The Impact of Radial Vs Femoral Access on Vascular Complications and Patients Outcomes in Complex PCI
Article Sidebar
Main Article Content
Abstract
Background: Percutaneous coronary intervention (PCI) is a primary treatment modality for coronary artery disease, particularly in complex cases involving multivessel disease, chronic total occlusions, or bifurcation lesions. The choice of vascular access site—radial versus femoral—can significantly impact patient outcomes and the incidence of vascular complications. Recent trends favor radial access due to its potential advantages in safety and recovery.
Objective: To evaluate the impact of radial versus femoral access on vascular complications and patient outcomes in complex PCI.
Methods: This randomized control trial was conducted at the Chaudhary Pervaiz Elahi Institute of Cardiology, Wazirabad, Pakistan, over a six-month period from September 2023 to February 2024. A total of 350 patients undergoing complex PCI were enrolled, with 210 assigned to radial access and 140 to femoral access. Baseline characteristics, including age, BMI, and prevalent comorbidities (dyslipidemia, hypertension, and diabetes mellitus), were recorded. Major outcomes measured included periprocedural myocardial infarction, in-hospital mortality, and stent thrombosis. Statistical analysis was performed using SPSS Version 26.
Results: The mean age of participants was 52.90 ± 8.07 years. No significant differences were found in BMI and comorbid conditions between the groups. In-hospital mortality was 1.4% in the radial group compared to 4.3% in the femoral group (P=0.05). Rates of periprocedural myocardial infarction were similar between groups (0.5% radial vs 0.7% femoral, P=0.77). Stent thrombosis was observed in 0.5% of the radial group and was absent in the femoral group.
Conclusion: Radial access in complex PCI was associated with lower in-hospital mortality compared to femoral access, with similar rates of myocardial infarction and stent thrombosis. These findings suggest that radial access may provide a safer alternative, supporting its increasing use in clinical practice.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Al-Lamee RK, Nowbar AN, Francis DP. Percutaneous coronary intervention for stable coronary artery disease. Heart. 2019;105(1):11-9.
Werner N, Nickenig G, Sinning J-M. Complex PCI procedures: challenges for the interventional cardiologist. Clinical Research in Cardiology. 2018;107:64-73.
Vogel B, Claessen BE, Arnold SV, Chan D, Cohen DJ, Giannitsis E, et al. ST-segment elevation myocardial infarction. Nature reviews Disease primers. 2019;5(1):39.
Capodanno D, Angiolillo DJ. Management of antiplatelet therapy in patients with coronary artery disease requiring cardiac and noncardiac surgery. Circulation. 2013;128(25):2785-98.
Karrowni W, Vyas A, Giacomino B, Schweizer M, Blevins A, Girotra S, et al. Radial versus femoral access for primary percutaneous interventions in ST-segment elevation myocardial infarction patients: a meta-analysis of randomized controlled trials. JACC: Cardiovascular Interventions. 2013;6(8):814-23.
Rodríguez R, Giavarini A, Vandormael I, Longo G, Di Mario C. Advantages and disadvantages in radial and femoral arterial access. Practical Interventional Cardiology: CRC Press; 2017. p. 335-48.
Best DG, Pike R, Grainger P, Eastwood CA, Carroll K. A Prospective Study of Early Ambulation 90 Minutes Post-Left Heart Catheterization Using a Retrospective Comparison Group. Canadian Journal of Cardiovascular Nursing. 2010;20(4).
Lee MS, Applegate B, Rao SV, Kirtane AJ, Seto A, Stone GW. Minimizing femoral artery access complications during percutaneous coronary intervention: a comprehensive review. Catheterization and Cardiovascular Interventions. 2014;84(1):62-9.
Agostoni P, Biondi-Zoccai GG, De Benedictis ML, Rigattieri S, Turri M, Anselmi M, et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures: systematic overview and meta-analysis of randomized trials. Journal of the American College of Cardiology. 2004;44(2):349-56.
Alkatiri AA, Firman D, Haryono N, Yonas E, Pranata R, Fahri I, et al. Comparison between radial versus femoral percutaneous coronary intervention access in Indonesian hospitals, 2017–2018: A prospective observational study of a national registry. IJC Heart & Vasculature. 2020;27:100488.
Krittanawong C, Uppalapati L, Virk HU, Qadeer YK, Irshad U, Wang Z, Sharma S, Jneid H. Complications of Radial vs Femoral Access For Coronary Angiography and Intervention: What Do The Data Tell Us?. The American Journal of Medicine. 2024 Feb 22.
Otsuka M, Shiode N, Nakao Y, Ikegami Y, Kobayashi Y, Takeuchi A, et al. Comparison of radial, brachial, and femoral accesses using hemostatic devices for percutaneous coronary intervention. Cardiovascular intervention and therapeutics. 2018;33:62-9.
Ahmad WAW, Bang LH. Annual Report of the Percutaneous Coronary Intervention (PCI) Registry. 2016.
Hamon M, Coste P, van’t Hof A, Ten Berg J, Clemmensen P, Tabone X, et al. Impact of arterial access site on outcomes after primary percutaneous coronary intervention: prespecified subgroup analysis from the EUROMAX trial. Circulation: Cardiovascular Interventions. 2015;8(6):e002049.
Mamas MA, Ratib K, Routledge H, Neyses L, Fraser DG, de Belder M, et al. Influence of arterial access site selection on outcomes in primary percutaneous coronary intervention: are the results of randomized trials achievable in clinical practice? JACC: Cardiovascular Interventions. 2013;6(7):698-706.
Hamon M, Pristipino C, Di Mario C, Nolan J, Ludwig J, Tubaro M, 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(11):1242-51.
Roffi M, Patrono C, Collet J-P, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Polish Heart Journal (Kardiologia Polska). 2015;73(12):1207-94.
Dobies DR, Barber KR, Cohoon AL. Analysis of safety outcomes for radial versus femoral access for percutaneous coronary intervention from a large clinical registry. Open Heart. 2016;3(2):e000397.
Merdler I, Case BC, Cellamare M, Bhogal S, Reddy PK, Zhang C, Ben-Dor I, Waksman R. Frequency of ventriculography during left heart catheterization for radial vs. femoral access. Cardiovascular Revascularization Medicine. 2024 Apr 15.
Louvard Y, Benamer H, Garot P, Hildick-Smith D, Loubeyre C, Rigattieri S, et al. Comparison of transradial and transfemoral approaches for coronary angiography and angioplasty in octogenarians (the OCTOPLUS study). The American journal of cardiology. 2004;94(9):1177-80.