Transradial versus transfemoral approach for percutaneous coronary intervention in cardiogenic shock: A radial-first centre experience and meta-analysis of published studies

Abstract

The transradial approach in the setting of PCI for ischaemic CS is associated with a dramatic reduction in mortality, ischaemic and bleeding events, and should be preferred to the transfemoral approach in radial expert centres.

In patients undergoing percutaneous coronary intervention with rotational atherectomy radial access is safer and as efficient as femoral access

“…Being a complex procedure, RA traditionally used to be performed via TFA, in about 70‐80% of all RA procedures . After the introduction of TRA several studies proved the safety and efficacy of radial access, in different clinical scenarios . Because no randomized trials comparing RA via TRA to via TFA are to date available, the knowledge concerning this issue comes from a couple of smaller observational studies while more extensive registries are still ongoing.…”

“…Additionally, the introduction of transradial approach (TRA) into daily practice is initially a challenging and demanding technique and a learning curve is longer. On the other hand, there is a growing evidence that TRA for PCI is safe, effective and associated with lower access site complication rates and even lower mortality, including complex procedures like in acute coronary syndromes and cardiogenic shock …”

Predictors of Outcomes in Myocardial Infarction and Cardiogenic Shock

“… 109 Another prospective study of 101 patients with MI-CS in a radial first center showed that transradial access was feasible in 73% of patients, that patients undergoing transfemoral PCI were sicker, and that transradial PCI was associated with lower mortality rates and fewer bleeding events. 110 These were all observational studies with potential selection bias, and no randomized trials specifically evaluating access site and outcomes in MI-CS are currently available.…”

Patient Versus Physician Variation in Use of Transradial Percutaneous Coronary Intervention

“…A recent meta-analysis showed that the average delay between TRA and TFA was only 1.5 minutes. 21 Concerns for increased radiation exposure have been voiced as well, however, Jolly et al concluded that radiation dose was only nominally higher with radial access (median air kerma 1046 vs 930 mGy P=0.051), with differences being present only in lower volume centers and operators. 13 Concerns over these and other technical challenges could discourage learners from adopting TRA.…”