The radial approach to angiography and intervention has emerged internationally as the preferred alternative to the traditional femoral approach. Multiple observational and randomized trials performed to date have shown an association between radial access and reduced risk for bleeding and vascular complications. Other studies have shown an association between radial approach and reduced costs, increased patient satisfaction, and reduced mortality in high-risk patient subgroups like those with ST-segment elevation myocardial infarction (STEMI). Disadvantages include increased radiation exposure to the operator during the learning curve, limitation of guide catheter size in some patients, and radial artery occlusion. The increased understanding of the potentially favorable risk:benefit ratio of transradial procedures has led to a near 10-fold increase in the adoption of radial access in the United States between 2007 and 2011. Concomitant with this surge in radial approach has been a proliferation of studies that have examined various technical aspects and outcomes from transradial procedures. Transradial angiography and intervention was once largely guided by anecdote and case series reports, but now there is a solid evidence base to guide some aspects of radial practice. The purpose of this document is to provide consensus opinion on what is considered "best practice" for facets of radial procedures where there is supportive evidence in order to maximize the benefits, standardize certain practices to minimize complications, and summarize areas that need further study.
Catheter Cardiovasc Interv. 2014;83:228-236.