Transradial versus transfemoral percutaneous coronary intervention in acute myocardial infarction

Vorobcsuk, András; Kónyi, Attila; Aradi, Dániel; Horváth, Iván; Ungi, Imre; Louvard, Yves; Komócsi, András

doi:10.1016/j.ahj.2009.08.022

Cited by 153 publications

(117 citation statements)

References 27 publications

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“…Staniloae et al, 3 in a small observational study of 27 TRA vs 41 FA patients undergoing aortoiliac interventions, reported no transfusions for either group, but 7.3% had access site access, showing an 8.7% (2102 patients) rate of periprocedural blood or blood product transfusions. Given the associations between procedure-related transfusion and increased mortality, 1,[26][27][28][29] findings in such a large population warrant concern, justifying the need for RCT comparisons. While the authors did not specify the source of bleeding events (eg, access site vs other sites), minimizing bleeding risk should remain a key consideration when deciding on TRA or FA access options, particularly when accessing potentially diseased and calcified vessels.…”

Section: Bleeding Complicationsmentioning

confidence: 99%

Comparison of Transradial vs Transfemoral Access for Aortoiliac and Femoropopliteal Interventions

et al. 2016

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Purpose: To compare the procedure and safety outcomes of the transradial approach (TRA) with the femoral approach (FA) for treating aortoiliac and femoropopliteal stenoses and occlusions. Methods: A single-center retrospective study was conducted involving 188 patients (mean age 66.4±10.8 years; 116 men) with lower limb claudication or critical limb ischemia who underwent aortoiliac (131, 62.4%) or femoropopliteal (79, 37.6%) interventions on 210 lesions over a 3-year period. Operator discretion determined TRA suitability; exclusions included Raynaud’s disease, upper limb occlusive disease, previous TRA difficulties, or planned hemodialysis. Lesion characteristics, clinical endpoints, and access site complications were compared. Results: FA was used primarily in 123 patients and the TRA (12 left and 53 right radial arteries) in 65 procedures. Eleven (16.9%) TRAs failed vs 9 (7.3%) FAs (p=0.42). Crossover to FA was due to occlusive lesions requiring alternative equipment in 9 cases and to tortuosity of the aortic arch vessels in 2 patients. The 134 FA interventions (balloon angioplasty, stents) were retrograde (112, 83.6%) or antegrade (22, 16.4%). There were significantly more TASC C/D lesions in the FA group (p=0.02). Sheath sizes (5-F to 8-F) did not differ between groups, and no significant differences were found between FA vs TRA in terms of procedure time (50.0±28.9 vs 46.8±25.1 minutes, p=0.50) or length of stay (2.2±0.6 vs 2.1±0.3 days, p=0.24). While there were no strokes, access site complications occurred in 6.0% of the FA patients vs 3.7% of the TRA patients (p=0.12). Conclusion: The transradial approach for aortoiliac and femoropopliteal interventions is safe and efficacious compared with the transfemoral approach for a range of lesion subtypes. Nevertheless, there remains a need for improvements in peripheral device and catheter technology to decrease transradial failure rates.

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Section: Bleeding Complicationsmentioning

confidence: 99%

Comparison of Transradial vs Transfemoral Access for Aortoiliac and Femoropopliteal Interventions

et al. 2016

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“…Because of patient discomfort, bleeding complications at the vascular access site and the necessity for prolonged follow-up and bed rest in the TFA (2-4), other approaches to reduce complications and improve quality of life for patients in the diagnostic and interventional procedures were searched. The radial approach appears as a safe method and multiple randomized clinical trials and reports have confirmed its applicability and potential advantages over the TFA in elective (5,6) and acute (7)(8)(9)(10)(11) procedures with excellent success rates and very low complication rates of transradial approach (TRA). In addition, TRA is associated with reduced procedural discomfort of the patients mostly due to prolonged bed rest and vascular compression (12,13).…”

Section: Introductionmentioning

confidence: 99%

Comparision of pain levels of transradial versus transfemoral coronary catheterization: a prospective and randomized study

Aktürk¹,

Kurtoğlu²,

Ermiş³

et al. 2014

Anadolu Kardiyol Derg

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Objective: The aim of the present study was to assess access site pain levels of patients undergoing coronary catheterization via transradial route. Methods: We performed a prospective and randomized study in which 408 patients underwent coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) via transradial approach (TRA) and 428 patients underwent CAG and/or PCI via transfemoral approach (TFA). Pain levels of patients were assessed with Visual Analog Scale (VAS) after catheterization and at 30 days. Student-t, Mann-Whitney U and chi-square tests were used for statistical analysis. Results: Patients in the TRA group showed higher VAS scores than those in TFA group after catheterization [CAG alone, 3 (2-5) vs. 1 (1-3), p<0.0001; PCI, 4 (2-6) vs. 2 (1-3), p<0.0001, respectively]. One month later, patients in TRA group also showed higher VAS scores than those in TFA group [CAG alone, 1 (0-1) vs. 0 (0-1), p<0.0001; PCI, 1 (0-2) vs. 0 (0-1), p<0.0001, respectively]. By the ROC analysis in TRA group, a level of BMI <24.3 kg/m 2 predicted unacceptable pain with a 87.3% sensitivity and 91.6% specificity [area under curve (AUC): 0.875, 95% CI: 0.839-0.906, p<0.0001], while a wrist circumference <16.7 cm predicted unacceptable pain with 84.6% sensitivity and 89.8% specificity (AUC: 0.900, 95% CI: 0.867-0.928, p<0.0001). Conclusion: The current study suggests that a radial approach for CAG and PCI in patients with a low BMI and small wrist circumference may cause more access site pain as compared with a femoral approach. (Anadolu Kardiyol Derg 2014; 14: 140-6)

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“…Transradial-approach has become the standard access for CCA because it allows earlier mobility, reduced hospital stay, and decrease rates of VACs [13,14]. Furthermore, the indications for TRA have expanded to include the pPCI and treatment of complex lesions, such as those occurring at bifurcations and those creating total occlusion [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Radial artery ultrasound predicts the success of transradial coronary angiography

et al. 2017

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Transradial versus transfemoral percutaneous coronary intervention in acute myocardial infarction

Cited by 153 publications

References 27 publications

Comparison of Transradial vs Transfemoral Access for Aortoiliac and Femoropopliteal Interventions

Comparison of Transradial vs Transfemoral Access for Aortoiliac and Femoropopliteal Interventions

Comparision of pain levels of transradial versus transfemoral coronary catheterization: a prospective and randomized study

Radial artery ultrasound predicts the success of transradial coronary angiography

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