Comparison of radial versus femoral approach for percutaneous coronary interventions in octogenarians

The safety and efficacy of a radial approach for percutaneous coronary intervention (PCI) in octogenarians is not well established.

To evaluate the benefits of a radial approach for preventing vascular complications after PCI, clinical, procedural, and outcome data were prospectively collected and compared for 228 octogenarians undergoing elective PCI either through a radial or a femoral approach.

Radial approach was associated with longer cannulation (3.1 +/- 2.9 vs. 2.0 +/- 2.0 min, P < 0.001) and fluoroscopy times (19.3 +/- 16.1 vs. 16.1 +/- 11.8 min, P = 0.04), greater utilization of contrast media (224 +/- 46 vs. 182 +/- 20 ml, P < 0.001) and higher crossover rate (11 vs 4%, P = 0.03) to alternate access site compared with the femoral approach. However, ambulation time (5.2 +/- 3.1 vs. 11.6 +/- 6.3 hr, P < 0.001), access site bleeding (4 vs. 14%, P = 0.007), hematoma (1 vs. 11%, P = 0.001) or any vascular complication (5 vs 26%, P = 0.001) were significantly reduced with a radial approach. Procedural success rates were equivalent with both approaches. Multivariate regression analysis identified radial approach (OR = 0.23; CI = 0.08, 0.65) as an independent negative predictor of postprocedural vascular complications.

Radial approach for PCI in octogenarians is technically challenging for the operator and exposes patients to greater volume of nephrotoxic contrast media. However, it results in early ambulation and significantly reduces vascular complications in this high risk population. These findings support a strategy of preprocedural risk assessment and use of radial approach for PCI in a select group of octogenarians to maximize benefits offered by this technique.