title: Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; Systematic overview and meta-analysis of randomized trials.
abstract: OBJECTIVE
  We sought to compare, through a meta-analytic process, the transradial and transfemoral approaches for coronary procedures in terms of clinical and procedural outcomes.
  
  
  BACKGROUND
  The radial approach has been increasingly used as an alternative to femoral access. Several trials have compared these two approaches, with inconclusive results.
  
  
  METHODS
  The MEDLINE, CENTRAL, and conference proceedings from major cardiologic associations were searched. Random-effect odds ratios (ORs) for failure of the procedure (crossover to different entry site or impossibility to perform the planned procedure), entry site complications (major hematoma, vascular surgery, or arteriovenous fistula), and major adverse cardiovascular events (MACE), defined as death, myocardial infarction, emergency revascularization, or stroke, were computed.
  
  
  RESULTS
  Twelve randomized trials (n = 3,224) were included in the analysis. The risk of MACE was similar for the radial versus femoral approach (OR 0.92, 95% confidence interval [CI] 0.57 to 1.48; p = 0.7). Instead, radial access was associated with a significantly lower rate of entry site complications (OR 0.20, 95% CI 0.09 to 0.42; p < 0.0001), even if at the price of a higher rate of procedural failure (OR 3.30, 95% CI 1.63 to 6.71; p < 0.001).
  
  
  CONCLUSIONS
  The radial approach for coronary procedures appears as a safe alternative to femoral access. Moreover, radial access virtually eliminates local vascular complications, thanks to a time-sparing hemostasis technique. However, gaining radial access requires higher technical skills, thus yielding an overall lower success rate. Nonetheless, a clear ongoing trend toward equalization of the two procedures, in terms of procedural success, is evident through the years, probably due to technologic progress of materials and increased operator experience.
authors.affiliation: Department of Biomedical and Surgical Sciences, Section of Cardiology, University of Verona, Verona, Italy. agostonipf@genie.it
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Agostoni
authors.forename: Giuseppe G L
authors.initials: GG
authors.lastname: Biondi-Zoccai
authors.forename: M Luisa
authors.initials: ML
authors.lastname: de Benedictis
authors.forename: Stefano
authors.initials: S
authors.lastname: Rigattieri
authors.forename: Marco
authors.initials: M
authors.lastname: Turri
authors.forename: Maurizio
authors.initials: M
authors.lastname: Anselmi
authors.forename: Corrado
authors.initials: C
authors.lastname: Vassanelli
authors.forename: Piero
authors.initials: P
authors.lastname: Zardini
authors.forename: Yves
authors.initials: Y
authors.lastname: Louvard
authors.forename: Martial
authors.initials: M
authors.lastname: Hamon
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D005263:Femoral Artery; D006801:Humans; D017534:Radial Artery; D016032:Randomized Controlled Trials as Topic