Precision approach for transradial access during PCI: a state-of-the-art review

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Access

Background:

• The transradial approach (TRA) is now the standard for coronary angiography and percutaneous coronary intervention (PCI).
• TRA offers significant benefits over the transfemoral approach, including reduced bleeding, vascular complications, and mortality in acute coronary syndromes (ACS).

Purpose of the Study:

• To review technical refinements and strategies to optimize TRA success.
• To discuss alternative access sites like distal radial (dTRA) and ulnar approaches.
• To examine optimal anticoagulation strategies and management of TRA-related complications.

Main Methods:

• Review of current literature on TRA techniques, including puncture methods and vasodilator use.
• Analysis of alternative access strategies (dTRA, ulnar) and their associated benefits and limitations.
• Discussion of anticoagulation protocols and complication management in the context of TRA.

Main Results:

• Technical refinements like ultrasound guidance and radial cocktails improve TRA success and reduce radial artery spasm (RAS).
• Distal radial (dTRA) and ulnar approaches may lower radial artery occlusion (RAO) rates and preserve conduit arteries but require more experience.
• Optimal anticoagulation strategies for TRA are still debated, as the bleeding risk is already low.

Conclusions:

• TRA is a safe and effective vascular access method for cardiac procedures, with ongoing refinements enhancing its utility.
• While dTRA and ulnar approaches show promise, further research and operator experience are needed.
• Preventing and managing complications like hematoma, RAS, and RAO remains crucial for successful TRA outcomes.