Safety and efficacy of radial versus femoral access for rotational Atherectomy: A systematic review and meta-analysis
Over the recent years, there has been increased interest in the use of transradial (TR) access for percutaneous coronary intervention (PCI), including rotational atherectomy (RA). However, a large proportion of operators seem to be reluctant to use TR access for complex PCI including rotational athe...
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| Veröffentlicht in: | Cardiovascular revascularization medicine 2019-03, Vol.20 (3), p.241-247 |
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| creator | Khan, Abdul Ahad Panchal, Hemang B. Zaidi, Syed Imran M. Papireddy, Muralidhar R. Mukherjee, Debabrata Cohen, Mauricio G. Banerjee, Subhash Rao, Sunil V. Pancholy, Samir Paul, Timir K. |
| description | Over the recent years, there has been increased interest in the use of transradial (TR) access for percutaneous coronary intervention (PCI), including rotational atherectomy (RA). However, a large proportion of operators seem to be reluctant to use TR access for complex PCI including rotational atherectomy for heavily calcified coronary lesions.
We searched MEDLINE, ClinicalTrials.gov and the Cochrane Library for studies comparing radial versus femoral access in patients undergoing RA. Studies were included if they reported at least one of the following outcomes in each group separately: major adverse cardiac events (MACE), major bleeding, stent thrombosis, myocardial infarction (MI), hospital length of stay, radiation exposure, procedure time, procedure success and all-cause mortality. Odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) were calculated and a p-value of |
| doi_str_mv | 10.1016/j.carrev.2018.06.006 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2073329781</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1553838918302501</els_id><sourcerecordid>2073329781</sourcerecordid><originalsourceid>FETCH-LOGICAL-c428t-38eff9e42489d2ce4e08533c49c3002167daa3fe37c2cb3470252e9f9a1ec3973</originalsourceid><addsrcrecordid>eNp9kEtv1DAQgC0EoqXwDxDykUuCH0lsc0BaVbykShyAs-VOxsKrzbrYTlH-PbNs4cjJM_Y3D3-MvZSil0JOb_Y9hFLwvldC2l5MvRDTI3YprbGdcNo-pngcdWe1dRfsWa17IbRRk3nKLjSFhI-XbP0aIraNh-PMMcYEATaeIy9hTuHA77HUtfKISy6UBgCslObCS26hpXyk2137gQWh5WV7y3e8brXhQo_Aab2Ev_40X7CFLhC-1VSfsycxHCq-eDiv2PcP779df-puvnz8fL276WBQtnXa0koOBzVYNyvAAYUdtYbBAa2v5GTmEHREbUDBrR6MUKNCF12QCNoZfcVen_velfxzxdr8kirg4RCOmNfqlTBaK2esJHQ4o1ByrQWjvytpCWXzUviTcL_3Z-H-JNyLyZNBKnv1MGG9XXD-V_TXMAHvzgDSP8lG8RUSHgHndHLm55z-P-E3JMSVDA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2073329781</pqid></control><display><type>article</type><title>Safety and efficacy of radial versus femoral access for rotational Atherectomy: A systematic review and meta-analysis</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Khan, Abdul Ahad ; Panchal, Hemang B. ; Zaidi, Syed Imran M. ; Papireddy, Muralidhar R. ; Mukherjee, Debabrata ; Cohen, Mauricio G. ; Banerjee, Subhash ; Rao, Sunil V. ; Pancholy, Samir ; Paul, Timir K.</creator><creatorcontrib>Khan, Abdul Ahad ; Panchal, Hemang B. ; Zaidi, Syed Imran M. ; Papireddy, Muralidhar R. ; Mukherjee, Debabrata ; Cohen, Mauricio G. ; Banerjee, Subhash ; Rao, Sunil V. ; Pancholy, Samir ; Paul, Timir K.</creatorcontrib><description>Over the recent years, there has been increased interest in the use of transradial (TR) access for percutaneous coronary intervention (PCI), including rotational atherectomy (RA). However, a large proportion of operators seem to be reluctant to use TR access for complex PCI including rotational atherectomy for heavily calcified coronary lesions.
We searched MEDLINE, ClinicalTrials.gov and the Cochrane Library for studies comparing radial versus femoral access in patients undergoing RA. Studies were included if they reported at least one of the following outcomes in each group separately: major adverse cardiac events (MACE), major bleeding, stent thrombosis, myocardial infarction (MI), hospital length of stay, radiation exposure, procedure time, procedure success and all-cause mortality. Odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) were calculated and a p-value of <0.05 was considered as a level of significance.
This meta-analysis included 5 retrospective studies with 3315 patients undergoing RA via radial access and 5838 patients via femoral access. Radial access was associated with lower major access site bleeding (OR: 0.45, 95% CI: 0.31–0.67, p < 0.001), and radiation exposure (MD: −16.1, 95%CI: −25.4–−6.7 Gy cm2, p = 0.0007). There were no significant differences observed in all-cause in-hospital mortality (OR: 0.92, 95% CI: 0.69–1.23, p = 0.58); MACE (OR: 0.80, CI: 0.63, 1.02, p = 0.08), stent thrombosis (OR: 0.28, 95%CI: 0.06–1.33 p = 0.11); and MI (OR: 0.43, 95%CI: 0.15–1.24, p = 0.12). There were no significant differences in hospital stay, procedure time or procedure success between the two groups (p > 0.05).
This meta-analysis of 9153 patients from observational studies demonstrates similar all-cause mortality, MACE, procedural success and procedural time during RA performed using TR access and TF access. However, TR access was associated with decreased access site bleeding and radiation exposure. Given the observational nature of these findings, a randomized controlled trial is warranted for further evidence.
•This article compares Radial versus Femoral access for Rotational Atherectomy.•Similar all-cause mortality, MACE rates between both groups•Similar procedural success and procedural time between both groups•Transradial approach associated with decreased bleeding and radiation exposure</description><identifier>ISSN: 1553-8389</identifier><identifier>EISSN: 1878-0938</identifier><identifier>DOI: 10.1016/j.carrev.2018.06.006</identifier><identifier>PMID: 30030065</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Atherectomy, Coronary - adverse effects ; Atherectomy, Coronary - mortality ; Catheterization, Peripheral - adverse effects ; Catheterization, Peripheral - mortality ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - mortality ; Coronary Artery Disease - therapy ; Female ; Femoral ; Femoral Artery - diagnostic imaging ; Humans ; Male ; Middle Aged ; Observational Studies as Topic ; Punctures ; Radial ; Radial Artery - diagnostic imaging ; Risk Assessment ; Risk Factors ; Rotablation ; Rotational Atherectomy ; Treatment Outcome ; Vascular Calcification - diagnostic imaging ; Vascular Calcification - mortality ; Vascular Calcification - therapy</subject><ispartof>Cardiovascular revascularization medicine, 2019-03, Vol.20 (3), p.241-247</ispartof><rights>2018 Elsevier Inc.</rights><rights>Copyright © 2018 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-38eff9e42489d2ce4e08533c49c3002167daa3fe37c2cb3470252e9f9a1ec3973</citedby><cites>FETCH-LOGICAL-c428t-38eff9e42489d2ce4e08533c49c3002167daa3fe37c2cb3470252e9f9a1ec3973</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.carrev.2018.06.006$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30030065$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Khan, Abdul Ahad</creatorcontrib><creatorcontrib>Panchal, Hemang B.</creatorcontrib><creatorcontrib>Zaidi, Syed Imran M.</creatorcontrib><creatorcontrib>Papireddy, Muralidhar R.</creatorcontrib><creatorcontrib>Mukherjee, Debabrata</creatorcontrib><creatorcontrib>Cohen, Mauricio G.</creatorcontrib><creatorcontrib>Banerjee, Subhash</creatorcontrib><creatorcontrib>Rao, Sunil V.</creatorcontrib><creatorcontrib>Pancholy, Samir</creatorcontrib><creatorcontrib>Paul, Timir K.</creatorcontrib><title>Safety and efficacy of radial versus femoral access for rotational Atherectomy: A systematic review and meta-analysis</title><title>Cardiovascular revascularization medicine</title><addtitle>Cardiovasc Revasc Med</addtitle><description>Over the recent years, there has been increased interest in the use of transradial (TR) access for percutaneous coronary intervention (PCI), including rotational atherectomy (RA). However, a large proportion of operators seem to be reluctant to use TR access for complex PCI including rotational atherectomy for heavily calcified coronary lesions.
We searched MEDLINE, ClinicalTrials.gov and the Cochrane Library for studies comparing radial versus femoral access in patients undergoing RA. Studies were included if they reported at least one of the following outcomes in each group separately: major adverse cardiac events (MACE), major bleeding, stent thrombosis, myocardial infarction (MI), hospital length of stay, radiation exposure, procedure time, procedure success and all-cause mortality. Odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) were calculated and a p-value of <0.05 was considered as a level of significance.
This meta-analysis included 5 retrospective studies with 3315 patients undergoing RA via radial access and 5838 patients via femoral access. Radial access was associated with lower major access site bleeding (OR: 0.45, 95% CI: 0.31–0.67, p < 0.001), and radiation exposure (MD: −16.1, 95%CI: −25.4–−6.7 Gy cm2, p = 0.0007). There were no significant differences observed in all-cause in-hospital mortality (OR: 0.92, 95% CI: 0.69–1.23, p = 0.58); MACE (OR: 0.80, CI: 0.63, 1.02, p = 0.08), stent thrombosis (OR: 0.28, 95%CI: 0.06–1.33 p = 0.11); and MI (OR: 0.43, 95%CI: 0.15–1.24, p = 0.12). There were no significant differences in hospital stay, procedure time or procedure success between the two groups (p > 0.05).
This meta-analysis of 9153 patients from observational studies demonstrates similar all-cause mortality, MACE, procedural success and procedural time during RA performed using TR access and TF access. However, TR access was associated with decreased access site bleeding and radiation exposure. Given the observational nature of these findings, a randomized controlled trial is warranted for further evidence.
•This article compares Radial versus Femoral access for Rotational Atherectomy.•Similar all-cause mortality, MACE rates between both groups•Similar procedural success and procedural time between both groups•Transradial approach associated with decreased bleeding and radiation exposure</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Atherectomy, Coronary - adverse effects</subject><subject>Atherectomy, Coronary - mortality</subject><subject>Catheterization, Peripheral - adverse effects</subject><subject>Catheterization, Peripheral - mortality</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - mortality</subject><subject>Coronary Artery Disease - therapy</subject><subject>Female</subject><subject>Femoral</subject><subject>Femoral Artery - diagnostic imaging</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Observational Studies as Topic</subject><subject>Punctures</subject><subject>Radial</subject><subject>Radial Artery - diagnostic imaging</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Rotablation</subject><subject>Rotational Atherectomy</subject><subject>Treatment Outcome</subject><subject>Vascular Calcification - diagnostic imaging</subject><subject>Vascular Calcification - mortality</subject><subject>Vascular Calcification - therapy</subject><issn>1553-8389</issn><issn>1878-0938</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEtv1DAQgC0EoqXwDxDykUuCH0lsc0BaVbykShyAs-VOxsKrzbrYTlH-PbNs4cjJM_Y3D3-MvZSil0JOb_Y9hFLwvldC2l5MvRDTI3YprbGdcNo-pngcdWe1dRfsWa17IbRRk3nKLjSFhI-XbP0aIraNh-PMMcYEATaeIy9hTuHA77HUtfKISy6UBgCslObCS26hpXyk2137gQWh5WV7y3e8brXhQo_Aab2Ev_40X7CFLhC-1VSfsycxHCq-eDiv2PcP779df-puvnz8fL276WBQtnXa0koOBzVYNyvAAYUdtYbBAa2v5GTmEHREbUDBrR6MUKNCF12QCNoZfcVen_velfxzxdr8kirg4RCOmNfqlTBaK2esJHQ4o1ByrQWjvytpCWXzUviTcL_3Z-H-JNyLyZNBKnv1MGG9XXD-V_TXMAHvzgDSP8lG8RUSHgHndHLm55z-P-E3JMSVDA</recordid><startdate>201903</startdate><enddate>201903</enddate><creator>Khan, Abdul Ahad</creator><creator>Panchal, Hemang B.</creator><creator>Zaidi, Syed Imran M.</creator><creator>Papireddy, Muralidhar R.</creator><creator>Mukherjee, Debabrata</creator><creator>Cohen, Mauricio G.</creator><creator>Banerjee, Subhash</creator><creator>Rao, Sunil V.</creator><creator>Pancholy, Samir</creator><creator>Paul, Timir K.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201903</creationdate><title>Safety and efficacy of radial versus femoral access for rotational Atherectomy: A systematic review and meta-analysis</title><author>Khan, Abdul Ahad ; Panchal, Hemang B. ; Zaidi, Syed Imran M. ; Papireddy, Muralidhar R. ; Mukherjee, Debabrata ; Cohen, Mauricio G. ; Banerjee, Subhash ; Rao, Sunil V. ; Pancholy, Samir ; Paul, Timir K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c428t-38eff9e42489d2ce4e08533c49c3002167daa3fe37c2cb3470252e9f9a1ec3973</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Atherectomy, Coronary - adverse effects</topic><topic>Atherectomy, Coronary - mortality</topic><topic>Catheterization, Peripheral - adverse effects</topic><topic>Catheterization, Peripheral - mortality</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Artery Disease - mortality</topic><topic>Coronary Artery Disease - therapy</topic><topic>Female</topic><topic>Femoral</topic><topic>Femoral Artery - diagnostic imaging</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Observational Studies as Topic</topic><topic>Punctures</topic><topic>Radial</topic><topic>Radial Artery - diagnostic imaging</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Rotablation</topic><topic>Rotational Atherectomy</topic><topic>Treatment Outcome</topic><topic>Vascular Calcification - diagnostic imaging</topic><topic>Vascular Calcification - mortality</topic><topic>Vascular Calcification - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Khan, Abdul Ahad</creatorcontrib><creatorcontrib>Panchal, Hemang B.</creatorcontrib><creatorcontrib>Zaidi, Syed Imran M.</creatorcontrib><creatorcontrib>Papireddy, Muralidhar R.</creatorcontrib><creatorcontrib>Mukherjee, Debabrata</creatorcontrib><creatorcontrib>Cohen, Mauricio G.</creatorcontrib><creatorcontrib>Banerjee, Subhash</creatorcontrib><creatorcontrib>Rao, Sunil V.</creatorcontrib><creatorcontrib>Pancholy, Samir</creatorcontrib><creatorcontrib>Paul, Timir K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Cardiovascular revascularization medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Khan, Abdul Ahad</au><au>Panchal, Hemang B.</au><au>Zaidi, Syed Imran M.</au><au>Papireddy, Muralidhar R.</au><au>Mukherjee, Debabrata</au><au>Cohen, Mauricio G.</au><au>Banerjee, Subhash</au><au>Rao, Sunil V.</au><au>Pancholy, Samir</au><au>Paul, Timir K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety and efficacy of radial versus femoral access for rotational Atherectomy: A systematic review and meta-analysis</atitle><jtitle>Cardiovascular revascularization medicine</jtitle><addtitle>Cardiovasc Revasc Med</addtitle><date>2019-03</date><risdate>2019</risdate><volume>20</volume><issue>3</issue><spage>241</spage><epage>247</epage><pages>241-247</pages><issn>1553-8389</issn><eissn>1878-0938</eissn><abstract>Over the recent years, there has been increased interest in the use of transradial (TR) access for percutaneous coronary intervention (PCI), including rotational atherectomy (RA). However, a large proportion of operators seem to be reluctant to use TR access for complex PCI including rotational atherectomy for heavily calcified coronary lesions.
We searched MEDLINE, ClinicalTrials.gov and the Cochrane Library for studies comparing radial versus femoral access in patients undergoing RA. Studies were included if they reported at least one of the following outcomes in each group separately: major adverse cardiac events (MACE), major bleeding, stent thrombosis, myocardial infarction (MI), hospital length of stay, radiation exposure, procedure time, procedure success and all-cause mortality. Odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) were calculated and a p-value of <0.05 was considered as a level of significance.
This meta-analysis included 5 retrospective studies with 3315 patients undergoing RA via radial access and 5838 patients via femoral access. Radial access was associated with lower major access site bleeding (OR: 0.45, 95% CI: 0.31–0.67, p < 0.001), and radiation exposure (MD: −16.1, 95%CI: −25.4–−6.7 Gy cm2, p = 0.0007). There were no significant differences observed in all-cause in-hospital mortality (OR: 0.92, 95% CI: 0.69–1.23, p = 0.58); MACE (OR: 0.80, CI: 0.63, 1.02, p = 0.08), stent thrombosis (OR: 0.28, 95%CI: 0.06–1.33 p = 0.11); and MI (OR: 0.43, 95%CI: 0.15–1.24, p = 0.12). There were no significant differences in hospital stay, procedure time or procedure success between the two groups (p > 0.05).
This meta-analysis of 9153 patients from observational studies demonstrates similar all-cause mortality, MACE, procedural success and procedural time during RA performed using TR access and TF access. However, TR access was associated with decreased access site bleeding and radiation exposure. Given the observational nature of these findings, a randomized controlled trial is warranted for further evidence.
•This article compares Radial versus Femoral access for Rotational Atherectomy.•Similar all-cause mortality, MACE rates between both groups•Similar procedural success and procedural time between both groups•Transradial approach associated with decreased bleeding and radiation exposure</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30030065</pmid><doi>10.1016/j.carrev.2018.06.006</doi><tpages>7</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Atherectomy, Coronary - adverse effects Atherectomy, Coronary - mortality Catheterization, Peripheral - adverse effects Catheterization, Peripheral - mortality Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - mortality Coronary Artery Disease - therapy Female Femoral Femoral Artery - diagnostic imaging Humans Male Middle Aged Observational Studies as Topic Punctures Radial Radial Artery - diagnostic imaging Risk Assessment Risk Factors Rotablation Rotational Atherectomy Treatment Outcome Vascular Calcification - diagnostic imaging Vascular Calcification - mortality Vascular Calcification - therapy |
| title | Safety and efficacy of radial versus femoral access for rotational Atherectomy: A systematic review and meta-analysis |
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