Unraveling the Radial Paradox
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- cardiac catheterization
- coronary angiography
- percutaneous coronary intervention
- radial artery
- shock, cardiogenic
Until recently, transfemoral access (TFA) was the primary mode of access for selective coronary angiography and percutaneous coronary intervention (PCI). In 1989, Lucien Campeau, a Canadian cardiologist, first described transradial access (TRA) for coronary angiography as an alternative.1 Since then, TRA has gained acceptance worldwide and has become the default mode of access in many centers.
See Article by Hulme et al
The embracement of TRA has been supported by observational studies and randomized trials that show a reduction in bleeding with TRA compared with TFA.2–5 Virtual elimination of bleeding at the access site has been attributed to the superficial and readily compressible nature of the radial artery. Retroperitoneal bleeding, a rare but dreadful complication associated with TFA, is not a concern when using TRA. In addition, studies confirm that bleeding complications after PCI are associated with mortality,6,7 and recent trials suggest that TRA lowers mortality.4,5
However, despite the increase in operator TRA experience and advances in technology, crossovers to TFA still occur in ≤7% of cases.8 Also, TFA may be the access of choice in some patients who have a weak or absent radial pulse (ie, cardiogenic shock). Because success and freedom from complications in the performance of medical procedures is generally linked to case volume,9 the shift in practice making TRA the primary mode of access has raised concerns that operators and their teams may become less adept at performing cardiac catheterization and PCI via TFA, which may be associated with an increase in procedural complications when this TFA is needed.10–12
Recently, Azzalini et al13 reported on 17 059 patients who underwent cardiac catheterization or PCI at the Montreal Heart Institute. They compared a contemporary cohort (2006–2008) in which TRA and TFA were …