Left main percutaneous coronary intervention—Radial versus femoral access: A systematic analysis

Abstract

Background Debate still occurs of the benefits of transradial access (TRA) versus transfemoral access (TFA), especially for complex percutaneous coronary interventions. Recent data has shown equivalent efficacy and improved safety outcomes with TRA. Objectives To systematically review and perform a meta‐analysis comparing procedural characteristics and clinical outcomes of TRA versus TFA in patients who underwent percutaneous coronary intervention (PCI) for left main (LM) disease. Methods We conducted an electronic database search of all published data for studies that compared TRA with TFA in patients undergoing PCI of LM disease. Event rates were compared using the odds ratio (OR) as a measure of effect size. Random‐effects models were used to account for interstudy heterogeneity. Results A total of 12 observational studies including 17,258 patients (TRA n = 7,971; TFA n = 9,287) were included. Compared to TFA, TRA was associated with a significant reduction in access site bleeding (OR = 0.11; 95% confidence interval [CI] = 0.04–0.26; I2 = 0%; p < .0001), major bleeding (OR = 0.44; 95% CI = 0.27–0.69; I2 = 0%; p = .0005) or any bleeding episode (OR = 0.43; 95% CI = 0.27–0.69; I2 = 12%; p = .0004). Rates of access site or vascular complications (OR = 0.26; 95% CI = 0.17–0.40; I2 = 0%; p < .00001) and in‐hospital mortality (OR = 0.49; 95% CI = 0.31–0.79: I2 = 11%; p = .004) were also lower in the TRA group. There were no significant differences in procedural outcomes between TRA and TFA except for a significant reduction in the rate of long‐term target vessel revascularization (TVR) in the TRA group (OR = 0.62; 95% CI = 0.41–0.94: I2 = 0%: p = .02). We further performed a subgroup analysis for unprotected left main PCI only, which showed a significant reduction in rates of any bleeding episode, lower access site or vascular complications, and in‐hospital mortality with TRA as compared to TFA. Conclusion Patients undergoing PCI for LM disease via TRA have with less bleeding, reduced access site or vascular complications, reduced in‐hospital mortality, comparable procedural success, and possibly better long‐term clinical efficacy when compared to those undergoing the procedure via TFA.

Radial versus femoral access for left main percutaneous coronary intervention: An analysis from the Veterans Affairs Clinical, Reporting, and Tracking Program

“…The current study supports the prior literature regarding use of TRA for LM‐PCI, with comparable procedural success and long‐term outcomes to transfemoral access 11,18–21 . Despite better patients' experience and improved outcomes with TRA in acute MI, its use has varied across the world with relatively lower rates in the United States compared to Europe and Asia 1 .…”

SCAI position statement on optimal percutaneous coronary interventional therapy for complex coronary artery disease

“…Radial access is associated with similar technical and procedural success compared to femoral access and often offers lower risks of major bleeding and vascular complications. [78][79][80] Complex interventions including LM bifurcations, CTO PCI, and large burr atherectomy may now be performed safely and effectively via the radial artery with standard or sheathless guide catheters up to eight French in size, and incorporating additional support strategies that include guide catheter extensions and anchor balloons. 79,81 Evidence also suggests that when necessary, femoral access may still be performed safely by expert operators using optimal ultrasound-guided access, including the use of micropuncture needles.…”

Study on the Safety of the New Radial Artery Hemostasis Device

“…Although TRA is often chosen, it also has certain complications, such as bleeding and hematoma at the puncture site, radial artery spasm, radial artery occlusion (RAO), even radial artery lacerations, pseudoaneurysm, and osteofascial compartment syndrome [8]. e application of radial hemostatic devices is widely used, especially in TR Band.…”