Advertisement

Radial Versus Femoral Access for the Treatment of Left Main Lesion in the Era of Second-Generation Drug-Eluting Stents

      Transradial access (TRA) is often avoided in favor of the transfemoral access (TFA) during percutaneous coronary interventions of the unprotected left main coronary artery (ULM), due to technical and safety concerns. The aim of this study was to compare the performance of TRA and TFA in the treatment of ULM with second-generation drug-eluting stents. Consecutive patients who underwent percutaneous coronary intervention on ULM with second-generation drug-eluting stents were retrospectively enrolled in the multicenter Failure in Left Main Study With 2nd Generation Stents (FAILS 2) registry. Patients were stratified according to the arterial access. The choice between TRA and TFA was left to each operator's preferences. Bleedings during index hospitalization were the primary end point. Secondary end points were major adverse cardiovascular events (a composite of death, reinfarction, and target lesion revascularization), the single components of major adverse cardiovascular events at follow-up and stent thrombosis. Propensity score matching was executed to account for possible confounding. Overall, 1,247 patients were enrolled (23.2% [289] of female gender, mean age 70.2 ± 10.2 years). Diagnosis at presentation was stable angina in 603 (48.7%) cases, non–ST-segment elevation acute coronary syndrome in 465 (37.3%), ST-segment elevation myocardial infarction in 117 (9.5%). Mean follow-up was 726 ± 654 days. After propensity score with matching, 354 patients were included. The primary end point was significantly reduced in patients treated with TRA (2.0% vs 4.0%, p = 0.042), whereas no differences emerged pertaining the secondary end points, including target lesion revascularization and reinfarction. In conclusion, TRA may reduce in-hospital bleedings in patients undergoing percutaneous treatment of the ULM, without increasing the rate of adverse cardiovascular events at follow-up, and may therefore be safely used in the treatment of the ULM.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Valgimigli M.
        • Gagnor A.
        • Calabró P.
        • Frigoli E.
        • Leonardi S.
        • Zaro T.
        • Rubartelli P.
        • Briguori C.
        • Andò G.
        • Repetto A.
        • Limbruno U.
        • Cortese B.
        • Sganzerla P.
        • Lupi A.
        • Galli M.
        • Colangelo S.
        • Ierna S.
        • Ausiello A.
        • Presbitero P.
        • Sardella G.
        • Varbella F.
        • Esposito G.
        • Santarelli A.
        • Tresoldi S.
        • Nazzaro M.
        • Zingarelli A.
        • de Cesare N.
        • Rigattieri S.
        • Tosi P.
        • Palmieri C.
        • Brugaletta S.
        • Rao S.V.
        • Heg D.
        • Rothenbühler M.
        • Vranckx P.
        • Jüni P.
        • MATRIX Investigators
        Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial.
        Lancet. 2015; 385: 2465-2476
        • Romagnoli E.
        • Biondi-Zoccai G.
        • Sciahbasi A.
        • Politi L.
        • Rigattieri S.
        • Pendenza G.
        • Summaria F.
        • Patrizi R.
        • Borghi A.
        • Di Russo C.
        • Moretti C.
        • Agostoni P.
        • Loschiavo P.
        • Lioy E.
        • Sheiban I.
        • Sangiorgi G.
        Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study.
        J Am Coll Cardiol. 2012; 60: 2481-2489
        • Hamon M.
        • Pristipino C.
        • Di Mario C.
        • Nolan J.
        • Ludwig J.
        • Tubaro M.
        • Sabate M.
        • Mauri-Ferré J.
        • Huber K.
        • Niemelä K.
        • Haude M.
        • Wijns W.
        • Dudek D.
        • Fajadet J.
        • Kiemeneij F.
        • European Association of Percutaneous Cardiovascular Interventions
        • Working Group on Acute Cardiac Care of the European Society of Cardiology
        • Working Group on Thrombosis on the European Society of Cardiology
        Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care** and thrombosis of the European Society of Cardiology.
        EuroIntervention. 2013; 8: 1242-1251
        • D'Ascenzo F.
        • Presutti D.G.
        • Picardi E.
        • Moretti C.
        • Omedè P.
        • Sciuto F.
        • Novara M.
        • Yan A.T.
        • Goodman S.
        • Mahajan N.
        • Kosuge M.
        • Palazzuoli A.
        • Jong G.P.
        • Isma'eel H.
        • Budoff M.J.
        • Rubinshtein R.
        • Gewirtz H.
        • Reed M.J.
        • Theroux P.
        • Biondi-Zoccai G.
        • Modena M.G.
        • Sheiban I.
        • Gaita F.
        Prevalence and non-invasive predictors of left main or three-vessel coronary disease: evidence from a collaborative international meta-analysis including 22 740 patients.
        Heart. 2012; 98: 914-919
        • Lee M.S.
        • Wolfe M.
        • Stone G.W.
        Transradial versus transfemoral percutaneous coronary intervention in acute coronary syndromes: re-evaluation of the current body of evidence.
        JACC Cardiovasc Interv. 2013; 6: 1149-1152
        • Yang Y.J.
        • Kandzari D.E.
        • Gao Z.
        • Xu B.
        • Chen J.L.
        • Qiao S.B.
        • Li J.J.
        • Qin X.W.
        • Yao M.
        • Wu Y.J.
        • Yuan J.Q.
        • Chen J.
        • Liu H.B.
        • Dai J.
        • Chen T.
        • Wang Y.
        • Li W.
        • Gao R.L.
        Transradial versus transfemoral method of percutaneous coronary revascularization for unprotected left main coronary artery disease: comparison of procedural and late-term outcomes.
        JACC Cardiovasc Interv. 2010; 3: 1035-1042
        • Egred M.
        Feasibility and safety of 7-Fr radial approach for complex PCI.
        J Interv Cardiol. 2011; 24: 383-388
        • D'Ascenzo F.
        • Chieffo A.
        • Cerrato E.
        • Ugo F.
        • Pavani M.
        • Kawamoto H.
        • di Summa R.
        • Varbella F.
        • Boccuzzi G.
        • Omedè P.
        • Rettegno S.
        • Garbo R.
        • Conrotto F.
        • Montefusco A.
        • Biondi-Zoccai G.
        • D'Amico M.
        • Moretti C.
        • Escaned J.
        • Gaita F.
        • Colombo A.
        Incidence and management of restenosis after treatment of unprotected left main disease with second-generation drug-eluting stents (from failure in left main study with 2nd generation stents-cardiogroup III study).
        Am J Cardiol. 2017; 119: 978-982
        • Sianos G.
        • Morel M.A.
        • Kappetein A.P.
        • Morice M.C.
        • Colombo A.
        • Dawkins K.
        • van den Brand M.
        • Van Dyck N.
        • Russell M.E.
        • Mohr F.W.
        • Serruys P.W.
        The SYNTAX score: an angiographic tool grading the complexity of coronary artery disease.
        EuroIntervention. 2005; 1: 219-227
        • Montalescot G.
        • Sechtem U.
        • Achenbach S.
        • Andreotti F.
        • Arden C.
        • Budaj A.
        • Bugiardini R.
        • Crea F.
        • Cuisset T.
        • Di Mario C.
        • Ferreira J.R.
        • ersh B.J.
        • Gitt A.K.
        • Hulot J.S.
        • Marx N.
        • Opie L.H.
        • Pfisterer M.
        • Prescott E.
        • Ruschitzka F.
        • Sabaté M.
        • Senior R.
        • Taggart D.P.
        • van der Wall E.E.
        • Vrints C.J.
        • Zamorano J.L.
        • Achenbach S.
        • Baumgartner H.
        • Bax J.J.
        • Bueno H.
        • Dean V.
        • Deaton C.
        • Erol C.
        • Fagard R.
        • Ferrari R.
        • Hasdai D.
        • Hoes A.W.
        • Kirchhof P.
        • Knuuti J.
        • Kolh P.
        • Lancellotti P.
        • Linhart A.
        • Nihoyannopoulos P.
        • Piepoli M.F.
        • Ponikowski P.
        • Sirnes P.A.
        • Tamargo J.L.
        • Tendera M.
        • Torbicki A.
        • Wijns W.
        • Windecker S.
        • Knuuti J.
        • Valgimigli M.
        • Bueno H.
        • Claeys M.J.
        • Donner-Banzhoff N.
        • Erol C.
        • Frank H.
        • Funck-Brentano C.
        • Gaemperli O.
        • Gonzalez-Juanatey J.R.
        • Hamilos M.
        • Hasdai D.
        • Husted S.
        • James S.K.
        • Kervinen K.
        • Kolh P.
        • Kristensen S.D.
        • Lancellotti P.
        • Maggioni A.P.
        • Piepoli M.F.
        • Pries A.R.
        • Romeo F.
        • Rydén L.
        • Simoons M.L.
        • Sirnes P.A.
        • Steg P.G.
        • Timmis A.
        • Wijns W.
        • Windecker S.
        • Yildirir A.
        • Zamorano J.L.
        • Task Force Members
        • ESC Committee for Practice Guidelines
        • Document Reviewers
        2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology.
        Eur Heart J. 2013; 34: 2949-3003
        • Roffi M.
        • Patrono C.
        • Collet J.P.
        • Mueller C.
        • Valgimigli M.
        • Andreotti F.
        • Bax J.J.
        • Borger M.A.
        • Brotons C.
        • Chew D.P.
        • Gencer B.
        • Hasenfuss G.
        • Kjeldsen K.
        • Lancellotti P.
        • Landmesser U.
        • Mehilli J.
        • Mukherjee D.
        • Storey R.F.
        • Windecker S.
        • Baumgartner H.
        • Gaemperli O.
        • Achenbach S.
        • Agewall S.
        • Badimon L.
        • Baigent C.
        • Bueno H.
        • Bugiardini R.
        • Carerj S.
        • Casselman F.
        • Cuisset T.
        • Erol Ç.
        • Fitzsimons D.
        • Halle M.
        • Hamm C.
        • Hildick-Smith D.
        • Huber K.
        • Iliodromitis E.
        • James S.
        • Lewis B.S.
        • Lip G.Y.
        • Piepoli M.F.
        • Richter D.
        • Rosemann T.
        • Sechtem U.
        • Steg P.G.
        • Vrints C.
        • Luis Zamorano J.
        • Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology
        2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).
        Eur Heart J. 2016; 37: 267-315
        • Steg P.G.
        • James S.K.
        • Atar D.
        • Badano L.P.
        • Blömstrom-Lundqvist C.
        • Borger M.A.
        • Di Mario C.
        • Dickstein K.
        • Ducrocq G.
        • Fernandez-Aviles F.
        • Gershlick A.H.
        • Giannuzzi P.
        • Halvorsen S.
        • Huber K.
        • Juni P.
        • Kastrati A.
        • Knuuti J.
        • Lenzen M.J.
        • Mahaffey K.W.
        • Valgimigli M.
        • van 't Hof A.
        • Widimsky P.
        • Zahger D.
        • Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC)
        ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.
        Eur Heart J. 2012; 33: 2569-2619
        • Reynolds H.R.
        • Hochman J.S.
        Cardiogenic shock: current concepts and improving outcomes.
        Circulation. 2008; 117: 686-697
        • Mehran R.
        • Rao S.V.
        • Bhatt D.L.
        • Gibson C.M.
        • Caixeta A.
        • Eikelboom J.
        • Kaul S.
        • Wiviott S.D.
        • Menon V.
        • Nikolsky E.
        • Serebruany V.
        • Valgimigli M.
        • Vranckx P.
        • Taggart D.
        • Sabik J.F.
        • Cutlip D.E.
        • Krucoff M.W.
        • Ohman E.M.
        • Steg P.G.
        • White H.
        Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium.
        Circulation. 2011; 123: 2736-2747
        • Thygesen K.
        • Alpert J.S.
        • Jaffe A.S.
        • Simoons M.L.
        • Chaitman B.R.
        • White H.D.
        • Thygesen K.
        • Alpert J.S.
        • White H.D.
        • Jaffe A.S.
        • Katus H.A.
        • Apple F.S.
        • Lindahl B.
        • Morrow D.A.
        • Chaitman B.A.
        • Clemmensen P.M.
        • Johanson P.
        • Hod H.
        • Underwood R.
        • Bax J.J.
        • Bonow R.O.
        • Pinto F.
        • Gibbons R.J.
        • Fox K.A.
        • Atar D.
        • Newby L.K.
        • Galvani M.
        • Hamm C.W.
        • Uretsky B.F.
        • Steg P.G.
        • Wijns W.
        • Bassand J.P.
        • Menasché P.
        • Ravkilde J.
        • Ohman E.M.
        • Antman E.M.
        • Wallentin L.C.
        • Armstrong P.W.
        • Simoons M.L.
        • Januzzi J.L.
        • Nieminen M.S.
        • Gheorghiade M.
        • Filippatos G.
        • Luepker R.V.
        • Fortmann S.P.
        • Rosamond W.D.
        • Levy D.
        • Wood D.
        • Smith S.C.
        • Hu D.
        • Lopez-Sendon J.L.
        • Robertson R.M.
        • Weaver D.
        • Tendera M.
        • Bove A.A.
        • Parkhomenko A.N.
        • Vasilieva E.J.
        • Mendis S.
        • Writing Group on the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction
        • ESC Committee for Practice Guidelines (CPG)
        Third universal definition of myocardial infarction.
        Eur Heart J. 2012; 33: 2551-2567
        • Gili S.
        • D'Ascenzo F.
        • Moretti C.
        • Omedè P.
        • Vilardi I.
        • Bertaina M.
        • Biondi Zoccai G.
        • Sheiban I.
        • Stone G.W.
        • Gaita F.
        Impact on prognosis of periprocedural myocardial infarction after percutaneous coronary intervention.
        J Interv Cardiol. 2014; 27: 482-490
        • Mehta R.L.
        • Kellum J.A.
        • Shah S.V.
        • Molitoris B.A.
        • Ronco C.
        • Warnock D.G.
        • Levin A.
        Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury.
        Crit Care. 2007; 11: R31
        • Cutlip D.E.
        • Windecker S.
        • Mehran R.
        • Boam A.
        • Cohen D.J.
        • van Es G.A.
        • Steg P.G.
        • Morel M.A.
        • Mauri L.
        • Vranckx P.
        • McFadden E.
        • Lansky A.
        • Hamon M.
        • Krucoff M.W.
        • Serruys P.W.
        • Academic Research Consortium
        Clinical end points in coronary stent trials: a case for standardized definitions.
        Circulation. 2007; 115: 2344-2351
        • Biondi-Zoccai G.
        • Romagnoli E.
        • Agostoni P.
        • Capodanno D.
        • Castagno D.
        • D'Ascenzo F.
        • Sangiorgi G.
        • Modena M.G.
        Are propensity scores really superior to standard multivariable analysis?.
        Contemp Clin Trials. 2011; 32: 731-740
        • Adamo M.
        • Byrne R.A.
        • Baumbach A.
        • Haude M.
        • Windecker S.
        • Valgimigli M.
        Assessing the cardiology community position on transradial intervention and the use of bivalirudin in patients with acute coronary syndrome undergoing invasive management: results of an EAPCI survey.
        EuroIntervention. 2016; 12: 1154-1163
        • Almudarra S.S.
        • Gale C.P.
        • Baxter P.D.
        • et al.
        • National Institute for Cardiovascular Outcomes Research (NICOR)
        Comparative outcomes after unprotected left main stem percutaneous coronary intervention: a national linked cohort study of 5,065 acute and elective cases from the BCIS Registry (British Cardiovascular Intervention Society).
        JACC Cardiovasc Interv. 2014; 7: 717-730
        • Sciahbasi A.
        • Mancone M.
        • Cortese B.
        • Pendenza G.
        • Romagnoli E.
        • Fischetti D.
        • Tomassini F.
        • Sardella G.
        • Lioy E.
        Transradial percutaneous coronary interventions using sheathless guiding catheters: a multicenter registry.
        J Interv Cardiol. 2011; 24: 407-412
        • Aminian A.
        • Dolatabadi D.
        • Lefebvre P.
        • Zimmerman R.
        • Brunner P.
        • Michalakis G.
        • Lalmand J.
        Initial experience with the Glidesheath Slender for transradial coronary angiography and intervention: a feasibility study with prospective radial ultrasound follow-up.
        Catheter Cardiovasc Interv. 2014; 84: 436-442
        • De Maria G.L.
        • Burzotta F.
        • Trani C.
        • Kassimis G.
        • Pirozzolo G.
        • Patel N.
        • Dato I.
        • Porto I.
        • Leone A.M.
        • Niccoli G.
        • Kharbanda R.
        • Crea F.
        • Banning A.P.
        Trends and outcomes of radial approach in left-main bifurcation percutaneous coronary intervention in the drug-eluting stent era: a two-center registry.
        J Invasive Cardiol. 2015; 27: E125-E136
        • D'Ascenzo F.
        • Barbero U.
        • Cerrato E.
        • Lipinski M.J.
        • Omedè P.
        • Montefusco A.
        • Taha S.
        • Naganuma T.
        • Reith S.
        • Voros S.
        • Latib A.
        • Gonzalo N.
        • Quadri G.
        • Colombo A.
        • Biondi-Zoccai G.
        • Escaned J.
        • Moretti C.
        • Gaita F.
        Accuracy of intravascular ultrasound and optical coherence tomography in identifying functionally significant coronary stenosis according to vessel diameter: a meta-analysis of 2,581 patients and 2,807 lesions.
        Am Heart J. 2015; 169: 663-673
        • D'Ascenzo F.
        • Iannaccone M.
        • Giordana F.
        • Chieffo A.
        • Connor S.O.
        • Napp L.C.
        • Chandran S.
        • de la Torre Hernández J.M.
        • Chen S.L.
        • Varbella F.
        • Omedè P.
        • Taha S.
        • Meliga E.
        • Kawamoto H.
        • Montefusco A.
        • Chong M.
        • Garot P.
        • Sin L.
        • Gasparetto V.
        • Abdirashid M.
        • Cerrato E.
        • Biondi-Zoccai G.
        • Gaita F.
        • Escaned J.
        • Hiddick Smith D.
        • Lefèvre T.
        • Colombo A.
        • Sheiban I.
        • Moretti C.
        Provisional vs. two-stent technique for unprotected left main coronary artery disease after ten years follow up: a propensity matched analysis.
        Int J Cardiol. 2016; 211: 37-42
        • Rafie I.M.
        • Uddin M.M.
        • Ossei-Gerning N.
        • Anderson R.A.
        • Kinnaird T.D.
        Patients undergoing PCI from the femoral route by default radial operators are at high risk of vascular access-site complications.
        EuroIntervention. 2014; 9: 1189-1194
        • Azzalini L.
        • Tosin K.
        • Chabot-Blanchet M.
        • Avram R.
        • Ly H.Q.
        • Gaudet B.
        • Gallo R.
        • Doucet S.
        • Tanguay J.F.
        • Ibrahim R.
        • Grégoire J.C.
        • Crépeau J.
        • Bonan R.
        • de Guise P.
        • Nosair M.
        • Dorval J.F.
        • Gosselin G.
        • L'Allier P.L.
        • Guertin M.C.
        • Asgar A.W.
        • Jolicœur E.M.
        The benefits conferred by radial access for cardiac catheterization are offset by a paradoxical increase in the rate of vascular access site complications with femoral access: the Campeau Radial Paradox.
        JACC Cardiovasc Interv. 2015; 8: 1854-1864