Related Experiment Video
Updated: Jun 18, 2026
Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients
Published on: September 20, 2020
Mechanism and predictors of failed transradial approach for percutaneous coronary interventions
Payam Dehghani1, Atif Mohammad, Ravi Bajaj
1Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Insights
Transradial approach percutaneous coronary intervention (PCI) has a low failure rate, even with less experienced operators. Advanced age, prior bypass surgery, and short stature predict TR-PCI failure, guiding patient selection.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Transradial approach (TR) percutaneous coronary intervention (PCI) offers reduced vascular complications compared to transfemoral (TF) approach.
- However, the specific mechanisms and predictors of TR-PCI procedural failure remain incompletely understood.
Purpose of the Study:
- To investigate the mechanisms leading to procedural failure in transradial PCI.
- To identify independent predictors of TR-PCI failure in a large patient cohort.
Main Methods:
- Prospective collection of baseline characteristics, procedural details, and clinical outcomes for patients undergoing TR-PCI.
- Utilized univariate and multivariate analyses to identify significant predictors of TR-PCI failure.
- Study included low-to-intermediate volume operators using traditional TF guide catheters for TR-PCI.
Main Results:
- Procedural failure occurred in 4.7% of 2,100 TR-PCI cases.
- Primary failure mechanisms included guide catheter advancement issues (51%) and inadequate support (36%).
- Independent predictors of failure were age >75 years (OR 3.86), prior coronary artery bypass graft surgery (OR 7.47), and shorter height (OR 0.97).
Conclusions:
- Transradial PCI is feasible with low failure rates among low-to-intermediate volume operators using standard equipment.
- Older age (>75), history of coronary artery bypass graft surgery, and short stature are key predictors of TR-PCI failure.
- Careful patient selection and risk stratification are crucial for optimizing TR-PCI outcomes.
Objectives:
The study aimed to determine the mechanism and predictors of procedural failure in patients undergoing percutaneous coronary intervention (PCI) from the transradial approach (TR).
Background:
Transradial approach PCI reduces vascular complications compared with a transfemoral approach (TF). However, the mechanism and predictors of TR-PCI failure have not been well-characterized.
Methods:
The study population consisted of patients undergoing TR-PCI by low-to-intermediate volume operators with traditional TF guide catheters. Baseline characteristics, procedure details, and clinical outcomes were prospectively collected. Univariate and multivariate analyses were performed to determine independent predictors of TR-PCI failure.
Results:
A total of 2,100 patients underwent TR-PCI and represented 38% of PCI volume. Mean age was 64 +/- 12 years, and 17% were female. Vascular complications occurred in 22 (1%), and TR-PCI failure was observed in 98 (4.7%) patients. The mechanism of TR-PCI failure included inability to advance guide catheter to ascending aorta in 50 (51%), inadequate guide catheter support in 35 (36%), and unsuccessful radial artery puncture in 13 (13%) patients. The PCI was successful in 94 (96%) patients with TR-PCI failure by switching to TF. On multivariate analysis, age >75 years (odds ratio [OR]: 3.86; 95% confidence interval [CI]: 2.33 to 6.40, p = 0.0006), prior coronary artery bypass graft surgery (OR: 7.47; 95% CI: 3.45 to 16.19, p = 0.0002), and height (OR: 0.97; 95% CI: 0.95 to 0.99, p = 0.02) were independent predictors of TR-PCI failure.
Conclusions:
Transradial approach PCI can be performed by low-to-intermediate volume operators with standard equipment with a low failure rate. Age >75 years, prior coronary artery bypass graft surgery, and short stature are independent predictors of TR-PCI failure. Appropriate patient selection and careful risk assessment are needed to maximize benefits offered by TR-PCI.
Related Concept Videos
01:11Assessment of radial pulse
The radial pulse, located at the wrist, is often the preferred site for assessing peripheral pulse because of its accessibility and dependability. The process of determining the radial pulse involves several steps:
01:27Peripheral Artery Disease III: Interprofessional Care
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:25Assessment of apical radial pulse
The A-R pulse assessment involves simultaneous evaluation of the apical and radial pulses. When the apical and radial pulse rates vary, this assessment helps identify a pulse deficit.
Pre-Procedural Preparation