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

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Access

Background:

• Transradial approach (TRA) reduces complications compared to transfemoral access during percutaneous coronary procedures (PCP).
• However, TRA has a higher rate of conversion to alternative vascular access methods.
• This study investigates the rate, direction, and clinical impact of access-site crossover following TRA failure.

Purpose of the Study:

• To evaluate the crossover rate and direction after primary TRA failure.
• To assess the clinical impact of access-site crossover on vascular and bleeding complications.
• To identify predictors of TRA crossover.

Main Methods:

• Prospective enrollment of patients undergoing TRA requiring crossover across 10 centers (July 2022-January 2025).
• Inclusion of a control group of successful TRA procedures (2:1 ratio).
• Primary endpoint: in-hospital vascular complications and major bleeding in crossover vs. non-crossover groups; univariate and multivariate analyses performed.

Main Results:

• Vascular crossover was required in 2.6% of 17,462 TRA-PCP patients; femoral access was used in 53% of crossovers.
• The crossover group had significantly higher major bleeding and vascular complications (7% vs. 1%, p < 0.001) compared to controls.
• Femoral access after TRA failure led to more complications (9% vs. 3%, p < 0.001) than a full radial approach; female sex was an independent predictor of crossover and complications.

Conclusions:

• The crossover rate during TRA-PCP is low.
• Access-site crossover, particularly to femoral access, is associated with increased vascular and bleeding complications.
• Female sex is identified as a predictor for TRA crossover and subsequent complications.