Few topics in interventional cardiology have received more fervent study than the
radial-vs-femoral debate. There is now overwhelming evidence that transradial access
(TRA) is associated with lower incidence of vascular complications and bleeding in
patients undergoing percutaneous coronary intervention (PCI), and even mortality in
the context of acute coronary syndromes (ACS)(
1
,
2
). For this reason, TRA is recommended as the default access route for PCI by guidelines(
3
,
4
).To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial.Lancet. 2015; 385: 2465-2476
- Radial versus femoral access for coronary interventions: an updated systematic review and meta-analysis of randomized trials. Catheter.Cardiovasc. Interv. 2021; 97: 1387-1396
- 2018 ESC/EACTS guidelines on myocardial revascularization.Eur. Heart J. 2019; 40: 87-165
- 2021 ACC/AHA/SCAI Guideline for coronary artery revascularization.J. Am. Coll. Cardiol. 2021; 79 (e21–e129)
- Defining percutaneous coronary intervention complexity and risk: an analysis of the United Kingdom BCIS Database 2006-2016.JACC. Cardiovasc. Interv. 2022; 15: 39-49
- Procedural outcomes of percutaneous coronary interventions for chronic total occlusions via the radial approach: insights from an international chronic total occlusion registry.JACC. Cardiovasc. Interv. 2019; 12: 346-358
- The wise radialist’s guide to optimal transfemoral access: selection, performance, and troubleshooting.Catheter. Cardiovasc. Interv. 2017; 89: 399-407
- Conventional vascular access site approach versus fully trans-wrist approach for chronic total occlusion percutaneous coronary intervention: a multicenter registry.Catheter. Cardiovasc. Interv. 2019:Oct; 9
- Randomized comparison between radial and femoral large-bore access for complex percutaneous coronary intervention.JACC Cardiovasc Interv. 2021; 14: 1293-1303
- Femoral or radial approach in treatment of coronary chronic total occlusion: a randomized clinical trial.JACC Cardiovasc. Interv. 2022; 15: 823-830
- Radial versus femoral access in chronic total occlusion percutaneous coronary intervention.Circ. Cardiovasc. Interv. 2019; 12e007778
Definition of “complex.” Merriam-Webster Dictionary. Available at: https://www.merriam-webster.com/dictionary/complex
- Efficacy and safety of dual antiplatelet therapy after complex PCI.J. Am. Coll. Cardiol. 2016; 68: 1851-1864
- Radial versus femoral access in ACS patients undergoing complex PCI is associated with consistent bleeding benefit and no excess of risks.Can. J. Cardiol. 2022; (In press)
- Guiding principles for chronic total occlusion percutaneous coronary intervention: a global expert consensus document.Circulation. 2019; 140: 420-433
- Radial versus femoral access for rotational atherectomy: a UK observational study of 8622 patients.Circ. Cardiovasc. Interv. 2017; 10e005311
- The benefits conferred by radial access for cardiac catheterization are offset by a paradoxical increase in the rate of vascular access site complications with femoral access: the Campeau Radial Paradox.JACC Cardiovasc. Interv. 2015; 8: 1854-1864
- Long-term outcomes of chronic total occlusion recanalization versus percutaneous coronary intervention for complex non-occlusive coronary artery disease.Am. J. Cardiol. 2020; 125: 182-188
Article Info
Publication History
Accepted:
June 29,
2022
Received in revised form:
June 27,
2022
Received:
June 21,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Disclosures: Dr. Azzalini received honoraria from Teleflex, Abiomed, GE Healthcare, Asahi Intecc, Philips, Abbott Vascular, and Cardiovascular System, Inc.
Funding: none
Identification
Copyright
© 2022 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Radial versus femoral access in ACS patients undergoing complex PCI is associated with consistent bleeding benefit and no excess of risksCanadian Journal of Cardiology
- PreviewWe evaluated the comparative efficacy and safety of transradial (TRA) compared with transfemoral access (TFA) in patients with acute coronary syndrome undergoing complex percutaneous coronary intervention (PCI). Among ACS patients, PCI complexity does not affect the comparative efficacy and safety of TRA versus TFA, whereas the absolute risk reduction of access-site major bleeding was greater with TRA compared with TFA in complex as opposed to noncomplex PCI.
- Full-Text
- Preview
