A European consensus document aims to encourage interventionalists to choose radial artery over femoral artery access where possible when performing percutaneous coronary intervention (PCI).
Radial access has clear advantages over femoral access, according to the statement from the European Association of Percutaneous Cardiovascular Interventions, the Acute Cardiovascular Care Association, and the European Society of Cardiology Working Group on Thrombosis.
These include faster patient ambulation, fewer access site complications, and a probable reduction in costs. However, the statement's authors stress that radial access may not be always be appropriate.
"In a small percentage of patients the radial approach does not work, for example if the arteries in the arm are too small, if rare anatomical situations hinder the radial approach, or if specific interventional strategies are necessary," said co-author Kurt Huber (Wilhelminen Hospital, Vienna, Austria) in a press statement. "So interventionalists should also know the femoral approach."
The consensus document notes that the rate of access failure with the radial artery has come down over the years as equipment improved and operators gained experience, and it is now on a par with femoral access. It is also the less risky strategy, with a large body of evidence showing a marked reduction in access-site major bleeding with no increase in non-access-site bleeding. This is particularly pertinent in groups at high risk for bleeding complications, namely patients with acute coronary syndromes, women, and the elderly.
The reduction in complications may result in improved longer-term outcomes, including survival. Although the evidence outlined in the statement remains equivocal, it does support the possibility of improved outcomes with radial versus femoral access, specifically in patients with ST-elevation myocardial infarction and those treated by the most experienced radial operators.
Moreover, patients strongly prefer radial access, mainly because they can be mobile immediately after the procedure. And "never subjected to research, but commonly cited, the 'discreteness' of the puncture site far from the pubic area also contributes to patient preference," say Martial Hamon (Centre Hospitalier Universitaire de Caen, France) and colleagues in EuroIntervention.
Besides outlining the rationale for a concerted move toward radial access, the statement also offers advice on implementing a radial access program and gives technical recommendations. In particular, the authors highlight the importance of attaining high center and operator volumes, maintaining expertise with the femoral approach, and managing the learning curve.
In relation to the learning curve, they draw attention to the risk for periprocedural stroke and silent cerebral infarction, which is thought to increase in line with procedure duration and time of catheter handling.
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