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Published on: September 20, 2020
Controversies in complex percutaneous coronary intervention: radial versus femoral
Ian C Gilchrist1, Stephen O Awuor1, Rhian E Davies1
1a College of Medicine, Heart & Vascular Institute, M.S. Hershey Medical Center , Pennsylvania State University , Hershey , PA , USA.
Insights
Transradial access in cardiac catheterization is evolving with new technology, improving outcomes. The best approach combines radial and femoral techniques based on patient needs.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
Background:
- Technological advancements have shifted cardiac catheterization access from femoral to radial artery.
- Transradial access, while beneficial, has faced controversies and challenges.
- Patient outcomes have improved with evolving access site technologies.
Purpose of the Study:
- To review patient subsets and technical challenges related to access site selection in interventional cardiology.
- To discuss evolving technological improvements in transradial techniques.
- To explore the fusion of radial and femoral approaches for optimal patient care.
Main Methods:
- Literature review of recent clinical trials and reports on transradial techniques.
- Analysis of patient subsets and perceived technical challenges.
- Discussion of technological advancements in cardiac catheterization.
Main Results:
- Radial techniques have been significantly enhanced by new technology and knowledge dissemination.
- A unifying concept is emerging, integrating radial and femoral approaches.
- No single access technique is universally applicable to all patient subsets.
Conclusions:
- Optimal patient outcomes require a flexible approach, utilizing the most appropriate access site.
- Complementary access skillsets are crucial for advanced cardiac catheterization procedures.
- The fusion of radial and femoral techniques represents an evolving standard of care.
Introduction:
Evolution in the technology used in the cardiac catheterization laboratory has permitted a migration from the femoral to radial artery access for many interventional procedures while concurrently improving outcomes. As a disruptive technology, transradial access has been associated with several controversies including a dichotomous relationship with femoral access. Areas covered: Several different patient subsets along with perceived technical challenges in interventional cardiology are reviewed with regard to the issue of access site. Evolving technological improvements germane to transradial techniques are also discussed as garnered from the literature of recent clinical trials and reports. Expert commentary: Radial techniques have been enhanced by newer technology and the spread of knowledge. Fusion of radial techniques with those of the femoral approach is evolving into a unifying concept of using the access that is most appropriate for the patient. No one access technique can cover all clinical subsets of patients. There is a need for complimentary access skillsets for even the most advanced cardiovascular technology used in the cardiac catheterization laboratory if the patients' outcomes are to be idealized.
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