Radial Access Group Research Articles

COMPARISON OF THE EFFECTIVENESS OF RADIAL VERSUS FEMORAL ACCESS FOR DIAGNOSTIC AND THERAPEUTIC PROCEDURES IN PATIENTS WITH PERIPHERAL ARTERIAL DISEASE

Peripheral arterial disease (PAD) is a medical condition in which the blood vessels outside the heart and brain were affected. The study's main objective is to compare the effectiveness of radial versus femoral access for diagnostic and therapeutic procedures in patients with peripheral arterial disease. The research article aimed to compare the effectiveness of radial and femoral access for diagnostic and therapeutic procedures in patients with the peripheral arterial disease (PAD). The study was conducted in two hospitals in Peshawar, Pakistan - Hayatabad Medical Complex and Lady Reading Hospital. The study duration was from January 2020 to December 2020. A total of 384 patients were enrolled in the study, with 192 randomly assigned to the radial access group and 192 to the femoral access group. The study found that RA was associated with a significantly lower risk of major bleeding and access site complications compared to FA. Specifically, the incidence of major bleeding was 1.56% in the radial access group and 5.73% in the femoral access group (p=0.02), and the incidence of access site complications was 2.6% in the radial access group, 8.3% in the femoral access group (p=0.01). In conclusion, our study suggests that radial access is a safe and effective alternative to femoral access for diagnostic and therapeutic procedures in patients with peripheral arterial disease. Radial access is associated with lower rates of major bleeding and access site complications, particularly for diagnostic procedures, and may offer advantages such as faster patient ambulation and improved patient comfort.

Efficacy and Safety of Distal Radial Access for Transcatheter Arterial Chemoembolization (TACE) of the Liver.

The distal radial artery has emerged as an alternative vascular-access site to conventional transfemoral and transradial approaches. The main advantage over the conventional transradial route is the reduced risk of radial artery occlusion, especially in those patients who, for various clinical reasons, have to undergo repeated endovascular procedures. This study aims to assess the efficacy and safety of distal radial access for transcatheter arterial chemoembolization of the liver. This investigation is a single-center retrospective analysis of 42 consecutive patients who had undergone, from January 2018 to December 2022, transcatheter arterial chemoembolization of the liver with distal radial access for intermediate-stage hepatocellular carcinoma. Outcome data were compared with a retrospectively constituted control group of 40 patients undergoing drug-eluting beads-transcatheter arterial chemoembolization with femoral access. Technical success was achieved in all cases, with a 2.4% conversion rate for distal radial access. A superselective chemoembolization was performed in 35 (83.3%) cases of distal radial access. No episode of radial artery spasm or radial artery occlusion occurred. No significant differences in efficacy and safety were observed between the distal radial access group and the femoral access group. Distal radial access is effective, safe, and comparable to femoral access in patients undergoing transcatheter arterial chemoembolization of the liver.

Radial versus femoral access in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: A propensity-matched analysis from real-world data of the K-ACTIVE registry

BackgroundThe access site for primary percutaneous coronary intervention (PCI) for patients with ST-elevation myocardial infarction (STEMI) recently shifted from femoral to radial. However, few real-world data on Japanese patients exist. MethodsTo elucidate the clinical selection and impact of the access site in STEMI patients, we analyzed a Japanese observational prospective multicenter registry of acute myocardial infarction (K-ACTIVE: Kanagawa ACuTe cardIoVascular rEgistry) in 2015 to 2021. Data were analyzed in the entire population and a propensity score-matched population adjusted for confounding factors. Major adverse cardiac event (MACE) was defined as cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Bleeding Academic Research Consortium (BARC) type 3 or 5 was used to assess bleeding events. MACE plus BARC type 3 or 5 bleeding were considered composite events. Clinical outcomes were followed for 30 days. ResultsThe 6802 STEMI patients included 4786 patients with radial access (70.3 %) and 2016 with femoral access (29.7 %). Femoral access tended to be selected for more severe conditions than radial access. The median door-to-device time in the radial access group was significantly shorter than the femoral access group in the entire population (75 min versus 79 min, p < 0.01). After propensity score matching (each group, n = 1208), the incidence of MACE tended to be lower in the radial access group [risk ratio (RR) 0.83, 95 % confidence interval (CI) 0.63–1.09, p = 0.17]. The incidence of BARC 3 or 5 bleeding was significantly less in the radial access group (RR 0.47, 95%CI 0.23–0.97, p = 0.04). The incidence of composite events was significantly less in the radial access group (RR 0.74, 95%CI 0.57–0.96, p = 0.02). ConclusionIn STEMI patients undergoing primary PCI, in comparison to femoral access, radial access reduced composite events in the entire population and the matched population, through a reduction in MACE and BARC 3 or 5 bleeding.

Rotational atherectomy via the transradial access: success rates, procedural parameters and complications

Radial access is recommended for percutaneous coronary intervention (PCI), but rotational atherectomy remains frequently performed via femoral access. Analyzing the procedural parameters, success rate and complications of rotational atherectomy, performed via radial in comparison to femoral access. We retrospectively analyzed 427 consecutive patients undergoing rotational atherectomy. Procedural parameters and outcome were determined in 171 patients, scheduled for radial and compared to 256 patients with femoral access use. In the radial access group (74 ± 9 years, 84% male), the LAD was most frequently treated (49%). Sheath size was 7F in 59% and 6F in 41%, burr size was 1.5 mm in 46% and 1.25 mm in 14% of patients. A temporary pacemaker was inserted in 14%. Procedural success rate stood at 97%. Access site complications occurred in 4% of patients, which was significantly less frequent than in in 256 patients treated via femoral access (13% p = 0.003). Compared to radial access, femoral access was associated with the use of larger sheaths (p < 0.001), more frequent treatment of non-LAD vessels (58.2% vs. 44.4%, p = 0.013) and a higher rate of temporary pacemaker use (27%; p = 0.001). No differences could be seen in procedural success (p = 0.83) and burr size (p = 0.51). Femoral access (OR 3.33; 95% CI 1.40–7.93), and female sex (OR3.40 95% CI 1.69–6.63) were independent predictors for access site complications. For coronary rotational atherectomy, radial access has a high success rate with overall use of smaller sheaths, but of equally sized burrs as well as a significant lower rate of access site-related complications than femoral access.

Safety and efficacy of percutaneous coronary interventions performed via anatomical snuffbox access in elderly patients

Abstract Funding Acknowledgements Type of funding sources: None. Background Radial artery thrombosis is a potential complication of transradial catheterization. For elderly patients greater attention should be paid to preserve radial arteries due to rather common comorbidities, such as renal failure and systemic atherosclerosis. Radial arteries in such cases may be required for hemodialysis, coronary artery bypass grafting and vascular reconstruction surgery. Presumably, the distal radial access can provide additional benefits in reducing the incidence of radial artery occlusion. Purpose To evaluate the radial artery thrombosis incidence and other complications in elderly patients undergone a percutaneous coronary intervention via anatomical snuffbox radial access. Methods This research (Jan 2018 – Aug 2020) was conducted as a single-center, prospective study in 141 patients over the age of 75 who had a percutaneous coronary intervention via the conventional radial access (n = 57) and radial access in the anatomic snuffbox (n = 84). The primary endpoints were: thrombosis; radial artery spasm; cannulation site hematoma with a diameter larger than 1 cm; crossover to the different access. We also evaluated the time for access establishment and total duration of the procedure. Results The groups had no significant differences in age and sex (the mean age was 81.9 ± 4.6 years, 67.9% females). The percutaneous coronary intervention was performed for STEMI in 73 (51.2%) patients, NSTEMI in 39 (27.7%) patients, or CAD in 35 (21.1%) patients. Two (2.4%) cases of vascular access crossover were reported in the anatomical snuffbox group compared with two (2.6%) cases in the conventional radial access group (p = 0.684). There were no statistically significant differences in the access time between the groups. It was 3.43 ± 0.78 min in the conventional radial access group versus 3.28 ± 0.76 min (p = 0.891) in the anatomical snuffbox access group. The total duration of percutaneous coronary intervention was also comparable in two groups (44.1 ± 15.6 min versus 45.9 ± 16.5 min, p = 0.936). The radial artery occlusion incidence was significantly lower in the anatomical snuffbox access group compared with the conventional radial access group (2 (2.4%) versus 8 (14.5%), respectively, p = 0.008). Also, radial artery spasm occurred significantly less frequently in the anatomical snuffbox access group compared with the conventional one (2 (2.4%) versus 7 (12.7%), respectively, p = 0.018). The incidence of cannulation site hematoma was significantly lower in the anatomical snuffbox access group than in the conventional access group (5 (6%) versus 10 (18.2%), respectively, p = 0.025). Conclusion Access via the anatomical snuffbox reduces the incidence of radial artery occlusion, cannulation-related spasm, and cannulation site hematoma. So it may be considered preferred to conventional radial access in elderly patients. However, randomized studies are needed to further investigate these results.

Distal radial access. Occlussion of the radial artery after percutaneus coronary intervention with radial access

In 2015, The European Society of Cardiology for Acute Coronary Syndrome recommended that Class I use radial as the preferred access method for any percutaneous coronary intervention regardless of clinical presentation. However, the use of TRA is associated with some complications: radiation artery occlusion (RAO) (The reported incidence of RAO is highly variable in the range of 2-11%, radial arterial spasm, radial arterial perforation, radial artery pseudoaneurysm, arteriovenous fistula, bleeding, nerve damage, and complex regional pain syndrome. Limited data are available regarding the technique of distal radial access, complications, and potential benefits. The purpose of our study is to compare the incidence of radial artery occlusion between distal radial and conventional radial access. The study included 292 patients (who underwent percutaneous coronary intervention)in who is felt pulsations at the site of a puncture of the radial artery. Patients were followed one month after the procedure, with Doppler ultrasonography or access from the same artery. After a month, the occlusion of the radial artery occurred in 8 (5.7%) patients in conventional radial access, there was no occlusion of the radial artery in the distal radial access group. This investigation shows that distal radial access is associated with a lower incidence of occlusion of the radial artery.

Distal Radial Artery Approach to Prevent Radial Artery Occlusion Trial.

The aim of this study was to compare the rate of proximal radial artery occlusion (RAO) with Doppler ultrasound between distal and conventional radial access 24h and 30days after a transradial coronary procedure. The use of distal radial access to prevent proximal RAO (PRAO) in the proximal segment at 24h and 30days after a procedure, compared with conventional radial access, is unknown. This was a prospective, comparative, longitudinal, randomized study. A total of 282 patients were randomized to either proximal radial access (n=142) or distal radial access (n=140) to evaluate the superiority of the distal approach in the prevention of PRAO with Doppler ultrasound 24h and 30days after a transradial coronary procedure. In the per protocol analysis, the rates of PRAO at 24h and 30days were 8.4% and 5.6% in the proximal group and 0.7% and 0.7% in the distal group, respectively (24 h: odds ratio [OR]: 12.8; 95% confidence interval [CI]: 1.6 to 100.0; p=0.002; 30days: OR: 8.2; 95%CI: 1.0 to 67.2; p=0.019). In an intention-to-treat analysis, the 24-h and 30-day rates of PRAO were 8.8% and 6.4% for proximal radial access and 1.2% and 0.6% in the distal radial access group (24 h: OR: 7.4; 95%CI: 1.6 to 34.3; p=0.003; 30days: OR: 10.6; 95%CI: 1.3 to 86.4; p=0.007). Distal radial access prevents RAO in the proximal segment at 24h and 30days after the procedure compared with conventional radial access.

Safety and Efficacy of Femoral Access vs Radial Access in ST-Segment Elevation Myocardial Infarction

Among patients with ST-segment elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention (PCI), a survival benefit associated with radial access compared with femoral access remains controversial. To assess whether there is a survival benefit when radial access is used instead of femoral access among patients with STEMI referred for primary PCI. This multicenter, open-label, randomized clinical trial was conducted at 5 PCI centers in Canada. In total, 2292 patients with STEMI referred for primary PCI were enrolled between July 2011 and December 2018, with a 30-day follow-up. The primary analyses were conducted based on the intention-to-treat population. Patients were randomized to radial access (n = 1136) or to femoral access (n = 1156) for PCI. Initially, the primary outcome was bleeding, but this outcome was modified to 30-day all-cause mortality following the recommendation of the granting agency. Secondary outcomes included recurrent myocardial infarction, stroke, and Thrombolysis in Myocardial Infarction-defined major or minor bleeding. Among the 2292 patients enrolled, the mean (SD) age of the patients randomized to radial access was 61.6 (12.3) years and to femoral access was 62.0 (12.1) years, with 883 male patients in the radial access and 901 male patients in the femoral access group. The trial was stopped early following a futility analysis. Primary PCI was performed in 1082 of 1136 patients (95.2%) in the radial access group and 1109 of 1156 patients (95.9%) in the femoral access group. Bivalirudin was administered to 1001 patients (88.1%) in the radial access group and to 1068 patients (92.4%) in the femoral access group, whereas glycoprotein IIb/IIIa inhibitors were administered in only 69 patients (6.1%) in the radial access group and 68 patients (5.9%) in the femoral access group. A vascular closure device was used in 789 patients (68.3%) in the femoral group. The primary outcome, 30-day all-cause mortality, occurred in 17 patients (1.5%) assigned to radial access and in 15 patients (1.3%) assigned to femoral access (relative risk [RR], 1.15; 95% CI, 0.58-2.30; P = .69). There were no significant differences between patients assigned to radial and femoral access in the rates of reinfarction (1.8% vs 1.6%; RR, 1.07; 95% CI, 0.57-2.00; P = .83), stroke (1.0% vs 0.4%; RR, 2.24; 95% CI, 0.78-6.42; P = .12), and bleeding (1.4% vs 2.0%; RR, 0.71; 95% CI, 0.38-1.33; P = .28). No significant differences were found for survival or other clinical end points at 30 days after the use of radial access vs femoral access in patients with STEMI referred for primary PCI. However, small absolute differences in end points cannot be definitively refuted given the premature termination of the trial. ClinicalTrials.gov identifier: NCT01398254.

Radial access versus femoral access in myocardial infarction – a single-center experience

Background&#x0D; Data on the relationship between radial access (RA) and outcome in patients with myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI) are inconclusive. The aim of our study was to assess whether RA is associated with 30-day mortality in patients with MI undergoing percutaneous coronary intervention in our center or whether the possible benefit of RA is the result of less bleeding and other confounding factors.&#x0D; Methods&#x0D; We retrospectively studied 3501 consecutive patients with MI who underwent PCI between January 2012 and December 2016. The 30-day mortality in the RA and femoral access (FA) groups was observed. Data were analyzed using descriptive statistics.&#x0D; Results&#x0D; RA patients had a significantly lower 30-day unadjusted mortality [53(3.8%) patients died in the RA group compared to 207(9.8%) patients in the FA group; p&lt;0.0001]. After adjustments for confounders, the difference was no longer significant (adjusted OR: 0.84; 95% CI: 0.58 to 1.22). Cardiogenic shock, age over 70 years, hypertension, hyperlipidemia, anemia on admission, renal dysfunction on admission, ST-elevation MI, bleeding, the contrast volume/GFR ratio, but not RA, predicted 30-day mortality.&#x0D; &#x0D; Conclusion&#x0D; RA was not associated with 30-day mortality in patients with MI undergoing PCI. Our study result suggests that the better outcome in the RA group was influenced by confounding factors, especially bleeding and hemodynamic impairment.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Acute kidney injury in patients with myocardial infarction undergoing percutaneous coronary intervention using radial versus femoral access

BackgroundData on radial access (RA) as an independent risk factor for acute kidney injury (AKI) in myocardial infarction (MI) patients are conflicting. Our aim was to assess how RA influences the incidence of AKI in MI patients undergoing percutaneous coronary intervention (PCI).MethodsData from 3842 MI patients undergoing PCI at our institution from January 2011 to December 2016, of which 35.8% were performed radially, were retrospectively analyzed. A propensity-matched analysis was performed to adjust for differences in the baseline characteristics between the RA and femoral access (FA) groups. The effect of RA on the incidence of AKI was observed.ResultsIn the unmatched cohort, AKI occurred less often in the RA group [77 (5.6%) patients in the RA group compared to 250 (10.1%) patients in the FA group; p = 0.001]. After propensity-matched adjustment, the incidence of AKI was similar in the two groups.After adjustment for potential confounders, RA was not identified as an independent predictive factor for AKI in either the unmatched or the propensity-matched cohort. Bleeding, heart failure, age ≥ 70 years, renal dysfunction, and the contrast volume/GFR ratio predicted AKI in both cohorts. Additionally, diabetes, contrast volume, and hypertension were predictive of AKI in the unmatched cohort.ConclusionThe access site was not independently associated with the incidence of AKI in patients with MI in both a non-matched and a propensity-matched cohort. Our study result suggests that the lower incidence of AKI in patients treated with RA in an unmatched cohort might be substantially influenced by confounding factors, especially bleeding.

Increased pulse wave transit time after percutaneous coronary intervention procedure in CAD patients

Pulse wave transit time (PWTT) has been widely used as an index in assessing arterial stiffness. Percutaneous coronary intervention (PCI) is usually applied to the treatment of coronary artery disease (CAD). Research on the changes in PWTT caused by PCI is helpful for understanding the impact of the PCI procedure. In addition, effects of stent sites and access sites on the changes in PWTT have not been explored. Consequently, this study aimed to provide this information. The results showed that PWTT significantly increased after PCI (p < 0.01) while the standard deviation (SD) of PWTT time series had no statistically significant changes (p = 0.60) between before and after PCI. Significantly increased PWTT was found in the radial access group (p < 0.01), while there were no significant changes in the femoral access group (p > 0.4). Additionally, PWTT in the left anterior descending (LAD) group significantly increased after PCI (p < 0.01), but the increase that was found in the right coronary artery (RCA) group was not significant (p > 0.1). Our study indicates that arterial elasticity and left ventricular functions can benefit from a successful PCI procedure, and the increase of peripheral PWTT after PCI can help to better understand the effectiveness of the procedure.

Radial versus femoral access, bleeding and ischemic events in patients with non–ST-segment elevation acute coronary syndrome managed with an invasive strategy

Bleeding is a major limitation of antithrombotic therapy among invasively managed non-ST-segment elevation acute coronary syndromes (NSTE-ACS) patients; therefore, we examined the use of radial access and its association with outcomes among NSTE-ACS patients. Clinical characteristics and geographic variation in radial access were examined, as well as its association with bleeding, red blood cell transfusion and ischemic outcomes (96-hour death/myocardial infarction/recurrent ischemic/thrombotic bailout; 30-day death/myocardial infarction; 1-year death) in the EARLY versus delayed, provisional eptifibatide in acute coronary syndromes trial. Of 9126 patients, 13.5% underwent radial-access catheterization. Female sex, age, weight, and prior revascularization were inversely associated with radial access, and its use varied widely by country (2%-97%). There were fewer GUSTO severe/moderate bleeds and red blood cell transfusions in the radial access group; however, it was attenuated after adjustment (odds ratio 0.73, 95% confidence intervals [CI] [0.50-1.06], P = .094 and 1.00 [0.71-1.40] P = .991). Ischemic outcomes did not differ by access site. In this post hoc analysis of a large clinical trial, there was significant international variation in use of radial access for NSTE-ACS patients undergoing invasive management, and it was preferentially used in those at lower risk for bleeding. Radial approach was not associated with a significant reduction in either bleeding or ischemic outcomes. Further study is needed to determine whether wider application of radial approach to acute coronary syndrome patients at high risk for bleeding improves overall outcomes.

Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial

Small trials have suggested that radial access for percutaneous coronary intervention (PCI) reduces vascular complications and bleeding compared with femoral access. We aimed to assess whether radial access was superior to femoral access in patients with acute coronary syndromes (ACS) who were undergoing coronary angiography with possible intervention. The RadIal Vs femorAL access for coronary intervention (RIVAL) trial was a randomised, parallel group, multicentre trial. Patients with ACS were randomly assigned (1:1) by a 24 h computerised central automated voice response system to radial or femoral artery access. The primary outcome was a composite of death, myocardial infarction, stroke, or non-coronary artery bypass graft (non-CABG)-related major bleeding at 30 days. Key secondary outcomes were death, myocardial infarction, or stroke; and non-CABG-related major bleeding at 30 days. A masked central committee adjudicated the primary outcome, components of the primary outcome, and stent thrombosis. All other outcomes were as reported by the investigators. Patients and investigators were not masked to treatment allocation. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, NCT01014273. Between June 6, 2006, and Nov 3, 2010, 7021 patients were enrolled from 158 hospitals in 32 countries. 3507 patients were randomly assigned to radial access and 3514 to femoral access. The primary outcome occurred in 128 (3·7%) of 3507 patients in the radial access group compared with 139 (4·0%) of 3514 in the femoral access group (hazard ratio [HR] 0·92, 95% CI 0·72-1·17; p=0·50). Of the six prespecified subgroups, there was a significant interaction for the primary outcome with benefit for radial access in highest tertile volume radial centres (HR 0·49, 95% CI 0·28-0·87; p=0·015) and in patients with ST-segment elevation myocardial infarction (0·60, 0·38-0·94; p=0·026). The rate of death, myocardial infarction, or stroke at 30 days was 112 (3·2%) of 3507 patients in the radial group compared with 114 (3·2%) of 3514 in the femoral group (HR 0·98, 95% CI 0·76-1·28; p=0·90). The rate of non-CABG-related major bleeding at 30 days was 24 (0·7%) of 3507 patients in the radial group compared with 33 (0·9%) of 3514 patients in the femoral group (HR 0·73, 95% CI 0·43-1·23; p=0·23). At 30 days, 42 of 3507 patients in the radial group had large haematoma compared with 106 of 3514 in the femoral group (HR 0·40, 95% CI 0·28-0·57; p<0·0001). Pseudoaneurysm needing closure occurred in seven of 3507 patients in the radial group compared with 23 of 3514 in the femoral group (HR 0·30, 95% CI 0·13-0·71; p=0·006). Radial and femoral approaches are both safe and effective for PCI. However, the lower rate of local vascular complications may be a reason to use the radial approach. Sanofi-Aventis, Population Health Research Institute, and Canadian Network for Trials Internationally (CANNeCTIN), an initiative of the Canadian Institutes of Health Research.

Decreased complication rates using the transradial compared to the transfemoral approach in percutaneous coronary intervention in the era of routine stenting and glycoprotein platelet IIb/IIIa inhibitor use: A large single-center experience

Studies evaluating the efficacy and safety of the transradial approach for percutaneous coronary intervention (PCI) were carried out mainly before the widespread use of stents and glycoprotein (GP) IIb/IIIa inhibitors. We sought to determine the association between the choice of the vascular access site and procedural complications after PCI performed with routine stenting and GP IIb/IIIa inhibition. The data source was a prospective registry of 13,499 consecutive cases of PCI at the University Health Network, Toronto, Canada, from April 2000 to September 2006. Logistic regression was used to calculate the probability of selection to the radial access group. Using propensity score methodology, 3,198 patients with femoral access were randomly matched to 3,198 patients with radial access based on clinical, angiographic, and procedural characteristics. Multivariable logistic regression analysis was used to identify the independent predictors of access site-related complications. Major adverse cardiac event was defined as death, myocardial infarction, abrupt vessel closure, or coronary artery bypass surgery. Use of the transradial approach was associated with fewer vascular access complications (1.5% vs 0.6%, P<.001) and a shorter length of hospital stay. Multivariable analysis revealed transradial access (OR 0.39, 95% CI 0.2-0.7) to be an independent predictor of lower risk, whereas primary PCI (OR 4.36, 95% CI 1.4, 13), recent myocardial infarction (OR 2.0 95% CI 1.2, 3.4), age (per 10 years increase: OR 1.37, 95% CI 1.1-1.7) and female gender (0R 2.78 95% CI 1.7, 4.6) were independent predictors of a higher risk of access site complications. Use of transradial access for PCI is safe and is independently associated with a reduced rate of in-hospital access site complications and reduced length of hospital stay.