Prediction and impact of failure of transradial approach for primary percutaneous coronary intervention

Abstract

In a high-volume radial centre, the incidence of TRA-PCI failure is low and can be accurately predicted using a 9-variables risk score. Since outcomes after TRA-PCI failure remained inferior, further effort to maximise the use of radial approach for primary PCI should be investigated.

Benefit of routine preprocedural radial artery angiography in STEMI patients

“…The reported overall failure in transradial procedures is between 1% and 10% [15][16][17][18][19]. Prior studies have reported that arterial anomalies found from wrist to aorta influence the success of transradial access and are cause for access crossover from TRA to other access sites [15][16][17][18].…”

Transradial versus transfemoral percutaneous coronary intervention of left main disease: A systematic review and meta‐analysis of observational studies

“…Although it is reassuring that procedural success rate was comparable between the two approaches for LM‐PCI, lesion complexity and operators' experiences/skills should be taken into considerations to decide whether TR or TF‐PCI should be performed for LM lesion because the learning curve for TR‐PCI was suggested in previous studies . Certain risk factors such as low body weight, renal impairment, older age, previous coronary bypass surgery, and female sex were reported as predictors of failure of TR‐PCI but unfortunately some of these risk factors are also associated with higher rates of vascular complications for TF access . Use of left radial approach could potentially result in better procedural success rate because of less possibility of tortuosity in the left brachiocephalic artery but this was not evident in previous meta‐analysis .…”

Sirens song or a bugle call to charge

“…In the case of operator bias toward access, there was some incremental difference in mortal outcome, but again these are now femoral access patients being compared to radial and this result would be expected. When failure was driven by in‐procedure cross‐over to a non‐radial site, the survival difference is significant with 1‐year survival rates on the order of 0.60 versus 0.95 for the group with successful transradial access .…”

“…Some of these problems are technically fixable with better approaches to placing larger guides such as balloon tracking or technology such as sheathless guides. Looking at factors associated with access failure in transradial experiences where patient level data is available repeatedly shows female gender, advanced age, and short stature as hazards for access site failure . These are just the groups that are at highest risk for bleeding from a femoral approach and a carte blanche shift to femoral will not improve their overall outcome.…”