Radial access crossover for percutaneous coronary procedures and outcome: The REPEAT study

Transradial approach (TRA), compared with transfemoral, reduces vascular and bleeding complications during percutaneous coronary procedures (PCP) at the expense of a higher conversion rate to another vascular access. Aim of our study was to evaluate the crossover rate and direction (other arm vs femoral access) after primary TRA failure and to assess the clinical impact of access-site crossover.

From July 2022 to January 2025, at 10 experienced radial Centers, we prospectively enrolled all patients with attempted TRA requiring vascular crossover. A control group of effective TRA procedures (with a rate of 2:1 compared to crossover) was also included. Primary endpoint was the rate of in-hospital vascular complications and major bleeding in crossover versus non-crossover groups. Univariate and multivariate analyses were performed to determine independent predictors of TRA crossover.

Among 17,462 undergoing TRA-PCP, vascular crossover was needed in 462 patients (2.6 %) and the second alternative vascular access was femoral in the majority of cases (53 %). Compared to controls (895 patients), the rate of major bleeding and vascular complications was significantly higher in the crossover group (7 % vs 1 %, p < 0.001). Patients undergoing femoral access after TRA failure showed higher bleeding and vascular complications compared to patients with a "full arm" approach (9 % vs 3 %, p < 0.001). Female sex was an independent factor associated with a higher rate of crossover, bleeding and vascular complications in the multivariable analysis.

The crossover rate during TRA-PCP is low but associated with increased vascular and bleeding complications in particular when a femoral access is required.