Barriers to use of radial access for percutaneous coronary intervention

Abstract

Objectives: The aim of this study was to identify barriers to transradial access percutaneous coronary intervention (PCI). Background: Transradial access yields fewer vascular complications, earlier ambulation, and more patient comfort. However, the adoption to practice is slow, and transfemoral access is still commonly used. Methods: We identified all PCIs done by one operator in a radial-first trainee-driven practice. The individual charts were reviewed for all PCIs using femoral access. Reasons for not using radial access were identified. Descriptive statistics were used to report reasons for not using transradial access. Analyses were performed on a per-procedure basis. Results: Of 1,948 PCIs, 1,790 (92%) were 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). Radial access was unsuccessful due to failure to cannulate radial artery, radial artery spasm, and radial loop in majority of radial access failure PCIs (n = 13). Femoral access was used as a primary strategy in 137 PCIs (87% of all femoral PCIs, 7% of all PCIs), mostly due to undetectable radial artery pulse (both left and right) (n = 40). Conclusions: Radial access can be used for PCI safely and effectively. Inadequate radial pulse is the main barrier. Adjunctive strategies such as ulnar access and use of ultrasound may further increase the success rate of arterial access from the upper extremities.

Correlation of a guidewire maximum insertion length with tortuous radial artery and the success rate during transradial coronary angiography

“…The common reasons for transradial coronary angiography failure include: 1) puncture failure; 2) the guidewire and catheter can’t pass through for the next step after vascular access is achieved; 3) the imaging device could enter the aortic root, but the catheter could not be inserted into position; and 4) forceful imaging resulting in unclear or incomplete blood vessels [ 13 , 14 ]. In a study by He et al, the above determination criteria were used.…”

Opioid Use and Its Relationship to Cardiovascular Disease and Brain Health: A Presidential Advisory From the American Heart Association

“…Transradial access for percutaneous interventions has increasingly replaced transfemoral approaches for vascular procedures, thereby reducing vascular complications and improving patient comfort. 41 To address opioid overprescribing after surgery, several societies, including the American Pain Society and the American Society of Anesthesiologists, have developed recommendations for the management of postoperative pain. 42 Likewise, both state agencies 43 and consensus expert panels have issued recommendations for the appropriate use of opioids after specific surgical procedures.…”

The efficacy of nitroglycerin to prevent radial artery spasm and occlusion during and after transradial catheterization: A systematic review and meta‐analysis of randomized controlled trials

“…Furthermore, RAS is a common intra‐procedural complication and the most frequent cause of transradial access site crossover. RAS is detected by various clinical criteria, such as limitation in catheter mobility, pain reported by the patient, resistance in catheter maneuvring, or difficulty in removing the catheter 11,12 . Female gender, low BMI, younger age, small radial artery diameter, large sheath, artery size ratio, and multiple catheter exchanges are the predictors of RAS 11 .…”

“…RAS is detected by various clinical criteria, such as limitation in catheter mobility, pain reported by the patient, resistance in catheter maneuvring, or difficulty in removing the catheter. 11 , 12 Female gender, low BMI, younger age, small radial artery diameter, large sheath, artery size ratio, and multiple catheter exchanges are the predictors of RAS. 11 Operator experience is also a significant factor that can influence the incidence of RAS, leading to incidence rate variations across centers with different levels of experience.…”