Transradial access to percuatanous coronary intervention shows significant advantages over the femoral approach when used by experienced clinicians.Load more
A growing body of evidence suggests that a transradial intervention rather than a transfemoral approach to PCI is associated with greater reductions in bleeding complications than those achieved with pharmacological strategies alone.
Whilst the transfemoral approach to cardiac catheterization has dominated the huge growth of invasive cardiology to date, transradial access appeared early in the development of cardiac catheterization techniques as early as 1948.
Despite early enthusiasm for the approach, equipment limitations resulted in a shift to larger vessels for most catheter-based procedures, and the radial artery was consigned as a site for monitoring arterial pressure.
In the late 1970s, percutaneous coronary angioplasty was introduced using predominantly 9-F guiding catheters. Building on reports of successful transradial angiography from Canada in 1989, four years later, Kiemeneij and Laarman first reported on the transradial approach for coronary stenting.
Given observed reductions in periprocedural bleeding and reported improvements in patient comfort, a few enthusiastic early adopters surfaced, although transradial intervention generally remained a niche technique. The greater technical complexity of the procedure compared to the transfemoral procedure and the associated significant learning curve hindered its uptake.
As experience with transradial intervention grew, the lack of severe access-site complications when compared with the transfemoral approach to coronary angiography and coronary intervention was repeatedly demonstrated in small observational studies.
Cost-effectiveness was also demonstrated and small single-centre or limited multicenter randomised comparisons to femoral and brachial approaches showed the superiority of transradial intervention with respect to vascular access site complications, patient preference and speed of post-procedural recovery.
There are important veins or nerves near to the radial artery in the wrist, which decreases the likelihood of arteriovenous fistulas or nerve lesions; the superficial trajectory of the artery and its proximity to the bone allow simple hemostasis by means of simple compression, bypassing the need for closure devices and decreasing the chance of hematoma and pseudoaneurysm.
Several studies have reported that the patients can ambulate almost immediately following the procedure, which increases the patient´s comfort and level of satisfaction, and at the same time decreases the length of hospital stay and the cost.
Nevertheless, the procedure could only be performed with safety in patients with a normal Allen test, and technically, the procedure is more complex than the transfemoral procedure due to the greater difficulty in cannulating the artery, variations in the arteries of the upper limb, possibility of spasm, and the manipulation of the catheters that is necessary to cannulate the coronary arteries.
These difficulties result in a slight increase in the length of time needed for the procedure and time needed for fluoroscopy. There is also a significant learning curve involved, even for specialists with a a lot of experience in transfemoral procedures.
However, ESC Guidelines published last year give the highly recommend the radial approach over the femoral one for coronary angiography and percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS). The ACS without persistent ST-segment elevation (NSTE-ACS) guidelines are published online on the ESC Website and in European Heart Journal.Load Less
Transradial Approach in Primary Percutaneous Coronary Intervention: Lessons from a High-volume CentreLieuwe H Piers, Maarten A Vink, Giovanni Amoroso, et al.Interventional Cardiology Review 2016;11 (2):88–92
Eric W Holroyd, Ahmad HS Mustafa, Chee W Khoo, et al.Interventional Cardiology Review, 2015;10(1):22–5
Key Transradial Guidelines From Around The Web
2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevationMarco Roffi, Jean-Philippe Collet , Marco Valgimigli, et al.European Heart Journal Jan 2016, 37 (3) 267-315
Key Transradial Articles From Around The Web
Sanjit S Jolly, Ashraf Alazzoni, et al.J Am Coll Cardiol. 2017 May 11. pii: S0735-1097(17)36901-2.
Giuseppe Andò, Bernardo Cortese, Filippo Russo, et al.J Am Coll Cardiol. 2017 May 11. pii: S0735-1097(17)36897-3.
Transradial or Transfemoral Access for Patients With De Novo Acute Coronary Syndrome? Choosing the Best ApproachKevser Gülcihan Balcı, Mustafa Mücahit Balcı, Mehmet Kadri Akboğa, et al.Angiology. 2017 Apr;68(4):374.
Does Previous Transradial Catheterization Preclude Use of the Radial Artery as a Conduit in Coronary Artery Bypass Surgery?Craig A. Mounsey, Jamie A. Mawhinney, Taggart DP, et al.Circulation. 2016 Aug 30;134(9):681-8.
Key Transradial presentations from around the web
Radial artery spasm: prevalence, prevention, and safety vasodilators agents in a prospective randomized meta-analysisJ Adjedj, R Jackamy, A Diallo, et al.
Safety and feasibility of the transradial approach in the treatment of CTO, tailored by a low intermediate grade J-CTO score : a single center experienceF Del Furia, F Casilli, R Jabbour, et al.
Radial versus femoral access for the treatment of left main lesion in the era of second generation drug eluting stents : data from the FAILS 2 registryF D’Ascenzo, A Chieffo, E Cerrato, et al.
Radial vs. femoral access in complex coronary lesions interventions: one-year outcomes of a singlecentre experience.Eddie Koifman, Ricardo O. Escarcega, R Didier, et al.
Kully Sandhu, Robert Butler, James Nolan, et al.Interventional Cardiology Review 2017;12(1):18–24DOI: .15420/icr.2017:2:2
Transradial Approach in Primary Percutaneous Coronary Intervention: Lessons from a High-volume CentreLieuwe H Piers, Maarten A Vink, Giovanni Amoroso, et al.Interventional Cardiology Review 2016;11 (2):88–92DOI: .15420/icr.2016:21:3
David Smith, Ahmed Hailan, Alexander Chase, et al.Interventional Cardiology Review, 2015;10(2):90–3DOI: 10.15420/icr.2015.10.2.90
Eric W Holroyd, Ahmad HS Mustafa, Chee W Khoo, et al.Interventional Cardiology Review, 2015;10(1):22–5DOI: 10.15420/icr.2015.10.1.22