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Brachial approach for intracoronary stent implantation: a feasibility study
J R Resar1, M R Wolff, R S Blumenthal
1Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD.
Insights
The left brachial approach for coronary artery stent implantation is a safe and feasible alternative to the femoral approach. This method reduces vascular complications and shortens hospital stays for patients undergoing stent procedures.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Cardiology
Background:
- Percutaneous femoral artery access for coronary artery stent implantation is linked to high rates of vascular complications.
- These complications stem from the large access site and necessary anticoagulation to prevent stent thrombosis.
Purpose of the Study:
- To evaluate the feasibility and safety of using the left brachial artery approach with open arterial repair for coronary artery stent implantation.
- To compare vascular complication rates and hospitalization duration between femoral and brachial approaches.
Main Methods:
- A comparative study involving 24 patients (Group A) undergoing femoral approach stent implantation and 16 patients (Group B) undergoing brachial approach stent implantation.
- Vascular complications, angiographic outcomes, and length of hospital stay were recorded and compared between the two groups.
Main Results:
- Coronary artery stent delivery was successful in all femoral cases (27 stents) but one brachial case (17/18 stents).
- Vascular complications (hematomas, hemorrhage, surgical injury, pseudoaneurysm) were significantly lower in the brachial group (6%) compared to the femoral group (33%).
- Hospital stay was significantly shorter for the brachial approach (6.5 days) versus the femoral approach (9.4 days).
Conclusions:
- The left brachial artery approach is technically feasible and safe for coronary artery stent implantation.
- This approach is associated with significantly fewer local vascular complications and reduced hospitalization compared to the traditional femoral approach.
Abstract:
Implantation of coronary artery stents via the percutaneous femoral approach is associated with a high rate of vascular complications at the access site related to the size of the entry hole and the intense anticoagulation required to prevent stent thrombosis. Therefore we studied the feasibility of using the left brachial approach utilizing open arterial repair for implantation of coronary artery stents. Intracoronary stent implantation via the femoral approach in 24 patients (group A) was compared with implantation via the brachial approach in 16 patients (group B). Baseline lesion characteristics were similar in the two groups. All stents in group A (n = 27 stents) were successfully delivered to their target vessel. One stent in group B (n = 18 stents) could not be delivered because of an inability to engage the coronary artery from the brachial approach. There were no significant differences in the angiographic outcome between the two groups. Complications including hematomas, hemorrhage requiring blood transfusion, vascular injury requiring surgery, and pseudoaneurysm formation were significantly more common in group A than in group B (8/24 [33%] versus 1/16 [6%], respectively; p < 0.05). In addition, the length of hospital stay was significantly longer for the femoral approach than the brachial approach (9.4 vs 6.5 days, respectively; p < 0.05). Thus the left brachial approach for intracoronary stent implantation is technically feasible, safe, and associated with fewer local vascular complications and a shorter hospitalization than the femoral approach.