Safety and efficacy of radial versus femoral access for rotational Atherectomy: A systematic review and meta-analysis

Abdul Ahad Khan, Hemang B. Panchal, Syed Imran M. Zaidi, Muralidhar R. Papireddy, Debabrata Mukherjee, Mauricio G Cohen, Subhash Banerjee, Sunil V. Rao, Samir Pancholy, Timir K. Paul

Research output: Contribution to journalArticle

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Abstract

Introduction: 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. Methods: 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. Results: 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). Conclusion: 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.

Original languageEnglish (US)
JournalCardiovascular Revascularization Medicine
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Coronary Atherectomy
Thigh
Meta-Analysis
Safety
Percutaneous Coronary Intervention
Length of Stay
Hemorrhage
Mortality
MEDLINE
Libraries
Stents
Observational Studies
Thrombosis
Randomized Controlled Trials
Odds Ratio
Myocardial Infarction
Confidence Intervals
Radiation Exposure

Keywords

  • Femoral
  • Radial
  • Rotablation
  • Rotational Atherectomy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Safety and efficacy of radial versus femoral access for rotational Atherectomy : A systematic review and meta-analysis. / 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.

In: Cardiovascular Revascularization Medicine, 01.01.2018.

Research output: Contribution to journalArticle

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. / Safety and efficacy of radial versus femoral access for rotational Atherectomy : A systematic review and meta-analysis. In: Cardiovascular Revascularization Medicine. 2018.
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title = "Safety and efficacy of radial versus femoral access for rotational Atherectomy: A systematic review and meta-analysis",
abstract = "Introduction: 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. Methods: 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. Results: 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). Conclusion: 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.",
keywords = "Femoral, Radial, Rotablation, Rotational Atherectomy",
author = "Khan, {Abdul Ahad} and Panchal, {Hemang B.} and Zaidi, {Syed Imran M.} and Papireddy, {Muralidhar R.} and Debabrata Mukherjee and Cohen, {Mauricio G} and Subhash Banerjee and Rao, {Sunil V.} and Samir Pancholy and Paul, {Timir K.}",
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T1 - Safety and efficacy of radial versus femoral access for rotational Atherectomy

T2 - A systematic review and meta-analysis

AU - Khan, Abdul Ahad

AU - Panchal, Hemang B.

AU - Zaidi, Syed Imran M.

AU - Papireddy, Muralidhar R.

AU - Mukherjee, Debabrata

AU - Cohen, Mauricio G

AU - Banerjee, Subhash

AU - Rao, Sunil V.

AU - Pancholy, Samir

AU - Paul, Timir K.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Introduction: 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. Methods: 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. Results: 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). Conclusion: 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.

AB - Introduction: 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. Methods: 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. Results: 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). Conclusion: 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.

KW - Femoral

KW - Radial

KW - Rotablation

KW - Rotational Atherectomy

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