Biomedical subjects

G Cubeddu

Publications and source records attributed to G Cubeddu.

6 recordsLinked to original sources

PubMed2000

Transradial coronary stenting: comparison with femoral access closed with an arterial suture device.

The purpose of this study was to determine if closure of the femoral artery access site using a percutaneous arterial suture device (Perclose, Menlo Park, CA) in patients undergoing coronary stenting can result in the same benefits as seen with radial artery access. A total of 218 consecutive patients underwent coronary stenting (109 femoral, 109 radial) by investigators experienced with each technique. The two groups were matched in terms of sex, age, clinical presentation (50% acute), number of vessels and lesions stented, and lesion morphology. The relative costs of the femoral and radial procedures were examined using a decision analytic model and sensitivity analysis. The suture device was not used in 20/109 patients (18%) for anatomic reasons and failed to obtain hemostasis in 9/89 patients (10%). One radial patient had an occluded radial artery postprocedure, but this was recanalized at follow-up a month later. Primary success, procedural complications, postprocedure length of stay, and the percentage of patients discharged the same day were the same in both groups. Because of the added time to deploy Perclose, total procedure time was significantly longer in the femoral group (57 +/- 22 min femoral vs. 44 +/- 22 min radial, P < 0.01). Access site complications occurred only in the femoral group. More patients were ambulatory the same day of the procedure in the radial group (95% radial vs. 56% femoral, P < 0.01). The cost of the radial approach was substantially less than the femoral approach because of lower supply costs and fewer access complications. The transradial approach is a dominant strategy for coronary stenting, offering better outcomes at lower cost. Cathet. Cardiovasc. Intervent. 49:150-156, 2000.

Aged↗

PubMed2000

Left internal mammary artery intervention: the left radial approach with a new guide catheter.

Coronary intervention involving left internal mammary bypass grafts is an increasingly common challenge for the interventionalist. Although successful in a high percentage of patients, the femoral approach may be technically challenging. The shorter, more direct approach from the left radial artery has potential advantages in these cases. The present study evaluated our experience using a new left transradial internal mammary guide catheter. Angiography alone was successfully performed with the catheter in 40 patients. In an additional 10 patients, internal mammary artery interventional procedures were performed. Angioplasty alone was performed in five patients. Five patients underwent coronary stenting within the internal mammary artery or native left anterior descending artery. Guide catheter backup was satisfactory and angioplasty catheters and/or stents could be advanced to the target lesion with minimal difficulty. No procedural complications occurred. The left radial artery access site is an excellent approach for left internal mammary intervention.

Angioplasty, Balloon, Coronary↗

PubMed1998

Stenting in acute coronary syndromes: a comparison of radial versus femoral access sites.

OBJECTIVES: The purpose of the present study was to compare the radial approach with the femoral approach for coronary stenting in patients with acute coronary syndromes. BACKGROUND: Aggressive anticoagulation in patients with acute coronary syndromes increases the risk of femoral vascular complications. The transradial approach has the potential to significantly reduce the incidence of access site bleeding complications in this group of patients. METHODS: One hundred forty-two patients with acute coronary syndromes undergoing coronary stenting were prospectively randomized to have their procedure performed from either the radial or femoral access site and the results compared. RESULTS: Nine of 74 patients randomized to the radial group crossed over to the femoral group (6 negative Allen tests, 3 access failures). Patient demographics were the same in both groups. Primary success was identical: 96% radial, 96% femoral, ns. There were no procedural myocardial infarctions or deaths, and no patient was referred for emergency bypass surgery. There were no access site bleeding complications in the radial group as opposed to 3 (4%) in the femoral group, p < 0.01. Postprocedure length of stay, days (1.4+/-0.2 radial vs. 2.3+/-0.4 femoral, p < 0.01) as well as total hospital length of stay (3.0+/-0.3 radial vs. 4.5+/-0.5 femoral, p < 0.01) were significantly reduced in the radial group. Total hospital charge was also significantly lower in the radial group ($20,476+/-811 radial versus $23,389+/-1,180 femoral, p < 0.01). CONCLUSION: Coronary stenting from the radial approach is efficacious in patients with acute coronary syndromes. Access site bleeding complications are less, and early ambulation results in a shorter hospital length of stay. There was a 15% reduction in total hospital charge in the radial group.

Aged↗

PubMed1996

Operator Radiation Exposure in PTCA: Comparison of Radial and Femoral Approaches.

In order to evaluate the radiation risk associated with PTCA from the right radial approach, operator radiation exposure was prospectively measured in 138 patients (pts) undergoing PTCA from the radial artery approach and in 126 patients from the femoral artery approach. Standard overhead and side table lead curtain shields were used in the femoral group and radial group I (66 pts). In radial group II (72 pts), a movable floor shield was added to the procedure for additional radiation protection. The external whole body dose was measured monthly using film dosimeters. Dose per case and dose per minute of fluoroscopy time were calculated. Operator external whole body dose was significantly higher when PTCA is performed from the radial artery (13.5 +/- 2.1 mrem/case) as compared to the femoral artery (8.8 +/- 1.3 mrem/case) approach (p <.01). This increased radiation exposure was reduced to less than the femoral artery when the movable floor shield is added to standard x-ray protection (3.3 +/- 2.3 mrem/case, p <.01 vs. femoral). Thus, PTCA can be performed from the radial artery approach without increased operator radiation exposure.

Journal Article↗

PubMed1996

Clinical Evaluation of Current Stent Deployment Strategies.

BACKGROUND: Coronary stenting has been demonstrated to reduce the incidence of abrupt closure and restenosis. However, intensive anticoagulation regimens have increased the number of vascular complications and hospital length of stay. Consequently, the potential long-term cost effectiveness of stenting has been jeopardized by a significant increase in procedural and hospital costs. These drawbacks have resulted in evaluation of reduced anticoagulation programs and alternative access sites. METHODS: Access-site and anticoagulation strategies were analyzed in 377 patients who had undergone coronary stenting. Four groups were compared: 114 patients stented from the femoral artery and treated with warfarin, 87 patients stented from the radial artery and treated with warfarin, 88 patients stented from the femoral artery and treated with ticlopidine and aspirin anticoagulation, and 88 patients stented from the radial artery and treated with ticlopidine and aspirin. RESULTS: Primary success was similar in all groups. Subacute closure occurred only in the groups managed with warfarin. Access-site complications occurred only in the groups with femoral access. Total hospital and post-procedure length of stay and total hospital charge were significantly less in the ticlopidine groups. The radial/ticlopidine group was the most cost-effective. CONCLUSIONS: Ticlopidine/aspirin therapy following coronary stenting from either the femoral or radial approach reduced hospital length of stay and hospital charge without subacute closure. Access-site complications were not reduced by femoral/ticlopidine strategy but were eliminated by the radial approach with either anticoagulation regimen. The radial/ticlopidine strategy eliminated access-site complications and significantly reduced hospital length of stay and hospital charge as compared to femoral/ticlopidine and was the most cost-effective strategy.

Journal Article↗

PubMed1995

PTCA using the right radial artery access site.

UNLABELLED: In order to evaluate the right radial artery approach (RRA) in PTCA, our first 50 patients (pts) who had undergone PTCA from this access site were evaluated. Seventy-eight percent of pts were male, 68% had unstable angina or recent MI. Seventy-seven lesions were dilated (31 type A, 32 type B, 13 type C). Access time was 4.3 +/- 2.4 minutes (min). Six French Voda and multipurpose guide catheters were primarily utilized (mean 1.2 guides/case). Several different balloon types were used satisfactorily (mean 1.5 balloons/case). Sheaths were pulled 3.4 +/- 1.2 hours post-procedure when ACT was less than 200 seconds. Compression time was 24.8 +/- 11 and heparin was immediately resumed. No access site complications occurred. Results were compared to a cohort of 100 pts who had undergone PTCA from the right femoral artery approach (RFA). PTCA time, fluoroscopy time, contrast utilized, primary success rate, emergency bypass and cath lab charges were the same in both groups. Access site complications were significantly less in the right radial group (0 RRA vs. 4 RFA, p < .02). Post PTCA length of stay (1.9 +/- 0.3 vs. 3.4 +/- 0.6, p < .05) and total hospital length of stay (3.7 +/- 0.5 vs. 5.2 +/- 0.6, p < .05) were significantly less in the radial group. As a result of the shorter hospital stay, total hospital charge was less in the radial group (14,730 +/- 882 vs. 17,461 +/- 908, p < .05). CONCLUSION: Results of PTCA performed from RRA are similar to those from RFA with a significant reduction in access site complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗