Radiologic predictors of access-site complications during support with micro-axial flow pump support in infarct-related cardiogenic shock and high-risk percutaneous coronary intervention
A Quinkler, L Degener, U Landmesser, Y Abdelwahed, C Skurk, T ThevathasanAbstract
Background
Micro-axial flow pumps are increasingly employed for temporary mechanical circulatory support in patients with acute myocardial infarction-related cardiogenic shock (AMI-CS) and during high-risk percutaneous coronary intervention (PCI). Despite hemodynamic benefits, device-related complications, including major access-site bleeding, limb ischemia and stroke, remain frequent and contribute substantially to morbidity and mortality. Access-site characteristics, particularly vascular anatomical features, may influence complication risk during mAFP therapy.
Purpose
To evaluate whether angiographic and computed tomographic access-site parameters, including vessel diameter, vascular length, calcification burden, tortuosity and stenosis of the common femoral artery (CFA), as well as level of the femoral bifurcation and epigastric zone, and angulation between the common iliac artery and aorta, are associated with an increased risk of clinically relevant access-site complications, defined as major bleeding at the access site (BARC ≥3), limb ischemia at the site of the mAFP insertion or stroke.
Methods
In this observational study conducted at a high-volume tertiary care center, consecutive patients undergoing mAFP therapy for AMI-CS or high-risk PCI were included. Procedural radiologic imaging (angiography or computed tomography) and procedural complications were independently analyzed by two blinded investigators. Logistic regression analyses were performed to evaluate associations between radiologic parameters and the primary endpoint (composite of any aforementioned access-site complication) as well as secondary endpoints (individual complications).
Results
A total of 202 patients receiving mAFP therapy were included, of whom 165 (82%) were male. Median age was 66 years (IQR 57-77). No radiologic parameter was significantly associated with the composite primary endpoint of any clinically relevant procedural complications. However, increasing CFA diameter was independently associated with a lower risk of limb ischemia: Each millimeter increase in CFA diameter was associated with a 45% risk reduction in limb ischemia (odds ratio 0.55; 95% confidence interval 0.33-0.91; p = 0.02). Receiver-operating-characteristic analysis identified a CFA diameter threshold of 7 mm or above as the optimal cut-off for minimizing limb ischemia risk. Other radiologic parameters were not significantly associated with secondary endpoints (Figure).
Conclusion
Radiologic access-site parameters show limited predictive value for major complications at the access site during mAFP support, with the exception of CFA diameter. These findings suggest that non-anatomical factors, such as patient-related risk profiles or puncture technique and the rate of mis-punctures, may play a more decisive role and warrant further investigation to improve complication risk stratification.Figure 1