Low rate of conversion to transfemoral approach when attempting both radial arteries for coronary angiography and percutaneous coronary intervention: a study of 1,826 consecutive procedures.
OBJECTIVE
Despite a proven safety profile, the transradial approach (TRA) for coronary procedures is regarded by many as complicated and the second-choice arterial access, with a high conversion rate to transfemoral access (TFA). This study reports causes of failure and the contemporary success rate of TRA when both radial arteries are attempted first before converting to TFA.


METHODS
This prospective, single-center study included 1,826 consecutive patients referred for cardiac catheterization, which was performed by two trained operators between January 2005 and June 2007. Procedural data were reported in a specific database.


RESULTS
The procedural success rate through TRA (attempting one or both radial arteries) was 98.8%. One hundred and thirty-five radial attempts failed. Inability to puncture or to wire the artery accounted for 52.6% of failures, inability to reach coronary or graft ostia accounted for 20.7% and the remaining failures were related to the inability to reach a contralateral mammary graft. By multivariate analysis, the best predictors for failures were peripheral artery disease (PAD) (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.1-2.8; p = 0.016), bedside clinical assessment of either a "small radial artery" size (OR 2.6, 95% CI 1.4 to 5.0; p = 0.003) or a "difficult access" (OR 2.5, 95% CI 1.3-4.9; p = 0.006). The number of failed attempts regresses annually by about 40% (OR 0.6, 95% CI 0.4-0.8; p < 0.001), thus demonstrating a continuous learning curve. Although rare, hematoma combined with swelling (3.8%) arises more frequently in females (OR 2.4, 95% CI 1.4-3.9; p = 0.001) and elderly patients (OR 1.9, 95% CI 1.0- 3.7; p = 0.040).


CONCLUSIONS
The TRA can be safely proposed for all patients, with a low conversion rate to TFA when an attempt on both radial arteries is considered first.
Guédès
Antoine
A
University of Louvain, Division of Cardiovascular Medicine, Cliniques Universitaires de Mont-Godinne, Yvoir, Belgium. antoine.guedes@uclouvain.be
Dangoisse
Vincent
V
Gabriel
Laurence
L
Jamart
Jacques
J
Chenu
Patrick
P
Marchandise
Baudouin
B
Schroeder
Erwin
E
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D001916:Brachial Artery; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000628:therapy*; D016208:Databases, Factual; D005260:Female; D005263:Femoral Artery; D006801:Humans; D016015:Logistic Models; D008297:Male; D008323:Mammary Arteries; D011446:Prospective Studies; D017534:Radial Artery; D017211:Treatment Failure; D014655:Vascular Resistance