Ikari Y - AIMRADIAL 2014 - Radial and IABP
-
Upload
international-chair-on-interventional-cardiology-and-transradial-approach -
Category
Health & Medicine
-
view
226 -
download
0
description
Transcript of Ikari Y - AIMRADIAL 2014 - Radial and IABP
![Page 1: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/1.jpg)
Radial Approach and Slender
Intra-Aortic Balloon Puming
Yuji Ikari, MD.Department of CardiologyTokai University School of Medicine
Chicago, IL Oct 2014
![Page 2: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/2.jpg)
Doyle BJ et al. JACC Intervention 2008;1:202-209.
BackgroundMajor Femoral Bleeding Complications
Impact on Survival
![Page 3: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/3.jpg)
Standardized Mortality Rate in Patients Undergoing PCIBased Upon the Guide Catheter Size
Larger guiding catheter had higher mortality.
Grossman PM, et al. JACC Cardiovasc Interv. 2009 Jul;2(7):636-44.
![Page 4: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/4.jpg)
< <
“Bigger is NOT Better”Grossman PM, et al. JACC Cardiovascular Interv. 2009 Jul;2(7):636-44.
Percutaneous Coronary Intervention Complications and Guide Catheter Size
![Page 5: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/5.jpg)
Transradial Approach with
Slender Cath is Superior!!!!• However, cardiac assist device such as
IABP is necessary for complex PCI.
GLOBAL CALIBRATION
7.5 Fr or 8 Fr
LM occlusion
![Page 6: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/6.jpg)
Slender IABP
• 6F IABP system (Zeon Medical)
• Compatible GW is 0.014 inch
– Impossible to monitor arterial pressure
• Only 30 ml type
• Catheter length is 777mm
0.017inch
![Page 7: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/7.jpg)
6Fr is OK from Trans-brachial IABP
But transradial is impossible
due to the short catheter length
777mm
![Page 8: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/8.jpg)
Indication of Trans-brachial IABP
IABP is necessary but no femoral approach site.
Brachial approach may be beneficial compared
with femoral approach
・There’s no need to keep the supine position.
![Page 9: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/9.jpg)
Quantitative Assess of Brachial Artery Inner Lumen Diameter
We previously reported that the mean lumen diameter of the brachial artery was 4.53 ± 0.62 mm.6-Fr can be applied to the brachial artery in terms of the arterial size.
Fujii T, Masuda N, et al. J Invasive Cardiol. 2010 Aug;22(8):372-6.
![Page 10: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/10.jpg)
6Fr IABPvia Lt. Brachial
Trans-Brachial IABP insertion Method
![Page 11: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/11.jpg)
Pressure wave pattern ofthe guiding catheter
6Fr IABPvia Lt. Brachial
Trans-Brachial IABP insertion Method
![Page 12: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/12.jpg)
IABP Remove & Hemostasis
Removing with a brachial compression device (Tometa-kun™).
![Page 13: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/13.jpg)
Fujii T, Masuda N, et al. J Invasive Cardiol. 2012 Dec;24(12):641-4.
![Page 14: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/14.jpg)
Aim
To show clinical outcomes 6Fr-IABP support in comparison with 8-Fr IABP.
Consecutive 42 patients who underwent elective PCI with a prophylactic IABP assistance from January 2006 to December 2009 at Tokai University Hospital
Subjects
![Page 15: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/15.jpg)
42 elective PCI cases
with a prophylactic
IABP assistance
6Fr TB-IABP (n=15)
6Fr TF-IABP(n=5)
8Fr TF-IABP(n=22)
![Page 16: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/16.jpg)
Endpoints
Primary Endpoint:
IABP access site complications:
Re-bleeding
Hematoma (>5cm)
Blood Transfusion
Secondary Endpoints:
In-hospital MACCE (Death, MI, Stroke)
ΔHemoglobin, ΔHematocrit, ΔPletelet
Bed Rest Time after PCI
In-hospital Stay after PCI
Defer the Discharge/Re-hospitalization for Bleeding Complications
![Page 17: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/17.jpg)
Two different IABP systems were
Slenderized: 6-Fr IABP system(Takumi; Zeon Medical)
Conventional: 8-Fr IABP system (TRUE8-Super Track; Datascope)
Selection of either system was at operator discretion.
Devices
![Page 18: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/18.jpg)
6Fr-IABP 8Fr-IABP P-value
(n=20) (n=22)
Male 15 (75%) 17 (77.3%) 0.867
Age (years) 72.3±8.8 71.2±7.9 0.945
Height (cm) 160.4±8.6 160.0±7.8 0.829
Weight (kg) 57.5±11.9 57.2±10.0 0.609
Smoking 9 (45.0%) 5 (22.7%) 0.192
Diabetes Mellitus 12 (60%) 6 (27.3%) 0.060
Dyslipidemia 13 (65%) 11 (50%) 0.366
Hypertension 18 (90%) 19 (86.4%) 1.000
Old Myocardial Infarction 6 (30%) 13 (59.1%) 0.072
prior PCI 10 (50%) 11 (50%) 1.000
prior CABG 0 0 N/A
Aspirin and Thienopyridine Preloading
20 (100%) 22 (100%) N/A
Patient Characteristics
![Page 19: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/19.jpg)
6Fr-IABP 8Fr-IABP P-value(n=20) (n=22)
LM-related 19 (95.0%) 20 (90.1%) 1.000
3-Vessels Disease 2 (10.0%) 2 (9.1%) 1.000
Ejection Fraction (%) 58.4±16.2 60.9±17.9 0.671
Target Lesion Characteristics
![Page 20: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/20.jpg)
Procedural Characteristics
6Fr-IABP 8Fr-IABP P-value(n=20) (n=22)
GC Size (Fr) 6.1±0.5 6.6±0.8 0.011
IABP Volume (ml) 30.0±0.0 35.4±5.7 <0.001
Numbers of Stent 2.1±1.2 1.8±1.0 0.927
Procedural Time (min) 141.9±56.6 108.1±60.7 0.092
Fluoroscopy Time (min) 42.9±24.7 28.7±19.9 0.055
IABP Actuation Time (min) 127.1±59.2 87.9±52.3 0.044
Contrast Volume (ml) 246.9±106.2 223.8±95.2 0.479
Total Heparin (units) 8277.8±1564.5 7617.6±1798.7 0.254
![Page 21: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/21.jpg)
6Fr-IABP 8Fr-IABP P-value
(n=20) (n=22)
Procedure Success 20 (100%) 22 (100%) N/A
IABP access site complications: 0 3 (13.6%) 0.091
Re-bleeding 0 3 (13.6%)
0.091Hematoma (>5cm) 0 3 (13.6%)
Blood Transfusion 0 3 (13.6%)
In-hospital MACCE 0 0 N/A
In-hospital Death 0 0 N/A
ΔHemoglobin (g/dl) -0.9±1.2 -1.5±0.9 0.064
ΔHematocrit (%) -2.9±3.9 -4.3±3.0 0.192
ΔPletelet (×104/µl) -2.0±3.0 -1.7±2.1 0.706
Bed Rest Time after PCI (min) 75.8±139.8 360.0±104.7 <0.001
In-hospital Stay after PCI (days) 1.0 (1.0-2.8) 2.0 (1.0-5.0) 0.899
Defer the Discharge for Bleeding Complications
0 3 (13.6%) 0.091
Re-hospitalization for Bleeding Complications
0 1 (4.5%) 0.347
Results
![Page 22: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/22.jpg)
6Fr TB-IABP 6Fr TF-IABP 8Fr TF-IABPP-value
(n=15) (n=5) (n=22)
IABP access site complications 0 0 3 (13.6%) 0.243
In-hospital MACCE 0 0 0 N/A
In-hospital Death 0 0 0 N/A
ΔHemoglobin (g/dl) -0.8±0.9 -1.2±1.9 -1.5±0.9 0.137
ΔHematocrit (%) -2.5±3.0 -4.7±5.3 -4.3±3.0 <0.001
ΔPletelet (×104/µl) -1.3±2.2 -4.3±3.9 -1.7±2.1 <0.001
Bed Rest Time after PCI (min) 0.0±0.0 288.0±107.3 360.0±104.7 <0.001
In-hospital Stay after PCI (days)1.0
(1.0-2.0)5.0
(3.0-8.0)2.0
(1.0-5.0)0.007
Defer the Discharge for Bleeding Complications
0 0 3 (13.6%) 0.243
Re-hospitalization for Bleeding Complications
0 0 1 (4.5%) 0.646
Results
![Page 23: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/23.jpg)
We studied clinical benefits and adverse events of the 6-Fr IABP system by comparison with the conventional 8-Fr IABP system.
No adverse events were observed in the 6-Fr IABP system.
The 6-Fr IABP system was superior to 8-Fr IABP in terms of shorter bed rest time.
TB-IABP was superior to TF-IABP in terms of shorter bed rest time and shorter hospital stay.
Summary
![Page 24: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/24.jpg)
Study Limitation
Not randomize study
Retrospective study and small sample This sample size might explain why we did not see
statistically significant differences in IABP access-site complications.
Only prophylactic-IABP cases
![Page 25: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/25.jpg)
Limitations (Device)
Balloon volume is ONLY 30ml.
IABP tip pressure is NOT available.
Trans-Brachial insertion is Off Label use.
In case of draw-back of the IABP catheter, it may cause injury on subclavian artery.
![Page 26: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/26.jpg)
Limitations (Approach)
Rt.Brachial and Lt.Radial artery are not available.
This IABP catheter is too short to insert via radial approaches.
![Page 27: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/27.jpg)
Limitations (Patients)
Not applicable to patients with subclavian arterial stenosis.
![Page 28: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/28.jpg)
Limitations (Patients)
Not applicable to patients with so-called type III arch.
⇒Checking the arch anatomy is important for safe TB-IABP.
![Page 29: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/29.jpg)
Conclusion
The 6-Fr IABP system will be feasible in clinical use and advantageous in terms of lower access-site complications.
TB-IABP application will be also possible using this system to achieve shorter bed rest time and shorter hospital stay.
![Page 30: Ikari Y - AIMRADIAL 2014 - Radial and IABP](https://reader033.fdocument.pub/reader033/viewer/2022052813/559c45cd1a28ab9a218b4631/html5/thumbnails/30.jpg)
Take Home Message
Along with an increase in complex
coronary interventions that might
require hemodynamic support, not
only conventional trans-femoral 6-Fr
IABP assistance but also trans-
brachial 6-Fr IABP insertion are sure
to be useful options for
interventional cardiologists.