Risk of brain injury during diagnostic coronary angiography: Comparison between right and left radial approach

Research output: Contribution to journalArticle

Andrea Pacchioni, Francesco Versaci, Antonio Mugnolo, Carlo Penzo, Dimitrios Nikas, Salvatore Saccà, Luca Favero, Pier Francesco Agostoni, Zsolt Garami, Francesco Prati, Bernhard Reimers

Objectives: To assess the incidence of silent cerebral embolization when using the transradial approach for diagnostic coronary angiography (DCA). Background: Compared to other vascular access sites, the right transradial approach (RTA) could reduce the amount of brain emboli by avoiding mechanical trauma to the aortic wall caused by catheters and wire, whereas it increases manipulation of catheters in the ascending aorta and has a higher risk of direct embolization into the right common carotid artery. A recent study showed an increased incidence of microembolic signals (MES) in RTA compared to femoral. However, left transradial approach (LTA) has never been assessed. Methods: 40 patients with suspected coronary artery disease were randomized to DCA via RTA (n = 20) or LTA (n = 20) with contemporaneous bilateral transcranial Doppler monitoring. Results: MES were detected in all patients, with a significantly higher rate in the RTA group (median 61, interquartile range (IQR) 47-105, vs 48, IQR 31-60, p = 0.035). MES generated during procedures needing > 2 catheters (n = 8), are higher than those detected during procedures performed with 2 catheters (n = 32, 102, IQR 70-108, vs 48, IQR 33-60, p = 0.001). At multivariate analysis increasing number of catheters was the only independent predictor of high incidence of MES (OR 16.4, 95% CI 1.23-219.9, p = 0.034, - 2LL = 26.7). Conclusions: LTA has a lower risk of brain embolization because of the lower number of catheter exchange maneuvers. Since the degree of brain embolism depends on the magnitude of mechanical manipulation, catheter changes should be minimized to reduce the risk of cerebral embolization.

Original languageEnglish
Pages (from-to)3021-3026
Number of pages6
JournalInternational Journal of Cardiology
Volume167
Issue number6
DOIs
StatePublished - Jan 1 2013

PMID: 23046593

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Risk of brain injury during diagnostic coronary angiography : Comparison between right and left radial approach. / Pacchioni, Andrea; Versaci, Francesco; Mugnolo, Antonio; Penzo, Carlo; Nikas, Dimitrios; Saccà, Salvatore; Favero, Luca; Agostoni, Pier Francesco; Garami, Zsolt; Prati, Francesco; Reimers, Bernhard.

In: International Journal of Cardiology, Vol. 167, No. 6, 01.01.2013, p. 3021-3026.

Research output: Contribution to journalArticle

Harvard

Pacchioni, A, Versaci, F, Mugnolo, A, Penzo, C, Nikas, D, Saccà, S, Favero, L, Agostoni, PF, Garami, Z, Prati, F & Reimers, B 2013, 'Risk of brain injury during diagnostic coronary angiography: Comparison between right and left radial approach' International Journal of Cardiology, vol. 167, no. 6, pp. 3021-3026. https://doi.org/10.1016/j.ijcard.2012.09.024

APA

Pacchioni, A., Versaci, F., Mugnolo, A., Penzo, C., Nikas, D., Saccà, S., ... Reimers, B. (2013). Risk of brain injury during diagnostic coronary angiography: Comparison between right and left radial approach. International Journal of Cardiology, 167(6), 3021-3026. https://doi.org/10.1016/j.ijcard.2012.09.024

Vancouver

Pacchioni A, Versaci F, Mugnolo A, Penzo C, Nikas D, Saccà S et al. Risk of brain injury during diagnostic coronary angiography: Comparison between right and left radial approach. International Journal of Cardiology. 2013 Jan 1;167(6):3021-3026. https://doi.org/10.1016/j.ijcard.2012.09.024

Author

Pacchioni, Andrea ; Versaci, Francesco ; Mugnolo, Antonio ; Penzo, Carlo ; Nikas, Dimitrios ; Saccà, Salvatore ; Favero, Luca ; Agostoni, Pier Francesco ; Garami, Zsolt ; Prati, Francesco ; Reimers, Bernhard. / Risk of brain injury during diagnostic coronary angiography : Comparison between right and left radial approach. In: International Journal of Cardiology. 2013 ; Vol. 167, No. 6. pp. 3021-3026.

BibTeX

@article{dc6aadc98d5f4128a94632f0e9c67317,
title = "Risk of brain injury during diagnostic coronary angiography: Comparison between right and left radial approach",
abstract = "Objectives: To assess the incidence of silent cerebral embolization when using the transradial approach for diagnostic coronary angiography (DCA). Background: Compared to other vascular access sites, the right transradial approach (RTA) could reduce the amount of brain emboli by avoiding mechanical trauma to the aortic wall caused by catheters and wire, whereas it increases manipulation of catheters in the ascending aorta and has a higher risk of direct embolization into the right common carotid artery. A recent study showed an increased incidence of microembolic signals (MES) in RTA compared to femoral. However, left transradial approach (LTA) has never been assessed. Methods: 40 patients with suspected coronary artery disease were randomized to DCA via RTA (n = 20) or LTA (n = 20) with contemporaneous bilateral transcranial Doppler monitoring. Results: MES were detected in all patients, with a significantly higher rate in the RTA group (median 61, interquartile range (IQR) 47-105, vs 48, IQR 31-60, p = 0.035). MES generated during procedures needing > 2 catheters (n = 8), are higher than those detected during procedures performed with 2 catheters (n = 32, 102, IQR 70-108, vs 48, IQR 33-60, p = 0.001). At multivariate analysis increasing number of catheters was the only independent predictor of high incidence of MES (OR 16.4, 95{\%} CI 1.23-219.9, p = 0.034, - 2LL = 26.7). Conclusions: LTA has a lower risk of brain embolization because of the lower number of catheter exchange maneuvers. Since the degree of brain embolism depends on the magnitude of mechanical manipulation, catheter changes should be minimized to reduce the risk of cerebral embolization.",
keywords = "Radial access, Silent cerebral embolization, Transcranial Doppler",
author = "Andrea Pacchioni and Francesco Versaci and Antonio Mugnolo and Carlo Penzo and Dimitrios Nikas and Salvatore Sacc{\`a} and Luca Favero and Agostoni, {Pier Francesco} and Zsolt Garami and Francesco Prati and Bernhard Reimers",
year = "2013",
month = "1",
day = "1",
doi = "10.1016/j.ijcard.2012.09.024",
language = "English",
volume = "167",
pages = "3021--3026",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",
number = "6",

}

RIS

TY - JOUR

T1 - Risk of brain injury during diagnostic coronary angiography

T2 - International Journal of Cardiology

AU - Pacchioni, Andrea

AU - Versaci, Francesco

AU - Mugnolo, Antonio

AU - Penzo, Carlo

AU - Nikas, Dimitrios

AU - Saccà, Salvatore

AU - Favero, Luca

AU - Agostoni, Pier Francesco

AU - Garami, Zsolt

AU - Prati, Francesco

AU - Reimers, Bernhard

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Objectives: To assess the incidence of silent cerebral embolization when using the transradial approach for diagnostic coronary angiography (DCA). Background: Compared to other vascular access sites, the right transradial approach (RTA) could reduce the amount of brain emboli by avoiding mechanical trauma to the aortic wall caused by catheters and wire, whereas it increases manipulation of catheters in the ascending aorta and has a higher risk of direct embolization into the right common carotid artery. A recent study showed an increased incidence of microembolic signals (MES) in RTA compared to femoral. However, left transradial approach (LTA) has never been assessed. Methods: 40 patients with suspected coronary artery disease were randomized to DCA via RTA (n = 20) or LTA (n = 20) with contemporaneous bilateral transcranial Doppler monitoring. Results: MES were detected in all patients, with a significantly higher rate in the RTA group (median 61, interquartile range (IQR) 47-105, vs 48, IQR 31-60, p = 0.035). MES generated during procedures needing > 2 catheters (n = 8), are higher than those detected during procedures performed with 2 catheters (n = 32, 102, IQR 70-108, vs 48, IQR 33-60, p = 0.001). At multivariate analysis increasing number of catheters was the only independent predictor of high incidence of MES (OR 16.4, 95% CI 1.23-219.9, p = 0.034, - 2LL = 26.7). Conclusions: LTA has a lower risk of brain embolization because of the lower number of catheter exchange maneuvers. Since the degree of brain embolism depends on the magnitude of mechanical manipulation, catheter changes should be minimized to reduce the risk of cerebral embolization.

AB - Objectives: To assess the incidence of silent cerebral embolization when using the transradial approach for diagnostic coronary angiography (DCA). Background: Compared to other vascular access sites, the right transradial approach (RTA) could reduce the amount of brain emboli by avoiding mechanical trauma to the aortic wall caused by catheters and wire, whereas it increases manipulation of catheters in the ascending aorta and has a higher risk of direct embolization into the right common carotid artery. A recent study showed an increased incidence of microembolic signals (MES) in RTA compared to femoral. However, left transradial approach (LTA) has never been assessed. Methods: 40 patients with suspected coronary artery disease were randomized to DCA via RTA (n = 20) or LTA (n = 20) with contemporaneous bilateral transcranial Doppler monitoring. Results: MES were detected in all patients, with a significantly higher rate in the RTA group (median 61, interquartile range (IQR) 47-105, vs 48, IQR 31-60, p = 0.035). MES generated during procedures needing > 2 catheters (n = 8), are higher than those detected during procedures performed with 2 catheters (n = 32, 102, IQR 70-108, vs 48, IQR 33-60, p = 0.001). At multivariate analysis increasing number of catheters was the only independent predictor of high incidence of MES (OR 16.4, 95% CI 1.23-219.9, p = 0.034, - 2LL = 26.7). Conclusions: LTA has a lower risk of brain embolization because of the lower number of catheter exchange maneuvers. Since the degree of brain embolism depends on the magnitude of mechanical manipulation, catheter changes should be minimized to reduce the risk of cerebral embolization.

KW - Radial access

KW - Silent cerebral embolization

KW - Transcranial Doppler

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UR - http://www.scopus.com/inward/citedby.url?scp=84883803945&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2012.09.024

DO - 10.1016/j.ijcard.2012.09.024

M3 - Article

VL - 167

SP - 3021

EP - 3026

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

IS - 6

ER -

ID: 2593729