Safety and efficacy of transradial access in coronary angiography: 8-year experience.
OBJECTIVE
The transradial approach (TRA) in coronary angiography is used less frequently than the transfemoral approach; the learning curve and transradial failure (TRF) have slowed its widespread use. We evaluate the incidence, causes, and predictors of TRF in TRA coronary angiographies in an unselected population.


RESULTS
All elective coronary angiographies using TRA from January 2002 to December 2009 were analyzed in this single-center, prospective, observational study. TRF occurred in 465/8463 procedures (5.5%). The main causes of TRF were puncture failure in 48.3% and tortuous brachiocephalic arteries in 22.8% of cases. The annual TRF percentage decreased from 9.1% in 2002 to 4.1% in 2009 (P<.001). In a multivariable regression model, the independent factors associated with TRF included use of >3 catheters (odds ratio [OR], 3.973; confidence interval [CI], 3.198-4.937), abnormal Allen test (OR, 3.231; CI, 1.839-5.676), radial spasm (OR, 3.896; CI, 2.903-5.229), peripheral vascular disease (OR, 1.900; CI, 1.426-2.532), female sex (OR, 1.451; CI, 1.094-1.925), and age >80 years (OR, 1.441; CI, 1.020-2.036). Intra-arterial administration of verapamil (OR, 0.137; CI, 0.098-0.190) and nitroglycerin (OR, 0.455; CI, 0.317-0.653), and height (OR, 0.974; CI, 0.959-0.990) reduced the risk of TRF.


CONCLUSIONS
Experience with TRA was associated with a low incidence of TRF. Independent factors associated with TRF were identified.
Cardiology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. xcarrillosuarez@gmail.com
Xavier
X
Carrillo
Josepa
J
Mauri
Eduard
E
Fernandez-Nofrerias
Oriol
O
Rodriguez-Leor
Antoni
A
Bayes-Genis
D000368:Aged; D003251:Constriction, Pathologic / Q000150:complications; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D059032:Learning Curve; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011677:Punctures / Q000009:adverse effects; D017534:Radial Artery; D012044:Regression Analysis; D012189:Retrospective Studies