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Lesion complexity and angiographic outcomes in radial access percutaneous coronary intervention
Elved Bryn Roberts1, Sudhir Rathore, Andrew Beaumont
1Liverpool Cardiothoracic Center, Liverpool, United Kingdom. elvedroberts@hotmail.com
Insights
A default radial approach for percutaneous coronary intervention (PCI) is effective for complex lesions, with a low crossover rate to femoral access. Failures are typically due to initial access issues, not guide catheter handling.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Percutaneous coronary intervention (PCI) increasingly utilizes radial artery (RA) access.
- Limited data exists on the interplay between default radial approach, lesion complexity, and angiographic outcomes.
- This study evaluates lesion complexity, access route, and outcomes in routine clinical practice using a default radial approach.
Purpose of the Study:
- To investigate the relationship between lesion complexity, arterial access route (radial vs. femoral), and angiographic outcomes in patients undergoing PCI.
- To assess the efficacy and safety of a default radial approach in a real-world clinical setting.
- To identify reasons for crossover from radial to femoral access during PCI.
Main Methods:
- Prospective data collection of PCI cases over 12 months, detailing access route, lesion characteristics, and angiographic success.
- Definition of angiographic success: <50% residual stenosis (balloon angioplasty) or <20% (stented lesion) with TIMI 3 flow.
- Retrospective analysis of procedures performed by default radial operators, comparing radial and femoral access outcomes based on lesion complexity.
Main Results:
- The radial artery was the intended access route in 91.5% of 1,324 procedures and the final route in 90.1%.
- Nineteen cases (30 lesions) required crossover from radial to femoral access, primarily due to cannulation or sheath placement issues.
- Angiographic success rate was 96% for lesions with an intended radial approach, even in complex lesions (80.1% ACC/AHA type B2 or C).
Conclusions:
- A default radial approach is feasible and effective for treating a wide spectrum of coronary lesions.
- The incidence of crossover to femoral access is low and mainly attributed to initial access difficulties.
- Radial access demonstrates successful outcomes comparable to femoral access for complex PCI cases.
Background:
Percutaneous coronary intervention (PCI) is increasingly performed from the radial arterial (RA) access site. Few studies have examined the interaction between a default radial approach, lesion complexity, and angiographic outcome. This study investigates lesion complexity, arterial access route, and angiographic outcome in routine clinical practice by default radial operators.
Methods:
All cases of PCI over a 12-month period (Jan 2005 to Jan 2006) at our regional cardiac center were prospectively entered into a database detailing arterial access route, target vessel and lesion characteristics, and lesion-specific angiographic outcome. Angiographic success was defined as residual stenosis <50% for balloon angioplasty alone or <20% for a stented lesion in the presence of TIMI 3 flow in the target vessel. All procedures carried out by default radial operators were selected for further retrospective analysis. Reasons for not completing a case via the radial route were recorded. Radial and femoral cases by default radial operators were evaluated on grounds of lesion complexity and angiographic outcome for each treated lesion.
Results:
RA was the intended route in 91.5% of 1,324 procedures (91.5% of 2,239 lesions), and the final route in 90.1% of procedures (90.2% of lesions). There were 19 crossover procedures (30 lesions), all from radial to femoral access (FA). Crossovers were due to failed radial artery cannulation or sheath placement (9 procedures), inability to advance the guide catheter into the aortic root (7 procedures), and other guide catheter handling or support issues (3 procedures). Counting crossovers as failures, angiographic success rate was 96% among lesions for which RA was the primary intention. Complexity of cases was high (80.1% of RA lesions ACC/AHA type B2 or C).
Conclusions:
A default radial approach is compatible with successful treatment of a wide range of coronary lesions, with a low incidence of crossover to femoral access. When the radial approach fails, it is usually due to access problems rather than issues of guide catheter handling and support.
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