Implementation of the transradial approach for coronary procedures is not associated with an elevated complication rate and elevated radiation patient exposure.
BACKGROUND
The transradial approach for coronary procedures is associated with a low complication rate, but specific training is considered mandatory.


METHODS
Procedural characteristics (contrast dye: CD; fluoroscopy time: FT, patient radiation dose: RD) and local complication rates were prospectively assessed in 784 consecutive patients who underwent transradial coronary procedures. The study was divided into an implementation (2008-IP) and an evaluation period (2009-EP). Transradial (N = 624) and transfemoral (N = 842) procedural characteristics were compared in the EP.


RESULTS
The amount of CD (mL) of transradial coronary angiography was similar between IP (75 [IQR 60-100]) and EP (70 [55-100]; P = 0.630). In contrast, FT (min) of transradial coronary angiography could be reduced from IP (4.4 [3.2-6.8]) to EP (4.1 [2.7-6.5]; P = 0.036), whereas RD (μGy * qcm) was similar (IP: 1623 [1042-3026]); EP (1576 [944-2530]; P = 0.149). Safety data showed a low complication rate: 0.2% access failure, 0.1% dissection, 0.7% vessel closure. Transfemoral procedures were followed by significantly more procedure- related transfusions (1.3% vs. 0%; P = 0.003). The comparison between transfemoral and transradial procedures demonstrated prolonged FT for transradial procedures (transfemoral 2.9 [1.7-5.5]; transradial 4.1 [2.7-6.5]; P = 0.002), whereas CD was similar (transfemoral 70 [55-100]; transradial 70 [55-100]; P = 0.248). The prolonged FT was restricted to coronary angiography but did not differ for PCI (transfemoral 9.7 [5.8-18.1]; transradial 8.9 [5.3-16.5]; P = 0.433).


CONCLUSIONS
A transradial program can be implemented with safety; therefore, the transradial approach should be preferred in suitable patients. Since spasm occurrence was the major determinant of procedural failure, further effort is need to develop better strategies for spasm prevention.
Department of Cardiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, D-60590 Frankfurt, Germany.
Ralf
R
Lehmann
Joachim R
JR
Ehrlich
Veronika
V
Weber
Salvatore
S
de Rosa
M Nieves Bellera
MN
Gotarda
Volker
V
Schächinger
Andreas M
AM
Zeiher
Stephan
S
Fichtlscherer
D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000532:radiotherapy*; D003331:Coronary Vessels / Q000528:radiation effects*; D004869:Equipment Safety; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011829:Radiation Dosage; D013223:Statistics as Topic; D013997:Time Factors
D003287:Contrast Media