Radial Access in Primary PCI for Acute Myocardial Infarction

Abstract

Transradial approach (TRA) is now considered the standard of care in many centers for elective and primary percutaneous coronary intervention (PCI). The use of the radial approach in ST-segment elevation myocardial infarction (STEMI) patients has been associated with a significant reduction in major adverse cardiac events. However, it is still unclear if the side of radial access (right vs. left) has impact on safety and effectiveness of TRA in primary PCI. So this chapter was conducted to summarize the benefits of transradial access over transfemoral access based on the most recent studies and to compare between using either right radial or left radial as an access for transradial procedure.

Outcomes of Transradial Approach in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute St Segment Elevation Myocardial Infarction

“…The main criticism encountered for radial artery access has always been expecting to be `delayed door to balloon (D2B) time`. Haq et al, 2015 demonstrated in their study that there is longer D2B time in TRA as compared to TFA 21 , and this was the vital reason for cardiologist to be reluctant to adopt TRA. According to Joint Commission on Accreditation of Healthcare Organization, the main goal to achieve in PCI centre should be less than 90 minutes in order to salvage myocardium and better outcomes [24][25] .…”

“…Several data from published study showed that there is not much difference in the success rate from right or left side approach 20 . Anyhow, left radial access is favourable in certain patients who have propensity of radial artery tortuosity like people thin lean body, short stature, female gender and elderly patients 21 . On the other hand, in the present study, failed radial artery access leads to switching to transfemoral and homolateral ulnar approach (4% v/s 2%) Jing et al, demonstrated the main cause for failure of transradial approach includes unsuccessful radial artery puncture (30%) followed by vascular abnormality (47%) and catheter related hinderance (23%) 22 .…”