Transitioning to the radial artery as the preferred access site for cardiac catheterization: An academic medical center experience

Abstract

To evaluate procedural and safety metrics of transradial (TR) versus transfemoral (TF) cardiac catheterization (CATH) and percutaneous coronary interventions (PCI) during a complete institutional transition from TF to TR as the preferred access. The TR approach has been shown to reduce complications compared to TF for CATH and PCI, but concerns of longer procedure times have limited utilization in the United States. 4,172 consecutive CATH and PCI procedures were performed (2,665 TF; 1,507 TR) at Wake Forest Baptist Medical Center from January 2009 to November 2010. We assessed in-hospital procedural and safety metrics. After 6 months of a preferred TR strategy, TR to TF crossover rate was 9.1%, and 65% of all cases were TR procedures. For the cath lab (all TF + TR), we observed small but significant increases in procedural metrics for Preferred TR (last third) compared to Preferred TF (first third). This appeared to be due to increased access times, procedure length, fluoroscopy times, and contrast use for TR versus TF (propensity score matched). Nonetheless, over the course of the study, there was a trend for a decrease in all procedural metrics with TR use. Access site complications (2.3% TF, 1.2% TR) and bleeding (2.5% TF, 2.1% TR), both P < 0.05, decreased over the course of the study. Our observations support the concept that complete transition of a cath lab to a preferred TR strategy is feasible, achieves lower rates of vascular and bleeding complications but with modest increases in overall procedural metrics.