FEMORAL OR RADIAL ACCESS FOR PRIMARY PCI: A DILEMMA OF CHOICE


Asim N. Cheema, M.D., St. Michael's Hospital, Toronto, ON, Canada

Several studies have shown significant reduction in bleeding and vascular complications with transradial percutaneous coronary intervention (PCI) compared to a transfemoral approach. More recently, data from RIVAL and RIFLE-STEACS studies have suggested a mortality benefit in favor of transradial approach for patients undergoing PCI for ST elevation myocardial infarction (STEMI). However, the transradial studies demonstrating these benefits were performed at high volume radial centres with expert transradial operators in a select group of patients. The translation of these benefits to a wider patient population undergoing primary PCI by low to intermediate volume operators remains unclear. Available evidence shows that the transradial PCI is associated with greater technical challenges compared to a transfemoral approach resulting in a higher procedural failure rate. In addition, the amount of contrast media and radiation exposure is higher for transradial PCI. In an era, where door to balloon times are publically reported and used as quality indicators for STEMI care, the appropriate choice for vascular access in primary PCI carries utmost importance. In this presentation, the challenges and difficulties encountered during primary PCI by transradial approach will be presented. In addition, strategies to overcome complications associated with transradial PCI with a focus on appropriate patient selection and advanced technical skills will be discussed. The presentation would share data that would help the interventional cardiologist to deliver the benefits of transradial primary PCI observed in large studies without added procedural complexity or adverse clinical events.