Comparison of the radial and the femoral approaches in percutaneous coronary intervention for acute myocardial infarction

A comparison of the radial and the femoral approaches in primary or rescue percutaneous coronary intervention for acute myocardial infarction in the elderly

“…Time from arrival in the catheterization laboratory to the first balloon inflation was similar in patients who underwent either radial or femoral PCI in this study, whereas total procedure time was significantly longer in the femoral group. Our finding of similar times from arrival in the catheterization laboratory to the first balloon inflation are consistent with other groups (6,7). Grafts injections increase diagnostic procedural time.…”

“…This finding could be explained, at least partially, by the use of larger sheaths in the femoral group, but it is consistent with most studies comparing femoral and radial approaches even when femoral closure devices are used (14). The femoral vascular complication rate is higher than the rate found in a similar study by our group, but this reflects the higher risk population examined in this study (6). The finding of a prolonged time to first balloon inflation in those patients with a failed radial approach needs to be carefully weighed against the benefit of less vascular complications with the radial approach.…”

“…There is limited data on the efficacy of the transradial approach for PCI in the setting of acute myocardial infarction (AMI) (4)(5)(6)(7). In primary and rescue PCI for AMI, the risk of access site complications is high because of the use of thrombolytic, antiplatelet drugs and glycoprotein IIb/IIIa inhibitors.…”

Overview of the transradial approach in percutaneous coronary intervention

“…Major concerns were an expected longer time for arterial cannulation and the unforeseeable need for intra-aortic counterpulsation and/or temporary lead placement. Many studies [10][11][12][13][14][15][16] have now demonstrated the safety, feasibility and good outcomes of primary PCI performed by TRA, which, in the hands of experienced operators, provides cannulation times, total procedural times, and procedural success similar to those of the transfemoral approach, but with a drastic reduction in vascular complications and length of in-hospital stays. In any case, the provisional use of the groin for additional procedures (intra-aortic counterpulsation, temporary leads, deep venous lines) is not excluded in the case of TRA.…”

The practice of transradial percutaneous coronary intervention in the Washington State Clinical Outcomes Assessment Program

“…1 In addition to evidence that patients prefer radial to femoral access, 2 there is increasing evidence from both randomized trials and observational studies that the transradial approach to PCI (tPCI) as opposed to the femoral (fPCI) is associated with fewer bleeding complications. [2][3][4][5][6][7][8] The purpose of this study was to describe the use of tPCI in Washington State hospitals that participate in the Clinical Outcomes Assessment Program (COAP), a continuous quality improvement program for cardiac surgery and PCI performed in the state. 9 In addition to a general description of the use of tPCI, the objectives of this study are to (1) compare patient characteristics according to radial and femoral approaches, (2) identify the most important predictors of bleeding, and (3) calculate adjusted bleeding rates for tPCI and fPCI for patients at highest risk of bleeding.…”