Transradial Versus Transfemoral Access for Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery Stenosis: A Systematic Review and Meta-Analysis

Bajaj, Archna; Pancholy, Samir; Sothwal, Arpit; Nawaz, Yassir; Boruah, Pranjal

doi:10.1016/j.carrev.2018.10.025

Cited by 11 publications

(14 citation statements)

References 13 publications

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“…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 .…”

Section: Discussionsupporting

confidence: 78%

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

Bhardwaj

Gunzburger

Valle

et al. 2021

Cathet Cardio Intervent

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Objectives We aimed to compare clinical characteristics and procedural outcomes of left main percutaneous interventions (LM‐PCI) by transradial (TRA) versus transfemoral (TFA) approach in the VA healthcare system. Background TRA for percutaneous coronary intervention (PCI) is steadily increasing. However, the frequency and efficacy of TRA for LM‐PCI remain less studied. Methods All LM‐PCIs performed in the VA healthcare system were identified for fiscal year 2008 through 2018. Patients' baseline characteristics and procedure‐related variables were compared by access site. Both short‐ and long‐term clinical outcomes were analyzed using propensity score matching. Results A total of 4004 LM‐PCI were performed in the VA via either radial or femoral access from 2008 to 2018. Among these, 596 (14.9%) LM PCIs were performed via TRA. Use of TRA for LM‐PCI increased from 2.2% to 31.5% over the study period. Propensity matched outcome analysis, comparing TRA versus TFA, showed a similar procedural success (98.4% for TRA vs. 97.8% for TFA; RR: 1.01 [0.98, 1.03]) and 1‐year major adverse cardiovascular events (MACE) (25.9% for TRA vs. 26.8% TFA; RR: 0.96 [0.74, 1.25]). There were no statistically significant differences among secondary outcomes analyses including major bleeding. Conclusion Use of TRA for LM‐PCI has been steadily increasing in the VA healthcare system. These findings demonstrate similar procedural success and 1‐year MACE across access strategies, suggesting an opportunity to continue increasing TRA use for LM‐PCI.

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Section: Discussionsupporting

confidence: 78%

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

Bhardwaj

Gunzburger

Valle

et al. 2021

Cathet Cardio Intervent

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“…This, combined with the decreased profile of newer generation balloons and stents, has allowed complex bifurcation procedures including two-stent techniques to be performed through radial access. 29,[38][39][40] Thus, large bore access via the femoral artery can often be avoided, and ultimately reducing the bleeding risk and vascular complications.…”

Section: Discussionmentioning

confidence: 99%

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

Goel

Pasam

Raheja

et al. 2019

Cathet Cardio Intervent

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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.

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“…Transradial access (TRA) has been considered as the default choice in cardiac catheterization because of the decreased access site complications, increased patients comfort, early mobilization, etc. [1]. Compared with femoral access, radial access has a similar procedural success rate and is associated with a significantly lower risk for allcause mortality and major adverse cardiovascular events [2].…”

Section: Introductionmentioning

confidence: 99%

Distal transradial access: a review of the feasibility and safety in cardiovascular angiography and intervention

Cai

Huang

Feng

et al. 2020

BMC Cardiovasc Disord

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Background: Transradial access (TRA) has been considered as the default choice in cardiac catheterization. Although infrequent, vascular complications of this approach remain. Recently, the distal transradial approach (dTRA) in cardiac catheterization was reported by interventionalists. Methods: We retrieved the relevant literatures and reviewed the safety and feasibility of this novel approach in cardiac catheterization. Results: The dTRA for cardiac intervention has superior safety and satisfaction. As a novel approach for cardiac catheterization, access related complications should also be considered by operators, such as RAO, radial spasm, bleeding and haematoma, and injury of the superficial branch of the radial nerve. Conclusions: The dTRA in cardiovascular angiography and intervention was safe and feasible.

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Transradial Versus Transfemoral Access for Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery Stenosis: A Systematic Review and Meta-Analysis

Cited by 11 publications

References 13 publications

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

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

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

Distal transradial access: a review of the feasibility and safety in cardiovascular angiography and intervention

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