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Vascular Access-Site Complications in Chronic Total Occlusion Percutaneous Coronary Intervention
Michaella Alexandrou1, Dimitrios Strepkos1, Pedro E P Carvalho1
1Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Insights
Vascular access-site complications during chronic total occlusion percutaneous coronary intervention are linked to female sex, femoral artery access, and larger sheath sizes. These findings aid in risk stratification for patients undergoing CTO PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Vascular access-site complications (VASC) are potential adverse events during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
- Understanding risk factors for VASC is crucial for improving patient safety in complex PCI procedures.
Purpose of the Study:
- To identify patient and procedural characteristics associated with vascular access-site complications in a large cohort undergoing CTO PCI.
- To determine independent predictors of VASC in this high-risk patient population.
Main Methods:
- A multicenter registry of CTO PCI patients was analyzed.
- Baseline demographics, procedural details, and VASC outcomes were compared between patients with and without VASC.
- Multivariable logistic regression was used to identify independent predictors of VASC.
Main Results:
- VASC occurred in 0.9% of 16,810 CTO PCIs.
- Independent predictors of VASC included female sex (OR 1.95), femoral access (OR 2.02), and larger sheath sizes (7-F: OR 2.16; 8-F: OR 2.11).
- Patients with VASC had higher rates of major adverse cardiac events and bleeding compared to those without.
Conclusions:
- Female sex, preference for femoral access, and the use of larger sheaths (≥7F) are significant risk factors for VASC in CTO PCI.
- These findings can inform pre-procedural risk assessment and guide access site selection to minimize complications.
Background:
Vascular access-site complications (VASC) can occur during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods:
We compared the baseline and procedural characteristics, and outcomes of patients with versus without VASC in a large multicenter CTO PCI registry. VASC was defined as any of the following: small hematoma (hematoma < 5 cm), large hematoma (hematoma ≥ 5 cm), arteriovenous fistula, pseudoaneurysm and acute arterial closure.
Results:
VASC occurred in 158 of 16,810 CTO PCIs (0.9%). VASC patients were older (67 ± 11 vs. 64 ± 10 years, p < 0.001), more likely to be women (28.4% vs. 19.1%, p = 0.004) and less likely to be current smokers (18.9% vs. 27.2%, p = 0.026). They were more likely to have at least one femoral access (89.2% vs. 75.3%, p < 0.001) and less likely to have any radial access (38.0% vs. 52.3%, p < 0.001). Transfemoral access was more common in patients with VASC (60.1% vs. 45.7%, p < 0.001). VASC cases had higher J-CTO (2.57 vs. 2.38, p = 0.05) and PROGRESS-CTO major adverse cardiac events (MACE) scores (3.27 vs. 2.58, p < 0.001). They had similar technical (87.3% vs. 87.1%, p > 0.9) and procedural (82.3% vs. 85.9%, p = 0.2) success, but higher MACE (6.3% vs. 1.9%, p < 0.001) and bleeding (23.4% vs. 0.4%, p < 0.001). Female gender (odds ratio [OR] 1.95, 95% confidence intervals [CI] 1.24-3.00, p = 0.003), at least one femoral access (OR 2.02, 95% CI 1.09-4.04, p = 0.034) and sheath size (7-F: OR 2.16, 95% CI 1.12-4.60, p = 0.031; 8-F: OR 2.11, 95% CI 1.03-4.70,p = 0.051) were associated with VASC in multivariable analysis.
Conclusion:
Female sex, femoral access and larger sheaths ≥ 7 F were associated with VASC in patients undergoing CTO PCI.
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