Related Experiment Videos
A pilot study of coronary angioplasty in outpatients
G J Laarman1, F Kiemeneij, L R van der Wieken
1Amsterdam Department of Interventional Cardiology Onze Lieve Vrouwe Gasthuis, The Netherlands.
Insights
Same-day discharge after percutaneous transluminal coronary angioplasty (PTCA) is safe for carefully selected low-risk patients. This approach utilizes miniature equipment via the brachial artery, minimizing post-procedure complications for outpatient suitability.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Assessing the safety and feasibility of same-day discharge following percutaneous transluminal coronary angioplasty (PTCA).
- Hypothesizing that meticulous patient selection pre- and post-procedure can identify a low-risk cohort for outpatient management.
- Investigating the potential for same-day discharge to reduce healthcare costs and improve patient convenience.
Purpose of the Study:
- To evaluate the safety and efficacy of same-day discharge for patients undergoing PTCA.
- To determine if careful patient selection can identify individuals suitable for outpatient angioplasty.
- To assess the complication rates associated with outpatient PTCA using miniature equipment.
Main Methods:
- Studied 63 patients undergoing limited-risk coronary angioplasty (72 lesions) using miniature 6 French catheters via the right brachial artery.
- Patients were categorized into inpatient or outpatient groups based on post-PTCA angiographic results and complications.
- Outpatient candidates had good angiographic outcomes without dissection, thrombus, or complications.
Main Results:
- 61 patients (70 lesions) were analyzed after excluding two due to brachial approach failure.
- 50 patients (82%) with 57 lesions (81%) were assigned to the outpatient group, experiencing zero cardiac complications (95% CI 0-7%).
- Eleven patients (18%) assigned to the inpatient group had 13 lesions attempted, with three (27%) experiencing cardiac complications; two required local surgical repair for brachial artery access site issues.
Conclusions:
- Percutaneous transluminal coronary angioplasty using miniature equipment via the brachial artery is a safe procedure with high initial success rates.
- This pilot study suggests that PTCA can be safely performed in outpatients when careful patient selection criteria are applied.
- Outpatient management of selected patients undergoing PTCA via the brachial artery appears to be a viable and safe strategy.
Background:
Is it safe to discharge patients from hospital on the same day as percutaneous transluminal coronary angioplasty (PTCA)? The hypothesis tested was that careful pre and post angioplasty selection of patients can identify a group that is at very low risk of postprocedural complications and that these patients may be discharged on the day of the procedure.
Methods:
63 patients undergoing limited risk coronary angioplasty of 72 lesions were studied. So that patients would be able to walk soon after PTCA miniature equipment (6 French catheters and balloon-on-a-wire devices) was passed percutaneously through the right brachial artery. After coronary angioplasty patients with angiographic evidence of dissection and/or thrombus and with complications were assigned to an inpatient group and those in whom PTCA had achieved a good angiographic result were assigned to an outpatient group.
Results:
Two patients were excluded because the brachial approach failed, leaving 61 patients (70 lesions). After PTCA 50 patients (82%) with 57 lesions (81%) attempted were assigned to the outpatient group. No cardiac complication occurred in this subset (0%; 95% confidence interval 0 to 7%). Eleven patients (18%), in whom 13 lesions (19%) were attempted, were assigned to the inpatient group. Three of these patients (27%; 95% confidence interval 6 to 61%) had cardiac complications. Two patients needed local surgical repair after catheterisation of the brachial artery; one had a haematoma and one had a false aneurysm.
Conclusions:
Coronary angioplasty with miniature equipment passed through the brachial artery was a safe procedure with a high initial success rate. The results of this pilot trial suggest that with careful selection of patients before and after angioplasty PTCA can be performed safely in outpatients.