Radial Approach to Percutaneous Coronary Intervention

The radial approach is considered alternative to the traditional femoral approach to perform coronary angiography and percutaneous coronary intervention (PCI). Transradial compared to transfemoral PCI has been consistently shown to be equally effective but safer, since it significantly reduces access site related and bleeding complications. Additionally, it increases patient comfort and reduces hospitalization cost. Modern interventional strategies and aggressive antithrombotic regimens have limited ischemic adverse events following PCI. At the downside, bleeding complications remain a serious problem and adversely affect outcomes. They can be reduced with novel pharmacologic agents but still have unacceptably high rates and are mostly related to femoral access. In this context the radial approach seems a reasonable choice to further reduce access related bleeding. A concise overview of recent data supporting a more widespread dissemination of transradial PCI and a brief presentation of the most important pertinent technical issues are attempted herein. I N T R O D U C T I O N Percutaneous coronary intervention (PCI) can be performed via the femoral, brachial, or radial arteries. The femoral approach has traditionally been and still is the primary approach for most operators. Campeau et al first described the radial approach for coronary angiography in 1989. The first transradial PCI was reported by Kiemeneij and Laarman in 1993. Later, their group published the first series of balloon angioplasty and bare-metal stent implantation performed through the radial artery. Transradial compared to classic transfemoral PCI has been shown to have similar efficacy rates, while being more cost-effective and most importantly safer due to fewer access site or bleeding complications. Furthermore, patient comfort is increased and outpatient treatment may be feasible. However, the penetration of radial approach is heterogeneous worldwide. It is mostly developed in northwestern Europe, Canada and Eastern Asia. Especially in France 60% of PCI procedures are performed transradially, while in Europe the percentage currently is around 20%. Despite the presence of dedicated radialists, utilization of the radial approach in the U.S. remains quite low. As recently reported by Rao et al the percentage of radial PCIs increased from approximately 1.3% to only 3.5% by the first quarter of 2007 for centers participating in the National Cardiovascular Data Registry database. This is largely due to lack of widespread training and subsequent trepidation involving the learning curve. ATHENS CARDIOLOGY UPDATE 2010 Cardiology Department and Cardiac Catheterization Laboratory, KAT General Hospital, Athens, Greece HOSPITAL CHRONICLES 2010, SUPPLEMENT: 128–136

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