Percutaneous Coronary Intervention and vascular access complications: A contemporary review

Area of Science:

• Cardiology
• Vascular Surgery
• Interventional Radiology

Background:

• Transradial approach (TRA) is increasingly favored for percutaneous coronary interventions (PCI).
• TRA offers potential advantages over transfemoral approach (TFA) in reducing complications and improving patient outcomes.
• Acute coronary syndrome (ACS) is a key indication where TRA may offer significant benefits.

Purpose of the Study:

• To compare the safety and efficacy of TRA versus TFA in PCI.
• To identify specific complications associated with each approach.
• To emphasize the importance of patient selection and procedural planning in minimizing vascular complications.

Main Methods:

• Review of existing literature comparing TRA and TFA for PCI.
• Analysis of complication rates, including bleeding, vascular issues, and mortality.
• Categorization of complications into intraprocedural and postprocedural events.

Main Results:

• TRA is associated with lower rates of bleeding, vascular complications, and mortality compared to TFA.
• Common radial access complications include spasm, dissection, perforation, radial artery occlusion, hematoma, pseudoaneurysm, arteriovenous fistula, nerve injury, and infection.
• TFA, while necessary in select cases, carries a higher inherent risk of complications.

Conclusions:

• TRA is the preferred approach for PCI, especially in ACS patients, due to its superior safety profile.
• Awareness and management of potential radial access complications are crucial.
• Optimizing patient selection and procedural techniques are essential for maximizing the benefits of TRA and minimizing vascular complications.