Transradial arterial access (TRA) was originally introduced for coronary angiography by Campeau in 1989. A few enthusiastic operators initially embraced this approach and were able to demonstrate the safety, utility and efficacy of TRA. Subsequent large multicenter randomized studies definitively revealed the benefits of TRA in comparison with transfemoral arterial access (TFA) for coronary procedures – particularly for patients at high bleeding risk and with acute coronary syndromes (ACS). The RIVAL study randomized ACS patients (n=7021) to radial or femoral access. Overall major vascular complications were significantly fewer in the TRA group (1.4% vs. 3.7%; p<0.001) with the largest magnitude of benefit seen at experienced high-volume TRA centers. The MATRIX study also randomized ACS patients (n=8404) to TRA or TFA. Bleeding Academic Research Consortium (BARC) 3 or 5 related bleeding was significantly lower with radial than with femoral arterial access (0.4% vs 1.1%; p<0.0001). The composite of surgical access site repair or blood products transfusion was also lower with TRA (1.0% vs. 1.8%; p=0.0025). The SAFE study randomized women (n=1787) presenting for elective or urgent catheterization to radial or femoral arterial access. As opposed to RIVAL or MATRIX, nearly half of the patients in SAFE presented with a non-ACS indication. Although the SAFE study was terminated early because of a lower-than-expected clinical event rate, the difference in vascular access site complications and BARC 2, 3, and 5 bleeding was lower in the overall cohort (0.6% vs. 1.7%; p=0.3). Although this endpoint did not reach clinical significance in the percutaneous coronary intervention (PCI) group, the absolute event rate did favor TRA (1.2% vs. 2.9%; p=0.12).
Cardiovascular Revascularization Medicine, 2020-02-01, Volume 21, Issue 2, Pages 227-229, Copyright © 2020
Read the full article on Science Direct: Editorial: Transradial Access – to the Heart of the Matter and More