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Background

T ransradial A pproach [ LE ft vs right] a N d procedural T imes during percutaneous coronary procedures: TALENT study ALESSANDRO SCIAHBASI, MD UO Cardiologia, Policlinico Casilino – ASL RM B, Rome, Italy. Policlinico CASILINO. Background.

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Background

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  1. Transradial Approach [LEft vs right] aNd procedural Times during percutaneous coronary procedures: TALENT study ALESSANDRO SCIAHBASI, MD UO Cardiologia, Policlinico Casilino – ASL RM B, Rome, Italy

  2. Policlinico CASILINO Background Coronary transradial procedures may be performed through right or left radial artery approach (RRA and LRA respectively) Most of studies assessing feasibility of the transradial approach have been performed through RRA, but the LRA may have some important anatomical advantages. Aim of this study was to evaluate safety and efficacy of RRA versus LRA approach in coronary diagnostic and interventional procedures.

  3. Policlinico Casilino Policlinico Gemelli Policlinico CASILINO Methods From January 2009 to December 2009 all patients who underwent percutaneous coronary procedures (diagnostic or PCI) Exclusion criteria: previous CABG, acute STEMI, haemodynamic instability, ischemic Allen test. Right Radial Approach Left Radial Approach

  4. Policlinico CASILINO Methods Primary end point: fluoroscopy time and the Dose Area Product (DAP) adsorbed by the patients. Secondary end-points: contrast amount, cannulation time, access shift rate, number of catheters employed, major complications. A sub-analysisregarding patient’s age and operator’s skillness (senior compared to fellow) was also pre-specified

  5. Policlinico CASILINO Methods 1540 consecutive patients were randomized to LRA(770) or RRA(770) 1467 patients 688 patients Diagnostic Group (coronary angiography) PCI Group (PCI post angiography or stand alone) 344 RRA 344 LRA 735 LRA 732 RRA

  6. Policlinico CASILINO Results Mean ± standard deviation; BMI: body mass index, GFR: glomerular filtration rate

  7. P= 0.0025 168 13 170 12.1 Gy/cm2 149 seconds 11 10.7 150 (32-1238) (31-1290) 0 0 Dose Area Product (Fluoroscopy) Fluoroscopy time P= 0.40 P= 0.004 23.5 23.3 25 (6.4-172) (1.9-328) Gy/cm2 20 (0.9-229) (0.8-378) 0 Dose Area Product (Fluorography) Policlinico CASILINO Results Diagnostic Group (n= 1467) RRA (n= 732) LRA (n= 735) Results are expressed as median with range in brackets

  8. P= 0.087 P= 0.17 P= 0.60 695 700 65 50 63.1 41.5 37.8 614 seconds (2.4-1058) (1.8-285) (54-5087) (5.7-307) Gy/cm2 Gy/cm2 53.7 600 55 30 (62-5653) (4.1-784) 0 0 0 Fluoroscopy time Dose Area Product (Fluoroscopy) Dose Area Product (Fluorography) Policlinico CASILINO Results PCI Group (n= 688) RRA (n= 344) LRA (n= 344) Results are expressed as median with range in brackets

  9. Policlinico CASILINO Results * Mean ± standard deviation; † Median with ranges

  10. 5 RRA (n= 770) P= 0.41 P= 0.70 LRA (n= 770) 4 3 Cases 2 P= 0.31 P= 0.31 1 0 Lack of radial Radial Severe spasm Subclavian-aortic canalization tortuosity/anomalies tortuosity PunctureFailure Epi-Aortic Failure Radial Failure Policlinico CASILINO Results Cross-over to femoral: Incidence and classification Overall 14 puncture and radial failure vs 1 epi-aortic failure, p= 0.0008

  11. Multivariate analysis OR=18.5; 95%CI, 6.4-54, p< 0.001 Radial tortuosity 0.01 0.1 1 5 10 50 Policlinico CASILINO Results Predictors of cross over to femoral Predictors of subclavian tortuosity Age >70 years OR=2.6; 95%CI, 1.8-3.7, p< 0.001 Right radial approach OR=2.7; 95%CI, 1.9- 4, p< 0.001 0.1 0.5 1 2 5 10

  12. SENIOR FELLOW P= 0.001 256 P= 0.11 RRA (n= 487) RRA (n= 245) 260 150 LRA (n= 478) LRA (n= 257) 140 132 208 seconds 200 (58-1170) seconds 130 (32-1238) (35-1290) (31-1282) 0 0 Fluoroscopy time Fluoroscopy time P= 0.26 P= 0.002 9.3 10 30 9 22.4 17.3 (2.2-229) (0.9-201) Gy/cm2 Gy/cm2 5 15 (0.8-197) (1.3-378) 0 0 Dose Area Product (Fluoroscopy) Dose Area Product (Fluoroscopy) Policlinico CASILINO Results Diagnostic Group (n= 1467) Results are expressed as median with range in brackets

  13. Age <70 years Age ≥70 years P= 0.048 P= 0.01 RRA (n= 430) RRA (n= 302) 158 200 160 199 LRA (n= 310) LRA (n= 425) 138 171 seconds (56-1238) seconds (32-990) 170 130 (32-1282) (31-1290) 0 0 Fluoroscopy time Fluoroscopy time P= 0.001 P= 0.11 12 15 14.2 11.1 11.2 10.2 10 10 Gy/cm2 Gy/cm2 (0.9-193) (1.7-229) (0.8-305) (0.9-378) 0 0 Dose Area Product (Fluoroscopy) Dose Area Product (Fluoroscopy) Policlinico CASILINO Results Diagnostic Group (n= 1467) Results are expressed as median with range in brackets

  14. Policlinico CASILINO Conclusions LRA for coronary angiographyand interventionsis associated with slight but significant lower fluoroscopy time and radiation dose compared to RRA The LRA advantage seems to be confined to operators at the beginning of learning curve (fellows) and to be more pronounced in older patients

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