Predictors of Access Site Crossover in Patients Who Underwent Transradial Coronary Angiography

Abstract

Despite increasing use of the transradial approach (TRA) for coronary angiography, TRA failure and subsequent access site crossover remain a barrier to TRA adoption. The aim of this study was to elucidate patient and procedural characteristics associated with TRA to transfemoral approach (TFA) crossover, as well as examine TRA to TFA crossover by operator experience over time. This retrospective analysis identified 1600 patients undergoing coronary angiography with possible PCI via TRA by operators with varied TRA experience in an urban tertiary care center from October 2010 to August 2013. Univariate and multivariable logistic regression were used to identify independent predictors of access site crossover, from TRA to TFA, and strength of association is presented as odds ratio (OR) [95% confidence interval]. Access site crossover was noted in 166 patients (10.4%). Multivariable predictors of access site crossover included age >75 years (OR 1.90 [1.23–2.91], p=0.004) and operator experience (OR 2.98 [1.96–4.52], p<0.0001). Less experienced operators (≤5 years TRA experience) had a decrease in access site crossover over time (Quartile 1: 8.9%, Quartile 2: 18.8%, Quartile 3: 16.4%, Quartile 4: 8.6%; p<0.001), which paralleled an increase in the proportion of procedures using initial TRA over time (Quartile 1: 38.0%, Quartile 2: 53.7%, Quartile 3: 54.8%, Quartile 4: 70.3%; p<0.001). Experienced operators (>5 years TRA experience) had no significant change in proportion of access site crossover over time (Quartile 1: 2.8%, Quartile 2: 6.4%, Quartile 3: 5.6%, Quartile 4: 5.8%; p=0.54). In conclusion, rate of access site crossover in the contemporary era is relatively low and can be mitigated with operator experience.

Transradial Artery Access in Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock

“…Although the STEMI RADIAL trial also reported a higher rate of crossover in the TRA vs. TFA groups (3.7 vs. 0.6%, p = 0.003), the overall TRA crossover rate was low, possibly due to one center's use of left radial artery access as the default access site [18]. Crossover rates with TRA are lowest in high-volume centers and with experienced operators and can be attenuated over time [5,37,38]. Crossover commonly occurs due to peripheral artery disease, significant tortuosity of the upper extremity vessels, or inadequate catheter support and less commonly due to failed puncture or radial artery spasm [18,37].…”

Cath lab costs in patients undergoing percutaneous coronary angioplasty — detailed analysis of consecutive procedures

“…Subgroup analysis of the TALENT study demonstrated age > 70 years as an independent predictor of subclavian tortuosity [16]. In the study by Le et al [17], analysing patient and procedural characteristics associated with transradial to transfemoral approach crossover, the only patient characteristic found to correlate with access site crossover was age > 75 years [17]. It was also confirmed by multicentre prospective study, demonstrating that anomalous radial artery anatomy is associated with transradial failure and that the only independent predictor of this anomaly is age [18].…”

Distal transradial access in the anatomic snuffbox: comparison with the proximal transradial access in the styloid process and the transfemoral access

“…15 Other significant predictors of access failure and need for crossover are age over 75 years and the operator experience. 16 The use of ultrasound to assist arterial puncture can increase first-time success rates and reduce the risk of complications, as well as the time devoted to this step and the crossover rate, with additional advantages over the conventional arterial puncture technique. 17,18 However, in this study, we did not use ultrasound due to the routine unavailability of the equipment in the Cath Lab.…”