency in Coronary Procedures: Is Heparin Enough or Should We Aim for Distal Transradial Access?

Transradial access is the preferred route in most coronary procedures due to its proven reduction in mortality compared to transfemoral access. However, one of...

iFR- vs. FFR-Guided Coronary Revascularization: 5-Year Clinical Outcomes

The assessment of coronary stenosis using coronary physiology has become a key tool in guiding revascularization. The two most widely used techniques are fractional...

Patients at High Risk of Bleeding After Coronary Angioplasty: Are Risk Assessment Tools ARC-HBR and PRECISE-DAPT Useful?

Patients undergoing coronary stenting typically receive dual antiplatelet therapy (DAPT) for 6 to 12 months, consisting of a P2Y12 receptor inhibitor and aspirin. While DAPT...

ACC 2025 | WARRIOR: Ischemia in Women with Non-Obstructive Coronary Artery Disease

Approximately half of all women with symptomatic ischemia who undergo coronary angiography are found to have non-obstructive coronary artery disease ((ischemia and non-obstructive coronary...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Percutaneous Tricuspid Valve Replacement with Lux-Valve

Tricuspid regurgitation (TR) is a condition associated with poor quality of life, frequent hospitalizations due to heart failure, and increased mortality, even under optimal...

Transcatheter Pulmonary Valve Implantation with a Self-Expanding Valve: Outcomes at 3 Years

Pulmonary regurgitation (PR) is a common condition in patients who have undergone surgical repair of Tetralogy of Fallot or other pathologies involving the right...

Radial Patency in Coronary Procedures: Is Heparin Enough or Should We Aim for Distal Transradial Access?

Transradial access is the preferred route in most coronary procedures due to its proven reduction in mortality compared to transfemoral access. However, one of...