Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; Systematic overview and meta-analysis of randomized trials.
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.
Agostoni
Pierfrancesco
P
Department of Biomedical and Surgical Sciences, Section of Cardiology, University of Verona, Verona, Italy. agostonipf@genie.it
Biondi-Zoccai
Giuseppe G L
GG
de Benedictis
M Luisa
ML
Rigattieri
Stefano
S
Turri
Marco
M
Anselmi
Maurizio
M
Vassanelli
Corrado
C
Zardini
Piero
P
Louvard
Yves
Y
Hamon
Martial
M
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D005263:Femoral Artery; D006801:Humans; D017534:Radial Artery; D016032:Randomized Controlled Trials as Topic