Brachial approach for intracoronary stent implantation: a feasibility study.
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.
Resar
J R
JR
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD.
Wolff
M R
MR
Blumenthal
R S
RS
Coombs
V
V
Brinker
J A
JA
D001916:Brachial Artery; D002404:Catheterization / Q000379:methods; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery; D005268:Femoral Vein; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects; D014652:Vascular Diseases / Q000453:epidemiology / Q000209:etiology