Transradial and transulnar access for percutaneous coronary interventions

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Vascular Access Techniques

Background:

• Periprocedural bleeding and vascular complications following percutaneous coronary intervention (PCI) are linked to adverse clinical outcomes and increased mortality.
• Transfemoral approach (TFA) in PCI accounts for over 80% of major bleeding events due to vascular access site complications.
• Pharmacological strategies have been the focus for reducing bleeding risk, but access site choice may offer greater benefits.

Purpose of the Study:

• To highlight the benefits of the transradial approach (TRA) in minimizing bleeding and vascular complications during PCI.
• To identify patient populations who may particularly benefit from TRA due to increased risk factors.
• To compare the efficacy of TRA versus TFA in reducing vascular access-related complications.

Main Methods:

• Review and synthesis of clinical trial data comparing transfemoral and transradial access for PCI.
• Analysis of bleeding event rates and vascular complication incidence between the two approaches.
• Evaluation of patient outcomes, satisfaction, and resource utilization associated with TRA.

Main Results:

• Transradial approach (TRA) virtually eliminates access site bleeding and vascular complications, unlike the transfemoral approach (TFA).
• High-risk patient groups, including those with acute coronary syndrome, ST-segment elevation myocardial infarction, women, obese, and elderly individuals, show significant benefit from TRA.
• TRA is associated with improved patient satisfaction, reduced healthcare costs, and shorter hospital stays, enabling outpatient PCI.

Conclusions:

• Adopting a transradial rather than a transfemoral access strategy for PCI can lead to greater reductions in bleeding complications than pharmacological interventions alone.
• TRA enhances patient safety and may be the preferred approach for high-risk populations undergoing PCI.
• The benefits of TRA extend to improved patient experience and resource efficiency, facilitating same-day discharge for uncomplicated procedures.