TRANSRADIAL ACCESS FOR PCI: A NOVEL APPROACH / CHANGING TRENDS OF VASCULAR ACCESS

Abstract

Objective: Vascular complications associated with femoral artery access for interventionalcardiological procedures may increase morbidity especially in patients receiving anticoagulants,aspirin, clopidogrel and platelet glycoprotein IIb/ IIIa receptor inhibitors. The use of radial arterialaccess reduces the incidence of access site bleeding complications. The purpose of the present study wasto assess the feasibility, success, and safety of the transradial approach (TRA) for PCI.Design: Single-centre, Prospective observational study.Place and Duration of Study: The study was carried out in Armed Forces Institute of Cardiology –National Institute of Heart Diseases (AFIC-NIHD) over a period of six months from july 2009 todecember 2009.Patients and Methods: We collected data of 100 consecutive patients who underwent PCI by thetransradial approach. Transradial access was performed only if the Allen’s test was normal (positive),suggesting the presence of an adequate collateral circulation from the ulnar artery. Patients withprevious CABG with LIMA grafting, ACS with cardiogenic shock or requiring TPM placement wereexcluded from this study. Study endpoints included procedure success rate, vascular complications ataccess site, and major adverse cardiac and cerebrovascular events during hospitalization.Results: Mean age of the patients was 53 years (range 31-79 yrs). Procedural success was achieved in100% cases. Right TR approach was used in 99% cases. Number of target lesions treated was 239 withmultivessel PCI done in 61% cases. DES was used in 72%cases and BMS was used in 28% cases.Maximum no of target lesions treated included LAD 114(47.6%), followed by RCA 50 (20.9%),LCX41(17.1%),OM branch 25(10.4%),Diagonal branch 9(10.4%). No case of vascular complications suchas major access site bleeding, vascular perforation, radial artery occlusion, forearm ischemia orcompartment syndrome was observed. There were no procedural myocardial infarctions or deaths, andno patient was referred for emergency bypass surgery.Conclusions: We conclude that the transradial access for PCI is a safe and effective alternative totransfemoral access. It adds to patients comfort and convenience and offers coronary intervention withthe potential of less vascular complications.Keywords: Transradial angioplasty, Allen’s test, coronary angiography, transradial intervention.