Current Cardiology Reports

, Volume 14, Issue 4, pp 502–509

Radial Versus Femoral Access for Percutaneous Coronary Intervention: Implications for Vascular Complications and Bleeding

Management of Acute Coronary Syndromes (R Mehran, Section Editor)

DOI: 10.1007/s11886-012-0287-5

Cite this article as:
Nathan, S. & Rao, S.V. Curr Cardiol Rep (2012) 14: 502. doi:10.1007/s11886-012-0287-5

Abstract

Since its advent over two decades ago, transradial access for cardiac catheterization and percutaneous intervention has evolved into a versatile and evidence-based approach for containing the risks of access-site bleeding and vascular complications without compromising the technical range or success associated with contemporary percutaneous coronary intervention (PCI). Early studies demonstrated reduced rates of vascular complications and access-site bleeding with radial-access catheterization but at the cost of increased access-site crossover and reduced procedural success. Contemporary data demonstrate that while the rates of major bleeding with femoral-access PCI in standard-risk cohorts have declined significantly over time, the transradial approach still retains significant advantages by way of reductions in vascular complications, length of stay, and enhanced patient comfort and patient preference over the femoral approach, while maintaining procedural success. Major adverse cardiovascular events and bleeding are lowest with the transradial approach when procedures are performed at high-volume radial centers, by experienced radial operators, or in the context of ST-segment elevation myocardial infarction. Choice of procedural anticoagulation appears to differentially impact access-site bleeding in transradial versus transfemoral PCI; however, non-access site bleeding remains a significant contributor to major bleeding in both groups. Despite abundant supporting data, adoption of transradial technique as the default strategy in cardiac catheterization in the United States has lagged behind many other countries. However, recent trends suggest that interest and adoption of the technique in the United States is growing at a brisker pace than previously observed.

Keywords

TransradialTransfemoralRadial accessPercutaneous coronary interventionBleedingVascular complications

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.University of Chicago Medical CenterChicagoUSA
  2. 2.Duke Clinical Research InstituteDurhamUSA