Objective

To compare procedural and clinical outcomes of PTCA via the TRA, TBA, or TFA

Study Population

900 patients (300 in each group) undergoing PTCA for ACS

Follow-up

In-hospital and 1 mo

End Point

Procedural outcomes and MACE (death, MI, CABG, or repeat PTCA) at 1 mo

Procedural Success Rate/Crossover

TRA → TFA: 20; TBA → TFA: 12; TFA → TRA: 1

Main Results (Fig. 28-2)

• Successful coronary cannulation—TRA:TBA:TFA = 93.0%:95.7%:99.7% (P < 0.001)

• Major entry site complications—TRA:TBA:TFA = 0%:2.3%:2.0% (P = 0.035)

• Entry site complications requiring transfusion—TRA:TBA:TFA = 0%:0.7%:0.7% (P = NS)

• RAO: 9 patients (3%)

• Similar rates of PTCA success (TRA:TBA:TFA = 88%:88%:90% [P = NS]), procedural and fluoroscopy times, and MACE at 1 mo

• No difference in length of hospital stay—TRA: 1.5 ± 2.5 d vs TBA: 1.8 ± 3.8 d vs TFA: 1.8 ± 4.2 d (P = NS)

Conclusion

Procedural and clinical success of PTCA were similar for the three subgroups, with reduced entry site complications but increased access failure with transradial PTCA

Reference

Kiemeneij F, Laarman GJ, Odekerken D, et al. A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: the access study. J Am Coll Cardiol. 1997;29(6):​1269–1275.

Objective

To compare procedural outcomes and length of hospitalization times

Study Population

150 patients (TRA: 56; TBA: 38; TFA: 56) undergoing PTCA for ACS

Follow-up

In-hospital and 1 mo

End Point

Primary-entry site complications (bleeding, hematoma, transfusion, occlusion, surgery) and average hospitalization time post–stent implantation

Procedural Success Rate/Crossover

TRA → TFA: 1; TBA → TFA: 0; TFA → TRA: 0

Main Results (Fig. 28-3)

• Similar entry site complications

• Similar in-hospital and 1 month outcomes (death, MI, revascularization, bleeding, and transfusions)

• Similar hospitalization time (TBA: 77 ± 36 h vs TFA: 83 ± 33 h vs TRA: 86 ± 39 h; P = NS)

• TRA had longer procedural times (TBA: 31.0 ± 10.0 min vs TFA: 42.2 ± 21.8 min vs TRA: 55.8 ± 31.3 min; P ≤ 0.001)

Conclusion

Procedural and clinical outcomes were similar for all three subgroups, with TRA having longer procedural times

Reference

Benit E, Missault L, Eeman T, et al. Brachial, radial, or femoral approach for elective Palmaz-Schatz stent implantation: a randomized comparison. Catheter Cardiovasc Diagn. 1997;41(2):124–130.

Objective

To compare TRA with TRF for coronary stenting in patients with ACS

Study Population

142 patients (TRA: 74; TRF: 68) undergoing PTCA for ACS

Follow-up

In-hospital

End Point

Hospital procedural and clinical outcomes

Procedural Success Rate/Crossover

TRA → TFA: 9; TFA → TRA: 0

Main Results (Fig. 28-4)

• Similar primary PTCA success rates (96%), death, MI, and CABG

• TRA had fewer access site complications (TRA: 0% vs TRF: 4%; P < 0.01)

• TRA had lower total hospital length of stay (TRA: 3.0 ± 0.3 d vs TRF: 4.5 ± 0.5 d; P < 0.01) and total hospital charge (reduction of 15%; P < 0.01)

Conclusion

Coronary stenting from the radial approach is efficacious in patients with ACSs. Access site bleeding complications are reduced, and early ambulation results in a shorter hospital length of stay

Reference

Mann T, Cubeddu G, Bowen J, et al. Stenting in acute coronary syndromes: a comparison of radial versus femoral access sites. J Am Coll Cardiol. 1998;32(3):572–576.

Objective

To assess QOL and costs of the TRA and TFA

Study Population

200 patients (TRA: 101 vs TRF: 99) undergoing catheterization

Follow-up

In-hospital and 1 wk

End Point

QOL (acute SF-36) measurements and hospitalization costs

Procedural Success Rate/Crossover

TRA → TFA: 2; TFA → TRA: 1

Main Results (Fig. 28-5)

• TFA group had longer procedural times (47 ± 2.7 min vs 31. ± 1.7 min; P < 0.001

• Measures of body and back pain as well as walking ability favored TRA on the first day and 1-wk follow-up (P < 0.05)

• TRA significantly reduced duration of hospital stay (10.4 [8.3–22.7] h vs 3.6 [3.0–4.6] h; P < 0.0001) and total hospital costs (13%)

Conclusion

Among patients undergoing diagnostic cardiac catheterization, TRA leads to improved QOL after the procedure and reduced hospital costs

Reference

Cooper CJ, El-Shiekh RA, Cohen DJ, et al. Effect of transradial access on quality of life and cost of cardiac catheterization: a randomized comparison. Am Heart J. 1999;138(3 pt 1):430–436.

Objective

To compare TRA and TFA with experienced radial operators

Study Population

210 (TRA: 140 vs TFA: 70) undergoing PTCA

Follow-up

In-hospital

End Point

Procedural and cost outcomes

Procedural Success Rate/Crossover

TRA → TFA: 0; TFA → TRA: 0

Main Results (Fig. 28-6)

• Procedural duration was longer with left TRA (14.2 ± 3.3 min; P < 0.05) than with right TRA (12.4 ± 5.8 min) and TFA (11.2 ± 3.3 min)

• X-ray exposure was shorter in the femoral group (3.1 ± 1.7 min) than in both radial groups (right: 3.8 ± 2.2 min; left: 4.2 ± 1.7 min)

• Higher comfort grade and preference for TRA

• Major complications (requiring prolonged hospitalization) were more in TFA than in TRA (3% vs 0%)

• Longer hospitalization in TFA (42.0 ± 44.8 h vs 31.4 ± 22.5 h; P < 0.05), causing higher hospitalization fees (P < 0.03)

Conclusion

After an initial learning period, TRA can be performed with a high success rate and a low complication rate. It is associated with a slight increase in procedural and fluoroscopy times, but permits earlier ambulation and discharge, improves patient comfort, and reduces costs

Reference

Louvard Y, Lefèvre T, Allain A, et al. Coronary angiography through the radial or the femoral approach: The CARAFE study. Catheter Cardiovasc Interv. 2001;52(2):181–187.

Objective

To compare the MACE between TRA and TFA

Study Population

149 patients (TRA: 77 vs TFA: 72) with STEMI

Follow-up

In-hospital and 9 mo

End Point

In-hospital and 9 mo MACE (repeat MI, TLR, and death)

Procedural Success Rate/Crossover

TRA → TFA: 0; TFA → TRA: 1

Main Results (Fig. 28-7)

• Similar fluoroscopy times but TRA had shorter procedural times (44 ± 18 min vs 51 ± 21 min; P = 0.033)

• Similar MACE, length and cost for hospital admission

Conclusion

In selected patients with AMI, PCI by TRA is feasible as compared to TFA

Reference

Saito S, Tanaka S, Hiroe Y, et al. Comparative study on transradial approach vs. transfemoral approach in primary stent implantation for patients with acute myocardial infarction: results of the TEst for Myocardial infarction by Prospective Unicenter Randomization for Access sites (TEMPURA) trial. Catheter Cardiovasc Interv. 2003;59(1):26–33.

Objective

To compare the incidence of significant vascular complications delaying hospital discharge in patients older than 80 yr

Study Population

377 patients (TRA: 192 vs TFA: 185) undergoing PCI for ACS or STEMI

Follow-up

In-hospital

End Point

Vascular complications

Procedural Success Rate/Crossover

TRA → TFA: 2; TFA → TRA: 0

Main Results (Fig. 28-8)

• Similar procedural success rates (96%)

• TRA had longer fluoroscopy (4.5 ± 3.7 min vs 6.0 ± 4.4 min) and procedural times (15.9 ± 9.5 min vs radial 18.5 ± 10.5 min) during coronary angiography, with no differences observed during PCI

• RAO: 5%

• Vascular complications were significantly fewer in TRA (1.6% vs 6.5%; P = 0.03)

Conclusion

In octogenarians, the incidence of vascular complications was significantly less in the TRA group, with no reduction of efficacy

Reference

Louvard Y, Benamer H, Garot P, et al. Comparison of transradial and transfemoral approaches for coronary angiography and angioplasty in octogenarians (the OCTOPLUS study). Am J Cardiol. 2004;94(9):​1177–1180.

Objective

To test the safety and feasibility of outpatient coronary angioplasty

Study Population

644 patients (322 in each group) undergoing PCI for SA or UA

Follow-up

In-hospital and 1 mo

End Point

MACE (cardiac death/MI/TVR), vascular complications, and major bleeding (>2 mmol/L drop)

Procedural Success Rate/Crossover

NA

Main Results (Fig. 28-9)

• Similar PCI success rates (96% vs 97%; P = NS)

• Similar in-hospital and 1-mo rates of cardiac death/MI/TVR

• TFA group had a higher number of patients with significant in-hospital bleeding (14.3% vs 6.3%), but no difference in transfusion rates was observed

• RAO: 0.3%

• A larger proportion (61% vs 55%; P = NS) of TRA patients could undergo same-day discharge (major bleeding was the sole reason for discharge delay in the TFA group)

Conclusion

PCI on an outpatient basis, performed via TRA or TFA, is safe and feasible in a considerable portion of a routine PCI population

Reference

Slagboom T, Kiemeneij F, Laarman GJ, et al. Outpatient coronary angioplasty: feasible and safe. Catheter Cardiovasc Interv. 2005;64(4):​421–427.

Objective

To compare TRA with TFA for coronary stenting in patients with STEMI (primary and rescue)

Study Population

50 patients (25 in each) undergoing PCI for STEMI with the use of thrombolytics and/or glycoprotein IIb/IIIa inhibitors

Follow-up

In-hospital and 1 mo

End Point

Perfusion time, major bleeding and access site bleeding

Procedural Success Rate/Crossover

TRA → TFA: 1; TFA → TRA: 0

Main Results (Fig. 28-10)

• Similar PCI success rates (87% vs 88%)

• Only difference in time intervals was greater time in TRA group from local anesthesia to first balloon inflation (32 min [26–38] vs 26 min [22–33]; P = 0.04)

• No difference in fluoroscopy and procedural times

• RAO: 9%

• Similar death/MI/TVR at 30 d and for QOL score (walking and back pain)

• No patient from either group experienced major bleeding or required blood transfusion

Conclusion

Primary and rescue PCI can be performed, with high success rates, using either TRA or TFA. Major bleeding and vascular complications were infrequent with either access site despite the high rates of thrombolysis and glycoprotein IIb/IIIa inhibitors use

Reference

Cantor WJ, Puley G, Natarajan MK, et al. Radial versus femoral access for emergent percutaneous coronary intervention with adjunct glycoprotein IIb/IIIa inhibition in acute myocardial infarction-the RADIAL-AMI pilot randomized trial. Am Heart J. 2005;150(3):543–549.

Objective

To evaluate whether significant differences in operator radiation exposure can be expected in the current era during radial coronary procedures

Study Population

297 patients (TRA → 146; TFA → 151) who underwent simple coronary angiography or PCI in one noncomplicated single epicardial vessel (no left ventriculogram or aortogram and no bypass grafts)

Follow-up

In-hospital

End Point

Fluoroscopy time and radiation measurements

Main Results (Fig. 28-11)

• Fluoroscopy time was 18% (P < 0.001) longer with TRA angiographies and 10% (P 5 NS) longer with TRA PCI

• DAP was 15% (P < 0.05) higher with TRA angiographies but did not increase with TRA PCI

• Operator radiation exposure was 100% (P < 0.001) higher with TRA angiographies and 51% (P < 0.05) higher with TRA PCI

Conclusion

TRA, compared to TFA, is burdened with an increase in operator radiation dose

Reference

Lange HW, Von Boetticher H. Randomized comparison of operator radiation exposure during coronary angiography and intervention by radial and femoral approach. Catheter Cardiovasc Interv. 2006;67:12–16.

Objective

To study the safety and feasibility of TRA in STEMI

Study Population

370 patients (TRA: 184 vs TFA: 186) with STEMI

Follow-up

In-hospital

End Point

Procedural and hospital outcomes

Procedural Success Rate/Crossover

TRA → TFA: 3; TFA → TRA: 2

Main Results (Fig. 28-12)

• Similar PCI success rates (95% vs 94%)

• Similar total procedural times (56.2 ± 12.1 min vs 54.8 ± 15.1 min; P 5 NS)

• Vascular access site and postprocedure complications occurred less in the TRA group (local hematoma: 4% vs 1%, P < 0.05; vagus reflex: 8% vs 0%, P < 0.01; low back pain: 4% vs 0%, P < 0.05)

Conclusion

TRA, compared to TFA, may represent a safer technique for AMI, with similar results and a trend toward fewer local vascular complications

Reference

Li WM, Li Y, Zhao JY, et al. Safety and feasibility of emergent percutaneous coronary intervention with the transradial access in patients with acute myocardial infarction. Chin Med J (Engl). 2007;120(7):598–600.

Objective

To compare bleeding complications and PCI results in patients treated by TRA and TFA for STEMI (primary, facilitated, and rescue) using abciximab

Study Population

114 patients (57 in each) with STEMI undergoing PCI

Follow-up

In-hospital

End Point

Bleeding and PCI outcomes

Procedural Success Rate/Crossover

TRA → TFA: 7; TFA → TRA: 1

Main Results

• Similar PCI success rates (TRA: 91% vs TFA: 97%)

• TRA group had longer mean fluoroscopy times (13 ± 9 min vs 8 ± 6 min; P < 0.01), but no difference was seen in mean PCI times (28 ± 14 min vs 26 ± 18 min; P 5 0.72)

• The delay between PCI and ambulation was lower in TRA group (22 ± 9 h vs 42 ± 27 h; P < 0.001), but this did not affect duration of hospitalization (7.2 ± 0.5 d vs 7.5 ± 0.4 d; P 5 0.59)

• Similar in-hospital death, TIMI minor/major bleeding, and transfusion rates

• Fewer peripheral artery complications (hematoma and ecchymosis) in TRA group (14% vs 35%; P 5 0.014)

Conclusion (Fig. 28-13)

TRA lowered peripheral arterial complication rates and allowed earlier ambulation in patients with STEMI treated with abciximab

Reference

Brasselet C, Tassan S, Nazeyrollas P, et al. Randomized comparison of femoral versus radial approach for percutaneous coronary intervention using abciximab in acute myocardial infarction: results of the FARMI trial. Heart. 2007;93(12):1556–1561.

Objective

To determine success rates, procedural data, and complication rates of TRA vs TFA in patients .75 yr

Study Population

307 patients (TRA: 152 vs TFA: 155) with ACS undergoing PCI

Follow-up

In-hospital

End Point

Success rate, major adverse events (death, periprocedural MI, stroke, or vascular access complications [bleeding, aneurysms, arteriovenous fistulae] requiring intervention), and minor adverse events (symptomatic bleeding requiring no intervention)