December 3, 2019
Study Identifies Barriers to Transradial Access for PCI
December 4, 2019—A study on the barriers to using transradial access for percutaneous coronary intervention (PCI) was published by Tanawan Riangwiwat, MD, et al in Catheterization & Cardiovascular Interventions.
According to the investigators, the adoption to practice for transradial access is slow; however, it yields fewer vascular complications, earlier ambulation, and more patient comfort than transfemoral access, which is still commonly used.
As summarized in Catheterization & Cardiovascular Interventions, the investigators identified all PCIs performed by one operator in a radial‐first, trainee‐driven practice. They reviewed individual charts for all PCIs using femoral access and then identified the reasons for not using radial access. Descriptive statistics were used to report reasons for not using transradial access. Analyses were performed on a per‐procedure basis.
The investigators reported that of 1,948 PCIs, 1,790 (92%) were performed via radial access and 158 (8%) via femoral access. Femoral access was used to bail out unsuccessful radial access in 21 PCIs (13% of all femoral PCIs, 1% of all PCIs).
They found that in the majority of radial access failure PCIs (n = 13), radial access was unsuccessful because of failure to cannulate the radial artery, radial artery spasm, and radial loop. Femoral access was used as a primary strategy in 137 PCIs (87% of all femoral PCIs, 7% of all PCIs), mostly because of undetectable radial artery pulse—both left and right (n = 40).
The study showed that transradial access can be used for PCI safely and effectively, but inadequate radial pulse is the main barrier to this approach. Adjunctive strategies such as ulnar access and use of ultrasound may further increase the success rate of arterial access from the upper extremities, concluded the investigators in Catheterization & Cardiovascular Interventions.