Instead of threading catheters from the femoral artery in the groin, cardiologists can safely use the radial artery in the arm to gain access to coronary arteries for angioplasty, stent placement, and other procedures, according to a new meta-analysis in the July 21, 2004 issue of the Journal of the American College of Cardiology.
“Overall, the radial approach is safe and reduces local complications, and if done by an expert, is almost always feasible. It is useful for cardiologists to learn the radial approach in addition to the femoral approach, so they have the opportunity to choose the right one in every patient, and in order to predict possible complications and avoid them,” said Pierfrancesco Agostoni, MD at the University of Verona in Italy.
The work was done in cooperation with colleagues at Catholic University in Rome; Piemonte Orientale University in Novara, Italy; Institut Hospitalier Jacques Cartier – ICPS in Massy, France; and Centre Hospitalier Universitaire in Caen, France.
Threading a catheter through arteries from the arm to the heart is considered more challenging because there are more turns than in the relatively straight route from the groin. Some catheter devices won’t fit through the radial artery. However, studies have generally seen fewer local complications, including bleeding, and quicker recovery among patients who had a transradial procedure.
Sorting out the pros and cons of each approach has been difficult.
“Several randomized trials have been undertaken to compare the transradial and transfemoral approach, but the majority of them carefully selected a small number of homogeneous patients, were underpowered to detect differences in major adverse events, and yielded somewhat conflicting and inconclusive results,” the authors wrote.
For this meta-analysis the researchers used data from 12 randomized trials that involved 3,224 patients to get a broader comparison of the arm and groin techniques. The two approaches had similar risks of a major cardiovascular event (including death, heart attack, stroke, or an emergency procedure to reopen a blocked heart artery). Patients who underwent the arm technique were much less likely to suffer a local complication, including damage to the artery and local blood flow. However, the arm procedures were significantly more likely to fail than those that started in the groin; so the researchers recommended always having a back-up plan.
“Always prep a groin!” they wrote.
Dr. Agostoni said that in recent years the success rates of the two approaches appear to be converging. He said this trend suggests that as practitioners gain experience and as new devices designed for the arm approach become more common, the two techniques may become equally successful.
Goran Stankovic, MD, with the Institute for Cardiovascular Diseases at the Clinical Center of Serbia in Belgrade, Serbia-Montenegro, who was not connected with this study, said it is the first meta-analysis of good quality randomized trials comparing the two approaches.
“These findings support the radial approach as an interesting choice in a broad range of patients, provided that experienced operators, state-of-the-art materials, and willingness to cross over to the femoral approach (‘always prep a groin!’) are available,” Dr. Stankovic said.