The Rising Tide of Transradial Cardiac Catheterization: Riding the Wave

A sea change begins with ripples becoming waves and finally the rising tide heralds a new environment, often a transformation of dramatic proportions. So it appears with the re-introduction of the transradial catheterization approach. While lately there are some new aspects of the technique (e.g., small needles, wires, sheaths and catheters), the transradial approach was known and used widely for the last decade outside the United States. What is it now that brings this rising tide of transradial activity to our shores? The answer is outcome data. Adding to an already large and persuasive body of literature in support of the safer access method, Wu et al report on yet another large single-center experience from Pennsylvania on the comparison between their transradial and transfemoral approach for percutaneous coronary intervention (PCI). In the 1,113 patients, comparing the two approaches, they found that the transradial approach was associated with significantly reduced bleeding complications (12 vs. 38, p = 0.002, with 0 vs. 7 at the access site, 1 vs. 16 for bleeding at the access and other sites; p = 0.03) and zero vascular complications. The observed in-hospital mortality rate was lower for the transradial approach (0.87% vs. 2.24%), but the difference was not statistically significant (p = 0.38). Same-day discharges were more common in the transradial patients (14.2% vs. 2.2%; p 1 along with Rao SV et al,² Mann T et al,³ Kiemeneij F et al⁴ and many others comprising the rising tide of transradial catheterization will be viewed years from now as prescient and an important approach that was neglected for too long in the world’s largest catheterization arena. The continued demonstration of superior outcomes and acceptance of one technique with the unavoidable involution of another is the most striking sign of a beneficial evolution and improvement in the field of medicine in which we practice.

Suggested Reading

1. Wu C, Liao D, Dyer A-M, et al. Transradial approach is associated with lower risk of adverse outcomes following percutaneous coronary intervention: A single center experience, J Invasive Cardiol 2011;23:88–92.
2. Rao SV, Ou FS, Wang TY, et al. Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention: A report from the National Cardiovascular Data Registry. J Am Coll Cardiol Intv 2008;1:379–386.
3. Mann T, Cubeddu G, Bowen J, et al. Stenting in acute coronary syndromes: A comparison of radial versus femoral access sites. J Am Coll Cardiol 1998;32:572–576.
4. Kiemeneij F, Laarman GJ, Odekerken D, et al. A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: The ACCESS study. J Am Coll Cardiol 1997;29:1269–1275.

———————————————————— From Long Beach Veterans Administration Hospital, Long Beach, California and University of California, Irvine Medical Center, Irvine, California. The author reports no conflicts of interest regarding the content herein. Address for correspondence: Morton J. Kern, MD, FSCAI, FAHA, FACC, Professor of Medicine, Chief Cardiology, Long Beach Veterans Administration Hospital 5901 East 7th Street, Bldg. 126, Long Beach, CA 90807. E-mail: mkern@uci.edu; mortonkern005@hotmail.com