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Bajraktari, G. Radial/Femoral Access in Coronary Angiography. Encyclopedia. Available online: https://encyclopedia.pub/entry/11519 (accessed on 19 June 2024).
Bajraktari G. Radial/Femoral Access in Coronary Angiography. Encyclopedia. Available at: https://encyclopedia.pub/entry/11519. Accessed June 19, 2024.
Bajraktari, Gani. "Radial/Femoral Access in Coronary Angiography" Encyclopedia, https://encyclopedia.pub/entry/11519 (accessed June 19, 2024).
Bajraktari, G. (2021, June 30). Radial/Femoral Access in Coronary Angiography. In Encyclopedia. https://encyclopedia.pub/entry/11519
Bajraktari, Gani. "Radial/Femoral Access in Coronary Angiography." Encyclopedia. Web. 30 June, 2021.
Radial/Femoral Access in Coronary Angiography
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In patients undergoing diagnostic coronary angiography (CA) and percutaneous coronary interventions (PCI), the benefits associated with radial access compared with the femoral access approach remain controversial. Radial access in patients undergoing CA with or without PCI is associated with lower mortality, MACE, major bleeding and vascular complications, irrespective of clinical presentation, ACS or STEMI, compared with femoral access. 

femoral radial coronarography PCI acute coronary syndrome stable coronary artery disease

1. Introduction

Patients with coronary artery disease (CAD) typically present with chest pain or shortness of breath. In patients with stable or unstable CAD, coronary angiography (CA), as the gold standard for detection and assessment of coronary artery stenoses, is performed, according to current clinical guidelines [1]. Revascularization therapy is indicated in patients with acute coronary syndrome (ACS) and in those with confirmed significant coronary stenosis not responding to optimal medical therapy or demonstrating marked limitation of physical activity [1]. Percutaneous coronary intervention (PCI), as an alternative to coronary artery bypass graft surgery, was introduced in the 1990s and is currently performed as a revascularization tool in the majority of patients with CAD [2]. The traditional approach for CA and PCI has been through the femoral artery, owing to its large caliber, which provides easy access [3]. Bleeding is the most common complication of PCI and is associated with poor clinical outcomes [4][5]. However, since 1989, the trans-radial approach has been attempted as an alternative to femoral access [6] and has resulted in less access-site bleeding due to the easily compressible radial artery; the superficial anatomy of the radial artery also encourages early patient discharge after procedures [7]. However, the radial approach for diagnostic CA and PCI requires a longer learning curve and higher procedure volumes in order to achieve adequate and safe skills. Over the last decades, several published randomized clinical trials (RCTs) assessed the value of the radial compared with the femoral approach in patients undergoing diagnostic CA and PCI with respect to residual ischemic, bleeding, and combined outcomes. The results of these RCTs remain controversial.

2. Radial Access for Coronary Angiography Compared with Femoral Access

References

  1. Neumann, F.-J.; Sousa-Uva, M.; Ahlsson, A.; Alfonso, F.; Banning, A.P.; Benedetto, U.; Byrne, R.A.; Collet, J.-P.; Falk, V.; Head, S.J.; et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Russ. J. Cardiol. 2019, 40, 87–165.
  2. Habib, R.H.; Dimitrova, K.R.; Badour, S.A.; Yammine, M.B.; El-Hage-Sleiman, A.K.M.; Hoffman, D.M.; Geller, C.M.; Schwann, T.A.; Tranbaugh, R.F. CABG Versus PCI: Greater Benefit in Long-Term Outcomes with Multiple Arterial Bypass Grafting. J. Am. Coll. Cardiol. 2015, 66, 1417–1427.
  3. Venkitachalam, L.; Kip, K.E.; Selzer, F.; Wilensky, R.L.; Slater, J.; Mulukutla, S.R.; Marroquin, O.C.; Block, P.C.; Williams, D.O.; Kelsey, S.F. Twenty-year evolution of percutaneous coronary intervention and its impact on clinical outcomes: A report from the National Heart, Lung, and Blood Institute-sponsored, multicenter 1985–1986 PTCA and 1997–2006 dynamic registries. Circ. Cardiovasc. Interv. 2009, 2, 6–13.
  4. Rao, S.V.; O’Grady, K.; Pieper, K.S.; Granger, C.B.; Newby, L.K.; Van de Werf, F.; Mahaffey, K.W.; Califf, R.M.; Harrington, R.A. Impact of Bleeding Severity on Clinical Outcomes Among Patients With Acute Coronary Syndromes. Am. J. Cardiol. 2005, 96, 1200–1206.
  5. Chhatriwalla, A.K.; Amin, A.P.; Kennedy, K.F.; House, J.A.; Cohen, D.J.; Rao, S.V.; Messenger, J.C.; Marso, S.P.; Registry, F.T.N.C.D. Association Between Bleeding Events and In-hospital Mortality After Percutaneous Coronary Intervention. JAMA 2013, 309, 1022–1029.
  6. Campeau, L. Percutaneous radial artery approach for coronary angiography. Catheter. Cardiovasc. Diagn. 1989, 16, 3–7.
  7. Hildick-Smith, D.J.; Lowe, M.D.; Walsh, J.T.; Ludman, P.F.; Stephens, N.G.; Schofield, P.M.; Stone, D.L.; Shapiro, L.M.; Petch, M.C. Coronary angiography from the radial artery—Experience, complications and limitations. Int. J. Cardiol. 1998, 64, 231–239.
  8. Wensley, C.J.; Kent, B.; McAleer, M.B.; Savage, S.M.; Stewart, J.T. Pain relief for the removal of femoral sheath after percutaneous coronary intervention. Cochrane Database Syst. Rev. 2008, 2008, CD006043.
  9. Kolkailah, A.A.; Alreshq, R.S.; Muhammed, A.M.; Zahran, M.E.; El-Wegoud, M.A.; Nabhan, A.F. Transradial versus transfemoral approach for diagnostic coronary angiography and percutaneous coronary intervention in people with coronary artery disease. Cochrane Database Syst. Rev. 2018, 2018, CD012318.
  10. Tavakol, M.; Ashraf, S.; Brener, S.J. Risks and Complications of Coronary Angiography: A Comprehensive Review. Glob. J. Health Sci. 2012, 4, 65–93.
  11. Dal Molin, A.; Faggiano, F.; Bertoncini, F.; Buratti, G.; Busca, E.; Casarotto, R.; Gaboardi, S.; Allara, E. Bed rest for preventing complications after transfemoral cardiac catheterisation: A protocol of systematic review and network meta-analysis. Syst. Rev. 2015, 4, 47.
  12. Kasapis, C.; Gurm, H.S. Current Approach to the Diagnosis and Treatment of Femoral-Popliteal Arterial Disease. A Systematic Review. Curr. Cardiol. Rev. 2009, 5, 296–311.
  13. Kim, J.-Y.; Yoon, J. Transradial Approach as a Default Route in Coronary Artery Interventions. Korean Circ. J. 2011, 41, 1–8.
  14. Brasselet, C.; Blanpain, T.; Tassan-Mangina, S.; Deschildre, A.; Duval, S.; Vitry, F.; Gaillot-Petit, N.; Clément, J.P.; Metz, D. Comparison of operator radiation exposure with optimized radiation protection devices during coronary angiograms and ad hoc percutaneous coronary interventions by radial and femoral routes. Eur. Heart J. 2007, 29, 63–70.
  15. Hess, C.N.; Peterson, E.D.; Neely, M.L.; Dai, D.; Hillegass, W.B.; Krucoff, M.W.; Kutcher, M.A.; Messenger, J.C.; Pancholy, S.; Piana, R.N.; et al. The Learning Curve for Transradial Percutaneous Coronary Intervention among Operators in the United States. Circulation 2014, 129, 2277–2286.
  16. Hamon, M.; Pristipino, C.; Di Mario, C.; Nolan, J.; Ludwig, J.; Tubaro, M.; Sabaté, M.; Mauri-Ferré, J.; Huber, K.; Niemelä, K.; et al. Consensus document on the radial approach in percutaneous cardiovascular interventions: Position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care and Thrombosis of the European Society of Cardiology. EuroIntervention 2013, 8, 1242–1251.
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