Transradial versus transfemoral approach for coronary angiography and angioplasty – A prospective, randomized comparison

Abstract

BackgroundPCI has been done traditionally through transfemoral route. But now transradial and transbrachial routes are also coming up in practice. We compared transradial versus transfemoral routes for ease of operability, time for procedure, complications, and failure rates through a prospective study.MethodsFour hundred Patients admitted in department of cardiology for percutaneous interventions were enrolled in the study. 200 patients were assigned to each group randomly. A single team did all the procedures. Pre procedure, intra procedure and post procedure data of all the patients was collected, tabulated and analysed properly.ResultsAccess time (6.0 ± 1vs 4.2 ± 0.7; P =0.001); Fluoroscopy time and overall procedure time (29 ± 11.3 Vs. 27.3 ± 12.4 min) were more with trans radial than transfemoral route, respectively. The most common post procedure complication, ecchymosis was seen in 20.5% in transfemoral group compared to 12.5% in transradial group (P 0.031). Thrombophelibites (17.5 VS 8%, P0.004); Hematoma (14.5 Vs 0%, P 0.005); post procedure access bleed (7 VS 3%, P 0.039) were seen in transfemoral than transradial group, respectively. Failure rates were almost similar. None of our patients had post procedure myocardial infarction, stroke, acute renal failure and infections.ConclusionTransradial approach of PCI is better than transfemoral route with respect to complications like bleeding, haematoma formation, thrombophelebites and ecchymosis is concerned. However access and fluoroscopic time is more with the former. We recommend the transradial route for PCI.Trial registrationTrial is retrospectively registered in ClinicalTrials.gov with the Identifier: NCT02983721, Date of registration is December 2, 2016.

Comparing of Efficacy of Different Self-Assessment Anxiety Scales for Predicting Radial Artery Spasm During Coronary Interventions

“…experience, particularly on issues like avoiding repeated punctures, selecting the proper catheters for cannulating coronary ostia, and manipulating them in the aorta. [2][3][4] Aside from the requirement for a certain time interval to complete the learning curve, radial artery spasm (RAS) constitutes a major drawback for choosing radial access as the default technique for the operators. 3,4 In association with these two factors, the risk of procedural failure in transradial interventions is higher as compared to transfemoral route.…”

Comparison of Transradial Versus Transfemoral Approach for Coronary Angiography and Percutaneous Coronary Intervention

“…The benefit in reduction of MACE has been proven even in with ACS who undergo transradial access (23) Further advantages of transradial approach include immediate ambulation, reduced post-procedure nursing care, reduced hospital stay and related costs, and an overwhelming patient preference for transradial angiography (24)(25)(26)(27)(28) . Opponents of radial access have cited an associated learning curve (29) with adopting the transradial approach resulting in longer procedural time and increased radiation exposure (30,31). Higher-volume radial operators however exhibit shorter procedural and fluoroscopy times as their procedural experience increases (32).…”

Complications and Avoidance in Neurointerventional Surgery

“…14 Radial puncture for the vascular access is on the rise among the interventionists, and few studies have shown that it is associated with significantly lower complications. 15 Problem with radial access is difficult navigation into the carotid system.…”