Original Research

DOI: 10.4244/EIJ-D-24-00089

Ultrasound-guided versus fluoroscopy-guided large-bore femoral access in PCI of complex coronary lesions: the international, multicentre, randomised ULTRACOLOR Trial

Tom A. Meijers1, MD; Alexander Nap2, MD, PhD; Adel aminian3, MD; Thomas Schmitz4, MD, PhD; Joseph Dens5, MD, PhD; Koen Teeuwen6, MD, PhD; Jan-Peter van Kuijk7, MD, PhD; Marleen van Wely8, MD; Yoann Bataille9, MD, PhD; Adriaan O. Kraaijeveld10, MD, PhD; Vincent Roolvink1, MD, PhD; Jan-Henk E. Dambrink1, MD, PhD; A.T. Marcel Gosselink1, MD, PhD; Renicus S. Hermanides1, MD, PhD; Jan Paul Ottervanger1, MD, PhD; Ioannis Tsilingiris4, MD, PhD; Deborah M.F van den Buijs5, MD; Niels van Royen8, MD, PhD; Maarten A.H. van Leeuwen1, MD, PhD

Abstract

BACKGROUND: Transfemoral access is often used when large-bore guide catheters are required for percutaneous coronary intervention (PCI) of complex coronary lesions, especially when large-bore transradial access is contraindicated. Whether the risk of access site complications for these procedures may be reduced by ultrasound-guided puncture is unclear.

AIMS: We aimed to show the superiority of ultrasound-guided femoral puncture compared to fluoroscopy-guided access in large-bore complex PCI with regard to access site-related Bleeding Academic Research Consortium 2, 3 or 5 bleeding and/or vascular complications requiring intervention during hospitalisation.

METHODS: The ULTRACOLOR Trial is an international, multicentre, randomised controlled trial investigating whether ultrasound-guided large-bore femoral access reduces clinically relevant access site complications compared to fluoroscopy-guided large-bore femoral access in PCI of complex coronary lesions.

RESULTS: A total of 544 patients undergoing complex PCI mandating large-bore (≥7 Fr) transfemoral access were randomised at 10 European centres (median age 71; 76% male). Of these patients, 68% required PCI of a chronic total occlusion. The primary endpoint was met in 18.9% of PCI with fluoroscopy-guided access and 15.7% of PCI with ultrasound-guided access (p=0.32). First-pass puncture success was 92% for ultrasound-guided access versus 85% for fluoroscopy-guided access (p=0.02). The median time in the catheterisation laboratory was 102 minutes versus 105 minutes (p=0.43), and the major adverse cardiovascular event rate at 1 month was 4.1% for fluoroscopy-guided access and 2.6% for ultrasound-guided access (p=0.32).

CONCLUSIONS: As compared to fluoroscopy-guided access, the routine use of ultrasound-guided access for large-bore transfemoral complex PCI did not significantly reduce clinically relevant bleeding or vascular access site complications. A significantly higher first-pass puncture success rate was demonstrated for ultrasound-guided access. ClinicalTrials.gov identifier: NCT04837404

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Volume 20 Number 14
Jul 15, 2024
Volume 20 Number 14
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