Study Indicates Transradial PCI Growing in Popularity
Radial access for percutaneous coronary intervention is associated with reduced vascular complications, but the procedure, which gains entry via the wrist instead of the femoral artery, has been slow to take hold in the U.S. A new study co-authored by Mauricio G. Cohen, M.D., associate professor of medicine in the Cardiovascular Division, finds that this trend is changing.
Previous reports indicated that less than 2 percent of percutaneous coronary intervention (PCI) procedures in the nation were performed using the radial approach. Cohen and the team, which included physicians from Weill Cornell Medical College, Duke University, Vanderbilt University and University of Alabama at Birmingham, among others, examined trends and outcomes of nearly three million procedures performed between January 2007 and September 2012.
They found that the rate of radial PCI procedures increased to more than 16 percent over that time, a 13-fold increase, and demonstrated a lower risk of vascular complications when compared to femoral PCI. The findings, “Adoption of Radial Access and Comparison of Outcomes to Femoral Access in Percutaneous Coronary Intervention,” were published in a recent issue of Circulation.
The femoral artery has been the traditional access point for catheterization procedures including PCI. However, the femoral approach can be complicated by severe bleeding and major vascular complications which are associated with a risk of subsequent morbidity, mortality and higher costs. A recent large randomized trial demonstrated that both radial and femoral approaches were equally safe and effective, with an even lower rate of vascular complications in the radial group.
Since 2007, many cardiovascular programs across the nation realized the need for dedicated training in transradial access to increase the operators skilled in performing radial PCI procedures. Researchers found that not only has the number of radial PCIs gone up, but in comparison with traditional femoral access, transradial PCI continues to be associated with lower vascular and bleeding complication rates.
Cohen said this study “offered us the largest cohort of cases showing that there is positive change in practice patterns by interventional cardiologists with more use of transradial access, which ultimately results in improved outcomes for our patients. As an example, here at the University of Miami Hospital we implemented a transradial access program in 2009. Since then, all our fellows have received full training and have actually started new transradial programs in Miami, other cities in Florida and other states.”
The research study team found that the greatest benefit of radial PCI in terms of reduced bleeding and vascular complications was seen in the high-risk groups of women aged 75 and older, where the use of radial PCI is the lowest.
“Our hope is that once operators are trained appropriately and select patients with greater potential for bleeding and vascular complications,” said Cohen, “we may start to see the true advantages to using radial access.”