Residual Challenges in Radial Approach for Percutaneous Coronary Interventions—Reply

In Reply We thank Agostoni and colleagues for their interest in the Safety and Efficacy of Femoral Access vs Radial Access in ST-Elevation Myocardial Infarction (SAFARI-STEMI) trial.¹ They suggest that bleeding could be significantly reduced by eliminating crossovers from radial access (RA) to femoral access (FA). In the SAFARI-STEMI trial, crossover from RA to FA occurred in 92 of 1236 patients (8.1%). This crossover rate is similar to the rates reported in other randomized trials, ie, in the Radial vs Femoral Access for Coronary Intervention (RIVAL) trial,² it was 7.6%, and in the Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome (RIFLE-STEACS) trial,³ it was 9.6%.