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Published on: September 20, 2020
A randomized comparison of transradial versus transfemoral approach for coronary angiography and angioplasty
Martin Brueck1, Dirk Bandorski, Wilfried Kramer
1Department of Cardiology, Clinic of Wetzlar, Wetzlar, Germany. Martin.Brueck@hkw.med.uni-giessen.de
Insights
Transradial coronary angiography is safe and effective, comparable to the transfemoral approach. However, transradial access involves longer procedure times and higher radiation exposure, but significantly fewer vascular complications.
Area of Science:
- Cardiovascular Interventions
- Vascular Access Techniques
- Interventional Cardiology
Background:
- Coronary catheterization traditionally uses the transfemoral approach.
- Transradial access offers potential benefits, particularly with aggressive anticoagulation/antiplatelet therapies.
Purpose of the Study:
- To compare the safety, feasibility, and procedural variables of transradial versus transfemoral access for coronary catheterization.
Main Methods:
- 1,024 patients undergoing coronary catheterization were randomized to transradial or transfemoral access.
- Exclusion criteria included abnormal Allen's test, prior coronary artery bypass surgery, and renal insufficiency.
Main Results:
- Successful catheterization rates were high for both groups (96.5% transradial, 99.8% transfemoral).
- Transfemoral access showed significantly shorter procedural duration and lower radiation dose.
- Vascular access site complications were substantially lower with transradial access (0.58%) compared to transfemoral (3.71%).
Conclusions:
- Transradial coronary angiography and angioplasty are safe, feasible, and effective, yielding results similar to the transfemoral approach.
- While transradial access has increased procedural duration and radiation exposure, it offers a significantly lower rate of major vascular complications.
Objectives:
The aim of the study was to evaluate the safety, feasibility, and procedural variables by the transradial approach compared with the transfemoral access in a standard population of patients undergoing coronary catheterization.
Background:
Coronary catheterization is usually performed via the transfemoral approach. Transradial access may offer some advantages in comparison with transfemoral access especially under conditions of aggressive anticoagulation and antiplatelet treatment.
Methods:
Between July 2006 and January 2008, a total of 1,024 patients undergoing coronary catheterization were randomly assigned to the transradial or transfemoral approach. Patients with an abnormal Allen's test, history of coronary artery bypass surgery, simultaneous right heart catheterization, chronic renal insufficiency, or known difficulties with the radial or femoral access were excluded.
Results:
Successful catheterization was achieved in 494 of 512 patients (96.5%) in the transradial and in 511 of 512 patients (99.8%) in the transfemoral group (p < 0.0001). Median procedural duration (37.0 min, interquartile range [IQR] 19.6 to 49.1 min vs. 40.2 min, IQR 24.3 to 50.8 min; p = 0.046) and median dose area product (38.2 Gycm(2), IQR 20.4 to 48.5 Gycm(2) vs. 41.9 Gycm(2), IQR 22.6 to 52.2 Gycm(2); p = 0.034) were significantly lower in the transfemoral group compared with the transradial access group. A median amount of contrast agent was similar among both groups. Vascular access site complications were higher in the transfemoral group (3.71%) than in the transradial group (0.58%; p = 0.0008)
Conclusions:
The findings of the present study show that transradial coronary angiography and angioplasty are safe, feasible, and effective with similar results to those of the transfemoral approach. However, procedural duration and radiation exposure are higher using the transradial access. In contrast to the transfemoral route, the rate of major vascular complications was negligible using the transradial approach.
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