Related Experiment Video
Updated: Jun 27, 2025
Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients
Published on: September 20, 2020
Frequency of ventriculography during left heart catheterization for radial vs. femoral access
Ilan Merdler1, Brian C Case1, Matteo Cellamare1
1Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
Insights
Radial artery access for percutaneous coronary intervention (PCI) may lead to fewer ventriculography and right heart catheterization procedures compared to femoral access. However, these procedures do not significantly impact patient outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Radial artery access is a widely used method for left heart catheterization (LHC) and percutaneous coronary intervention (PCI).
- Its popularity stems from easy accessibility, compressibility, and effective hemostasis due to superficial vessel anatomy.
Purpose of the Study:
- To compare the utilization of ventriculography and central venous access in patients undergoing PCI via radial versus femoral artery access.
- To analyze procedural trends across different acute coronary syndromes and stable angina.
Main Methods:
- Retrospective analysis of 7714 patients undergoing PCI between November 2013 and February 2023.
- Patients were categorized into ST-elevation myocardial infarction (STEMI), non-ST-elevation acute coronary syndrome (NSTE-ACS), and stable angina groups.
- Comparison of ventriculography and central venous access rates between radial and femoral access groups.
Main Results:
- A trend towards higher ventriculography rates was observed with femoral access in STEMI (53.4% vs. 47.5%) and NSTE-ACS (34.2% vs. 31.8%) patients.
- Central venous access was significantly more common with femoral access across all diagnoses (STEMI: 36.2% vs. 7.6%; NSTE-ACS: 19.3% vs. 2.8%; Stable Angina: 26.4% vs. 2.7%).
- Operators performed fewer ventriculography and right heart catheterization (RHC) procedures with radial access.
Conclusions:
- Radial artery access may be associated with reduced performance of ventriculography and RHC compared to femoral access.
- Despite discrepancies in performing these procedures, routine ventriculography and hemodynamic assessment have not demonstrated a significant impact on patient outcomes.
- The findings suggest that while radial access may influence procedural choices, established outcomes are not compromised.
Background:
Radial artery access has been used for left heart catheterization (LHC) and percutaneous coronary intervention (PCI) for over 30 years. This method has gained popularity among operators due to superficial vessel anatomy, allowing for easy accessibility and compressibility, resulting in effective hemostasis.
Methods:
We conducted a retrospective analysis of patients who underwent PCI due to ST-elevation myocardial infarction (STEMI), non-ST-elevation acute coronary syndrome (NSTE-ACS), and chest pain (stable angina) from November 2013 to February 2023.
Results:
We analyzed validated registries and found 7714 PCIs. Of these, 1230 were STEMI patients, 5585 were NSTE-ACS patients, and 899 were stable angina patients, forming the basis of our final analysis. In STEMI patients, there was a trend toward a higher rate of ventriculography with femoral access compared to radial access (53.4 % vs. 47.5 %, p = 0.06), which was also observed in NSTE-ACS patients (34.2 % vs. 31.8 %, p = 0.07). The use of central venous access was more common with femoral access in all three diagnoses, with significantly higher rates seen in STEMI patients (36.2 % vs. 7.6 %, p < 0.001), NSTE-ACS patients (19.3 % vs. 2.8 %, p < 0.001), and chest pain patients (26.4 % vs. 2.7 %, p < 0.001).
Conclusions:
The analysis revealed that operators may perform fewer ventriculography and RHC procedures when using radial access as compared to femoral access. While there is discrepancy in performing left ventriculography and RHC when using a radial artery, it is essential to emphasize that routinely performing ventriculography and hemodynamic assessment has not proven to impact outcomes, despite their contributions to proper decision-making and treatment.
More Related Videos
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:
01:25Assessment 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
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...