Tizon-Marcos et al

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Are Neurologic Complications Following Percutaneous Coronary Angiography or Intervention More Common in Transfemoral versus Transradial Approach?

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  • Il y a un 2è abstractaccepté sur les facteursprédicteurs…
  • RR ofdeathifstrokeoccursrangingfrom 4.3 to 34. Inhospital mortality > 35% and 10-foldincreasemortality at one-year. Factorsassociatedwith Femoral NC Femalegender,age, peripheral vascular disease, extensive CAD, loverejectionfraction, veingraftintervention, IABP use, DM, HTA, Urgentprocedures, Use of GPI, Renal andHeartFailure.
  • RR ofdeathifstrokeoccursrangingfrom 4.3 to 34. Inhospital mortality > 35% and 10-foldincreasemortality at one-year.
  • RR ofdeathifstrokeoccursrangingfrom 4.3 to 34. Inhospital mortality > 35% and 10-foldincreasemortality at one-year. Factorsassociatedwith Femoral NC Femalegender,age, peripheral vascular disease, extensive CAD, loverejectionfraction, veingraftintervention, IABP use, DM, HTA, Urgentprocedures, Use of GPI, Renal andHeartFailure.
  • RR ofdeathifstrokeoccursrangingfrom 4.3 to 34. Inhospital mortality > 35% and 10-foldincreasemortality at one-year. Factorsassociatedwith Femoral NC Femalegender,age, peripheral vascular disease, extensive CAD, loverejectionfraction, veingraftintervention, IABP use, DM, HTA, Urgentprocedures, Use of GPI, Renal andHeartFailure.
  • Differentdefinitions in literatureforper-procedural CVA dependingonframe time.
  • Incidenceof NC remainedstablebelow 0.2%
  • Temporal trends in usingtransradialapproachthatbecamethemostusedapproach in 1996. Nowadaysitisused in about 93% ofallpatients.
  • JP4:Sont de nombres en “brut”…à quoi je dois les ajuster? Par ce que il y a un posteraussiacceptépourprésenter les facteurs? Est-ce que je doismettre le deux danscetteprésentation?
  • JP4:Sont de nombres en “brut”…à quoi je dois les ajuster? Par ce que il y a un posteraussiacceptépourprésenter les facteurs? Est-ce que je doismettre le deux danscetteprésentation?
  • JP5:ok.
  • JP5:ok.
  • Tizon-Marcos et al

    1. 1. Are neurologiccomplicationsfollowingpercutaneouscoronaryangiographyorintervention more common in transfemoral versus transradialapproach?<br />Helena Tizón-Marcos, Gérald R. Barbeau, Jean-Pierre Déry, Jacques R. Rouleau, Louis Roy, OnilGleeton, Jean-RochBoudreault, Guy Proulx, Olivier F. Bertrand, Can Mahn Nguyen, Bernard Noël, JosepRodés-Cabau, Eric Larose, StéphaneRinfret and Robert Delarochellière.<br />InstitutUniversitaire de Cardiologie et Pneumologie de Québec. Québec, Canada. <br />
    2. 2. Are neurologiccomplicationsfollowingpercutaneouscoronaryangiographyorintervention more common in transfemoral versus transradialapproach?<br />Nothingtodisclose. <br />
    3. 3. Are neurologiccomplicationsfollowing percutaneous coronaryangiographyorintervention more common in transfemoral versus transradialapproach?<br />Neurologiccomplications (NC) havebeendescribed as a rarebutpotentiallycatastrophiccomplicationfollowing transfemoral coronaryangiographyorintervention.<br />Ratesof NC rangefrom 0.07% to 3% in diagnostic femoral procedures and rangefrom 0.17% to 0.45% in interventional femoral procedures<br />Theincidenceof NC varies in thedifferent series dependingon:<br /><ul><li>periodstudied
    4. 4. Timingafterangiographyor PCI in whichtheeventoccurs
    5. 5. typeofprocedure</li></ul>. <br />
    6. 6. Are neurologiccomplicationsfollowing percutaneous coronaryangiographyorintervention more common in transfemoral versus transradialapproach?<br />Factorsassociatedwith NC followingcoronaryangiographyorprocedureshavebeenwelldescribed.<br />Transradialapproach has lowerhemorrhagic and vascular complicationratesbutitsvaluetolower NC followingdiagnosticcatheterizationor PCI has notbeenyetestablished. <br />. <br />
    7. 7. Are neurologiccomplicationsfollowing percutaneous coronaryangiographyorintervention more common in transfemoral versus transradialapproach?<br />Objective<br />Determine the incidence and different characteristics of neurologic complications following transradial and transfemoral approach. <br />
    8. 8. Are neurologiccomplicationsfollowing percutaneous coronaryangiographyorintervention more common in transfemoral versus transradialapproach?<br />Methods<br />Retrospectivereview of allpatientswhounderwentcoronaryangiographyorinterventionbetweenApril 1990 and October 2007 at InstitutUniversitaire de Cardiologie et Pneumologie Québec. <br />The complete chart of allpatientsdischargedwith a diagnostic of strokeortransientischemicattackwerereviewedextensively. <br />All patients who experienced a per-procedural neurologic complication were included in the present analysis. <br />Patients who developed neurological symptoms after by-pass surgery were excluded.<br />
    9. 9. Are neurologiccomplicationsfollowingpercutaneouscoronaryangiographyorinterventions more common in transfemoral versus transradialapproach?<br />Statistics<br /><ul><li> Quantitative variables are expressed as mean  standard deviation and qualitative variables as count and percentages.  
    10. 10. Depending on variable distribution, Student’s t-test or Wilcoxon rank-sum test were used to assess differences in continuous variables.
    11. 11. Chi-square and Fisher’s exact tests were used to compare categorical variables.  </li></li></ul><li>Are neurologiccomplicationsfollowingpercutaneouscoronaryangiographyorinterventions more common in transfemoral versus transradialapproach?<br />Definitions<br /><ul><li>Per-procedural NC: anynewneurologicaldeficitarisingwithinthefirst 36 hoursaftertheindexprocedureorsymptomsappearingaftercessation of anestheticmedicationsforpatientsundergoing PCI under general anesthesia and/ormechanicalventilation
    12. 12. Stroke: anynewneurologicalsignorsymptomthatlasted more than 24 hoursaftertheonsetofsymptoms.
    13. 13. TIA: anynewneurologicalsignorsymptomthatlastedlessthan 24 hoursaftertheonsetofsymptoms. </li></li></ul><li>Are neurologiccomplicationsfollowing percutaneous coronaryangiographyorintervention more common in transfemoral versus transradialapproach?<br />Procedures<br />TypeofProcedureandanticoagulation:<br /><ul><li>Diagnostic transfemoral: usuallywithoutheparin, occasionally 20-30 UI/kgofunfractionedheparin.
    14. 14. Diagnostictransradial: 70 UI/kgofunfractionedheparin.
    15. 15. Interventionalprocedures: 70-100 UI/kgofunfractionedheparindependingon GP IIb/IIIainhibitorsadministration. </li></li></ul><li>Are neurologiccomplicationsfollowingpercutaneouscoronaryangiographyorinterventions more common in transfemoral versus transradialapproach?<br />Results<br />BetweenApril 1990 toOctober 2007 a total of 83409 patientshavebeentreatedwith:<br /><ul><li> 52018 diagnosticcoronarystudies
    16. 16. 31391 coronaryintervention</li></ul>Neurologiccomplicationsoccurred in 63 patients. <br />Theoverallincidenceof NC is 0.075% <br />
    17. 17. Are neurologiccomplicationsfollowingpercutaneouscoronaryangiographyorinterventions more common in transfemoral versus transradialapproach?<br />Numberoftreatedpatientsperyearandincidenceof NC peryear<br />
    18. 18. Are neurologiccomplicationsfollowingpercutaneouscoronaryangiographyorinterventions more common in transfemoral versus transradialapproach?<br />Overthestudyperiod:<br /><ul><li>Diagnosticprocedures: 55% radial, 45% femoral
    19. 19. Interventionalprocedures: 76% radial, 24% femoral</li></li></ul><li>Are neurologiccomplicationsfollowingpercutaneouscoronaryangiographyorinterventions more common in transfemoral versus transradialapproach?<br />
    20. 20. Are neurologiccomplicationsfollowing percutaneous coronaryangiographyorintervention more common in transfemoral versus transradialapproach?Baselinecharacteristics<br />
    21. 21. Are neurologiccomplicationsfollowingpercutaneouscoronaryangiographyorinterventions more common in transfemoral versus transradialapproach?Baselinecharacteristics<br />
    22. 22. Are neurologiccomplicationsfollowingpercutaneouscoronaryangiographyorinterventions more common in transfemoral versus transradialapproach?Procedural data<br />
    23. 23. Are neurologiccomplicationsfollowingpercutaneouscoronaryangiographyorinterventions more common in transfemoral versus transradialapproach?Procedural data<br />Peri-proceduralcomplication : Ventricular tachycardiaorfibrillation, complete atrioventricular block, heartfailurerequiringintervention, endotrachealurgentintubation and coronaryembolization. <br />
    24. 24. Are neurologiccomplicationsfollowingpercutaneouscoronaryangiographyorinterventions more common in transfemoral versus transradialapproach?NC Data<br />
    25. 25. Are neurologiccomplicationsfollowingpercutaneouscoronaryangiographyorinterventions more common in transfemoral versus transradialapproach?<br />Limitations<br /><ul><li>Retrospectivereview
    26. 26. Single-centre experience
    27. 27. Lackofrandomisation
    28. 28. Graftangiographyusually done by transfemoral approachwithoutheparinwhereasheparinisalwaysgiven in transradialapproach. Graftangiographyisoneofthepredictivefactorsof NC in multivariateanalysis. Nevertheless, vascular approachdoesnotappearto be a significantindependent factor. </li></li></ul><li>Are neurologiccomplicationsfollowingpercutaneouscoronaryangiographyorinterventions more common in transfemoral versus transradialapproach?<br />Conclusions: <br /><ul><li> In this large series, per-procedural NC was an uncommon complication in patients undergoing coronary angiography or intervention.
    29. 29. Compared to transfemoral approach, transradial approach is associated with an unadjusted lower incidence of per-procedural NC.
    30. 30. Differences in NC rates may be explained by a higher rate of vein graft procedures in the transfemoral group or by routine heparin use in the transradial group.
    31. 31. In-hospital mortality was higher in patients experiencing a NC after a transradial procedure compared to patients suffering a NC after transfemoral procedure. </li></li></ul><li>Are neurologiccomplicationsfollowingpercutaneouscoronaryangiographyorinterventions more common in transfemoral versus transradialapproach?<br />Thank you for your attention. <br />helenatizon@hotmail.com<br />
    32. 32. Factors predicting neurological complications following percutaneous coronary angiography and interventions in a large series of transfemoral and transradial approach <br />Methods<br />83409 procedures from April 1990 to October 2007<br />63 patients with discharge diagnosis of:<br /> Stroke<br /> CVA<br /> TIA<br /> Visual disturbances<br /> Intracranial haemorrhage<br />83346 patients without discharge diagnosis of Neurological haemorrhage<br />Control group of 254 patients matched by date of procedure. <br />

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