Optimising access-site risks and complications in coronary angiography and percutaneous coronary intervention

Abstract

Major access-site bleeding and vascular complications are among the most dreaded complications following coronary angiography and percutaneous coronary intervention. Despite continual improvements in pharmacological and technical measures, bleeding complications still remain a major concern in patients with acute coronary syndrome undergoing invasive coronary intervention. Major bleeding and vascular complications are not only associated with prolonged hospital stay, increased costs, and reduced quality of life; but also with increased morbidity and mortality. Thus, the objective of this research thesis is to investigate measures, particularly the role of ultrasound guidance, in optimising access-site risks and complications in coronary angiography and percutaneous coronary intervention. The results showed that transradial access significantly reduced the composite outcome compared to transfemoral access. Transfemoral access remained superior to transradial access in terms of reduced mean access time, mean access attempts, number of difficult accesses, as well as procedural time and dose-area product. However, there was no difference in the number of first pass successes between the two groups. The rate of venepuncture was markedly higher in the transfemoral approach. Ultrasound guidance did not demonstrate a benefit in clinical outcomes compared with standard access. Ultrasound guidance improved the efficiency and overall success rate of arterial access when compared with the standard palpation technique. It reduced mean access time, mean access attempts, number of difficult accesses, rate of venepuncture, and improved the number of first pass success. Ultrasound guidance significantly improved successful catheterisation of the femoral artery above the bifurcation without an increase in the rate of high punctures. Ultrasounnd guidance in femoral access achieved a high level of ideal puncture and did not increase the risk of retroperitoneal haemorrhage. Obese patients with an abdominal circumference ≥ 100cm had higher rates of vascular complications and ACUITY minor bleeding in comparison to those with an abdominal circumference < 100cm, when undergoing coronary angiogram and/or PCI via a transfemoral approach. Ultrasound guidance was shown to significantly improve femoral artery access outcomes in obese patients with thigh circumference ≥ 60cm when compared with the standard palpation technique. The numbers required to attain competency in ultrasound-guided transfemoral and transradial access were 15 and 25 punctures, respectively. The incidence of subclinical stenoses of the radial artery after being cannulated for catheterization occurred more frequently than anticipated. There were no significant changes in the levels of intercellular adhesion molecule-1, vascular cell adhesion molecule-1, P-selectin and E-selectin when comparing pre- and immediately post-coronary procedures.

Date of Award	2021
Original language	English