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October 2017

Balanced Adoption of Radial Artery Access for Primary Percutaneous Coronary Intervention

Author Affiliations
  • 1Division of Cardiology, University of Texas Health Science Center, McGovern Medical School, Houston
  • 2Division of Cardiology, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Cardiol. 2017;2(10):1059-1060. doi:10.1001/jamacardio.2017.2346

Vascular access for elective, urgent, or emergency percutaneous coronary interventions (PCIs) can be obtained at several anatomical sites. Originally, all selective coronary angiography was performed using brachial arteriotomy (Sones technique), but gradually this approach was replaced with percutaneous femoral artery (FA) access owing to the development of small preformed catheters and fewer vascular complications. Although radial artery (RA) access had been used for diagnostic angiograms early on, this approach was later abandoned. However, as both catheters and catheter manipulation skills of operators improved, the RA approach was again adopted, including for PCI.1 In an amazing reversal, abundant and robust data from randomized clinical trials, observational studies, registry reports, and meta-analyses now support the RA as the preferred access site for not only elective PCI but also primary PCI (PPCI) in ST-elevation myocardial infarction.2 The general consensus is that when performed by skilled operators at higher-volume facilities, RA access for PPCI is associated with less access site bleeding and lower incidence of acute kidney injury as well as lower mortality compared with FA access. These findings appear true for patients who are elderly, in cardiogenic shock, or undergoing rescue PCI after fibrinolytic therapy, although again, as long as the procedure is performed by an experienced operator at a higher-volume center.3,4

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