Transradial
-
Transradial access to percuatanous coronary intervention shows significant advantages over the femoral approach when used by experienced clinicians.
Load moreA growing body of evidence suggests that a transradial intervention rather than a transfemoral approach to PCI is associated with greater reductions in bleeding complications than those achieved with pharmacological strategies alone.
Whilst the transfemoral approach to cardiac catheterization has dominated the huge growth of invasive cardiology to date, transradial access appeared early in the development of cardiac catheterization techniques as early as 1948.
Despite early enthusiasm for the approach, equipment limitations resulted in a shift to larger vessels for most catheter-based procedures, and the radial artery was consigned as a site for monitoring arterial pressure.
In the late 1970s, percutaneous coronary angioplasty was introduced using predominantly 9-F guiding catheters. Building on reports of successful transradial angiography from Canada in 1989, four years later, Kiemeneij and Laarman first reported on the transradial approach for coronary stenting.
Given observed reductions in periprocedural bleeding and reported improvements in patient comfort, a few enthusiastic early adopters surfaced, although transradial intervention generally remained a niche technique. The greater technical complexity of the procedure compared to the transfemoral procedure and the associated significant learning curve hindered its uptake.
As experience with transradial intervention grew, the lack of severe access-site complications when compared with the transfemoral approach to coronary angiography and coronary intervention was repeatedly demonstrated in small observational studies.
Cost-effectiveness was also demonstrated and small single-centre or limited multicenter randomised comparisons to femoral and brachial approaches showed the superiority of transradial intervention with respect to vascular access site complications, patient preference and speed of post-procedural recovery.
There are important veins or nerves near to the radial artery in the wrist, which decreases the likelihood of arteriovenous fistulas or nerve lesions; the superficial trajectory of the artery and its proximity to the bone allow simple hemostasis by means of simple compression, bypassing the need for closure devices and decreasing the chance of hematoma and pseudoaneurysm.
Several studies have reported that the patients can ambulate almost immediately following the procedure, which increases the patient´s comfort and level of satisfaction, and at the same time decreases the length of hospital stay and the cost.
Nevertheless, the procedure could only be performed with safety in patients with a normal Allen test, and technically, the procedure is more complex than the transfemoral procedure due to the greater difficulty in cannulating the artery, variations in the arteries of the upper limb, possibility of spasm, and the manipulation of the catheters that is necessary to cannulate the coronary arteries.
These difficulties result in a slight increase in the length of time needed for the procedure and time needed for fluoroscopy. There is also a significant learning curve involved, even for specialists with a a lot of experience in transfemoral procedures.
However, ESC Guidelines published last year give the highly recommend the radial approach over the femoral one for coronary angiography and percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS). The ACS without persistent ST-segment elevation (NSTE-ACS) guidelines are published online on the ESC Website and in European Heart Journal.
Load Less
Key Transradial Articles From Around The Web
-
Petroglou D, et al. Cardiovasc Revasc Med 2019 (Epub ahead of print).
-
O'Riordan M. TCTMD 29 May 2018.
-
Chacko Y, Parikh RV, Tremmel JA. Curr Atheroscler Rep 2018;20 41.
-
Gaudino M, Burzotta F, Bakaeen F, et al. J Am Coll Cardiol 2018;71:1167–75.
Key Transradial presentations from around the web
Transradial Intervention
Transradial artery access (TRA) for diagnostic CA or percutaneous coronary intervention (PCI) is associated with lower bleeding and vascular complications than transfemoral artery access (TFA). The European Society of Cardiology guidelines and American Heart Association support TRA first strategy and evidence also supports, an improvement in healthcare quality, and reduced cost. While TFA predominates peripheral interventions, increases in dedicated equipment and the technical expertise may result in it as a preferred access in this patient group as well.
The Radcliffe Transradial Intervention educational programme is supported by:
Section editor
University Hospital North Staffordshire, Stoke-on-Trent, UK
-
Guedeney P, Thiele H, Kerneis M, et al. Am Heart J 2020;225:60–8.
-
Tehrani BN, Damluji AA, Sherwood MW, et al. Catheter Cardiovasc Interv 2020; epub ahead of press.
-
Miller TJ, Lin WC, Safa B. J Hand Surg Am 2020;45:664.E1–664.E5.
-
Chugh Y, Bavishi C, Mojadidi MK, et al. Catheter Cardiovasc Interv 2020;96:285–95.
Videos
Pages
Guidelines
Pages
Clinical Trials
-
Doubell J, et al EuroIntervention 2019. (Epub ahead of print).
-
van der Heijden DJ, et al. EuroIntervention 2019. (Epub ahead of print).
-
Hahn JY, Song YB, Oh JH, et al. Lancet 2018;391:1274–84.
-
Chen Y, Ke Z, Xiao J, et al. Circ Cardiovasc Interv 2018;11:e006571.
-
Yamada R, Bracewell S, Bassaco B, et al. J Vasc Interv Radiol 2018;29:38–43.
Pages
Real World/ Registry
-
Perl L, et al. Coron Artery Dis 2020;31;1:40-48.
-
Campelo-Parada F, Carrié D, Bartorelli AL, et al. J Invasive Cardiol 2018;30:262–8.
-
Kübler P, Zimoch W, Kosowski M, et al. J Interv Cardiol 2018;31:471–4.
-
Chong AY, Lo T, George S, et al. Cardiovasc Revasc Med 2018;19:163–7.
-
Rychlik J, Hornacek I, Tejc M, et al. Acta Cardiol 2018;74:325–30.
Pages
Case Studies
-
Hidalgo ML, Rampersad RD. Case Rep Cardiol 2018;2018:6073567.
-
Mohsen A, Alqasrawi M, Shantha GPS, et al. Sci Rep 2018;8:12026.
-
Lino Patricio, Renato Fernandes, Angelo Bento, et alRadcliffCardiology.com, October 2018.
-
Ali KhavandiRadcliffeCardiology.com, November 2017.
Pages
Risks
-
Madder RD, LaCombe A, VanOosterhout S, et al. JACC Cardiovasc Interv 2018;11:213–4.
-
Rodriguez Goyes JC, Jaramillo Gomez N, Jaramillo Restrepo V, et al. Interventional Cardiology 2018:10:73–9.
-
Sciahbasi A, Frigoli E, Sarandrea A, et al. Am Heart J 2018;196:113–8.
-
Mohsen A, Alqasrawi M, Shantha GPS, et al. Sci Rep 2018;8:12026.
Pages
Review
-
Gaudino M, Burzotta F, Bakaeen F, et al. J Am Coll Cardiol 2018;71:1167–75.
-
Maxwell YL. TCTMD 21 May 2018.
-
Susanu S, Angelillis M, Giannini C, et al. Clin Exp Emerg Med 2018;5:95–9.
-
Angiolillo DJ. Lancet 2018;392:801–2.
-
Gargiulo G, Carrara G, Frigoli E, et al. J Am Coll Cardiol 2018;71:1231–42.
Pages
Radial Artery Occlusion
-
Rashid M, Kwok CS, Pancholy S, et al. J Am Heart Assoc 2016;5:e002686.
-
Dharma S, Kedev S, Patel TM et al. Catheter Cardiovasc Interv 2015;85:818–25.
-
Jolly SS, Mehta S. Lancet 2015;385:2437–39.
Pages
Pages
Registry/Cohort Studies
-
Kopin D, et al JACC Cardiovasc Interv 2019;12;22: 2247-2256.
-
Murray D, et al. J Vasc Surg 2019. (Epub ahead of print).
-
Doshi R, et al. J Invasive Cardiol 2019;31;11:325-330.
-
Perl L, et al. Coron Artery Dis 2020;31;1:40-48.
Techniques
-
Chen SH, et al. Endovascular Today 2019;18;11:42-46.
-
Sgueglia GA, et al JACC Cardiovasc Interv 2020;13;1: e9-e10.
-
Krayukhina E, et al. J Pharm Sci 2020;109;1:515-523.
-
Parikh A, Jia KQ, Lall SK, et al. Curr Treat Options Cardiovasc Med 2020;22:1.
Case Studies
-
Riangwiwat T, et al. Catheter Cardiovasc Interv 2019. (Epub ahead of print).
-
Aramsareewong T. J Am Coll Cardiol 2018;71(16 Suppl):S280–2.
-
Rammos C, Burghardt A, Lortz J, et al. Eur J Med Res 2018;23:25.
-
Hidalgo ML, Rampersad RD. Case Rep Cardiol 2018;2018:6073567.
Transradial Randomised Clinical Trials (RCT)
-
Chen SH, Brunet M, Sur S, et al. J Neurointerv Surg 2020;12:431–4
-
Tuttle MK, et al. Cardiol Res 2019;10;6:331-335.
-
Garcia-Garcia HM, et al. Eur Heart J Cardiovasc Imaging 2019;20;12:1418-1428.
-
Doubell J, et al EuroIntervention 2019. (Epub ahead of print).
Transradial Radial Artery Occlusion (RAO)
-
van der Heijden DJ, et al. J Vasc Interv Radiol 2019;30;11:1832-1839.
-
Parikh A, et al. Expert Rev Cardiovasc Ther 2019;17;11: 827-836.
-
Dos Santos SM, et al. J Cardiovasc Nurs 2020. (Epub ahead of print)
-
Rashid M, Kwok CS, Pancholy S, et al. J Am Heart Assoc 2016;5:e002686.
