Transradial Approach for Coronary Interventions

Abstract

The transradial approach has been introduced as an alternative to the transfemoral approach to reduce bleeding complications after percutaneous coronary procedures. Over the past decade the transradial approach has been shown to reduce nurse workload, shorten hospital stay, and possibly reduce mortality in high-risk patients. Based on this experience the radial artery has become the preferred access site in a number of countries, and recently it has been endorsed as the preferred arterial access by the European Society of Cardiology (ESC). Following dedicated training, use of the transradial approach can be performed safely and efficiently in most patients; however, certain limitations apply, including anatomical abnormalities of the brachiocephalic vasculature and undue vasospasm. Radial artery occlusion represents the most common complication of this approach and, although mostly asymptomatic, it prevents reuse of the radial artery for future procedures, as well as its use as for a graft conduit or hemodialysis shunt. The risk of radial artery occlusion can be reduced by meticulous puncture technique, proper anticoagulation, nonocclusive hemostasis, and catheter downsizing. An arterial–introducer mismatch is responsible for patient discomfort, vessel trauma, and radial artery occlusion. By using smaller catheters or a «sheathless» approach, an arterial–introducer mismatch is avoided. Downsized («Slender») transradial coronary procedures have been shown to be safe and effective, and dedicated materials are now available.