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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\n      \u003Ch2\u003ESummary\u003C\/h2\u003E\n      \u003Cp id=\u0022p-1\u0022\u003ECompared with a transfemoral approach (TFA), using a transradial approach (TRA) for unprotected left main coronary artery (ULMCA) disease results in a comparable procedural success rate, a lower rate of vascular complications, similar fluoroscopy time, and shorter hospital stays. TRA should be considered as an alternative to TFA in performing percutaneous coronary intervention for ULMCA diseases.\u003C\/p\u003E\n   \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ecoronary artery disease clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n      \u003Cp id=\u0022p-2\u0022\u003ECompared with a transfemoral approach (TFA), using a transradial approach (TRA) for unprotected left main coronary artery (ULMCA) disease results in a comparable procedural success rate, a lower rate of vascular complications, similar fluoroscopy time, and shorter hospital stays. TRA should be considered as an alternative to TFA in performing percutaneous coronary intervention (PCI) for ULMCA diseases.\u003C\/p\u003E\n      \u003Cp id=\u0022p-3\u0022\u003EAli A. Youssef, MD, Suez Canal University Hospital, Ismailia, Egypt, presented the results of a retrospective analysis of patients (mean age 67 years; mostly men) with LM stenosis \u226550% who were not eligible for coronary artery bypass graft (CABG) and underwent either TRA (n=116) or TFA (n=15) for ULMCA stenting. Patients were stratified for risk of death at 30 days using the EuroSCORE, with high risk being a score \u22656. Angiographic success was defined as TIMI 3 flow with residual diameter stenosis \u0026lt;30%. Procedural success was defined as angiographic success that was achieved without procedure-related death, myocardial infarction (MI), repeat PCI, or emergent CABG during hospitalization. Other study endpoints included vascular complications (eg, local hematoma, regional ischemic changes, peripheral artery occlusion, TIMI major and minor bleeds) and early (in-hospital and 6-month) outcomes (eg, postprocedural MI, stent thrombosis, pulmonary edema, stroke). With the exception of significantly higher rates of hypertension (p=0.043) and prior stroke in the TFA group (p=0.019), patients were well matched on demographics and clinical characteristics. Almost two-thirds of the patients in both groups were high-risk (mean EuroSCORE 7.3 \u00b1 3.7 in the TRA group vs 8.7 \u00b1 5.1 in the TFA group; p=NS).\u003C\/p\u003E\n      \u003Cp id=\u0022p-4\u0022\u003EThere were no differences in procedural time, angiographic or procedural success, TIMI 3 flow rates, percent residual stenosis, or achievement of complete revascularization (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). In general, smaller catheter sizes were used with the TRA (85.3% of procedures used a 6 French in the TRA approach vs only 20% of TFA procedures). Local vascular complications were significantly (p\u0026lt;0.001) more common among patients in whom a TFA was used (26.6%) compared with those in whom a TRA was used (1.7% of patients). Events that were significantly more common in the TFA group were hematoma\/ecchymosis \u0026gt;5 cm (20% of patients vs 1.7% of TRA patients; p=0.001) and pseudoaneurysm and TIMI minor bleeding (both 6.7% vs 0%; p=0.005). There were no TIMI major bleeds in either group.\u003C\/p\u003E\n      \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\n         \u003Cdiv class=\u0022table-inline\u0022\u003E\n            \u003Cdiv class=\u0022callout\u0022\u003E\n               \u003Cspan\u003EView this table:\u003C\/span\u003E\n               \u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12473\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12473\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12473\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\n            \u003C\/div\u003E\n         \u003C\/div\u003E\n         \u003Cdiv class=\u0022table-caption\u0022\u003E\n            \u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EAngiographic Outcomes.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\n      \u003Cp id=\u0022p-6\u0022\u003EUnadjusted event rates between the two groups during hospitalization and at 6 months are shown in \u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETables 2\u003C\/a\u003E and \u003Ca id=\u0022xref-table-wrap-3-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T3\u0022\u003E3\u003C\/a\u003E. In-hospital cardiovascular (CV) events were significantly (p=0.003) more common among patients in the TFA group. Mortality was also significantly higher in the TFA group (13.3% of patients) compared with the TRA group (0.9%; p=0.002). There were no differences in mean duration of hospitalization (6.9 \u00b1 13.3 days for TRA and 7.5 \u00b1 9.1 days for TFA; p=NS) or outcomes at 6 months.\u003C\/p\u003E\n      \u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\n         \u003Cdiv class=\u0022table-inline\u0022\u003E\n            \u003Cdiv class=\u0022callout\u0022\u003E\n               \u003Cspan\u003EView this table:\u003C\/span\u003E\n               \u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12475\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12475\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12475\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\n            \u003C\/div\u003E\n         \u003C\/div\u003E\n         \u003Cdiv class=\u0022table-caption\u0022\u003E\n            \u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EIn-Hospital Outcomes.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\n      \u003Cdiv id=\u0022T3\u0022 class=\u0022table pos-float\u0022\u003E\n         \u003Cdiv class=\u0022table-inline\u0022\u003E\n            \u003Cdiv class=\u0022callout\u0022\u003E\n               \u003Cspan\u003EView this table:\u003C\/span\u003E\n               \u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12477\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12477\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12477\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\n            \u003C\/div\u003E\n         \u003C\/div\u003E\n         \u003Cdiv class=\u0022table-caption\u0022\u003E\n            \u003Cspan class=\u0022table-label\u0022\u003ETable 3.\u003C\/span\u003E \n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EClinical Outcomes at 6 Months.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\n      \u003Cp id=\u0022p-10\u0022\u003ELimitations to this study include its modest size, the lack of randomization to TRA or TFA, and the assessment at a single center, where the majority of approaches that were reported was a TRA. While the data that were presented are promising, in that they suggest that TRA may be considered as an approach for ULMCA interventions, larger randomized trials will be necessary to ascertain differences in outcomes between these two approaches.\u003C\/p\u003E\n   \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/6\/10.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn0e2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzn0e2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}