Introduction on The Role of the Transradial Approach for Complex Coronary Interventions in Patients with Acute Coronary Syndrome
An invasive strategy including percutaneous coronary intervention (PCI) improves clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and in high-risk patients with non-ST-segment elevation acute coronary syndrome (NSTEACS).1,2 The femoral approach (TFA) is the preferred and most widely used percutaneous access site in most cardiac catheterisation laboratories worldwide. However, being a relatively deep and terminal vessel, the femoral artery may expose the patient to frequent bleeding and vascular complications,3,4 especially in the setting of acute coronary syndrome (ACS) where potent antithrombotic drugs are frequently used.5,6
Since its initial description as a safe and feasible access route for cardiac catheterisation,7,8 the transradial access (TRA) has increasingly been used for PCI. The main advantage over the TFA is a reduced risk of access site bleeding and major vascular complications, particularly in the presence of multiple and more powerful antiplatelet and antithrombotic agents.9 This is mainly ascribed to the more favourable anatomy of the radial artery that runs supercially, separated from major neurovascular structures, thus allowing shorter times to haemostasis and ambulation as compared with the TFA.10
More recently, the radial approach has been shown to confer mortality benets for STEMI patients and a reduction in mortality, myocardial infarction (MI) and stroke for patients undergoing the procedure at high-volume radial centres.11-13
Reported access failure for radial procedures in primary PCI (PPCI) is low with an access crossover rate between 3.84% 14 and 9.6% 13 with negligible time delay by expert operators. There are several reasons leading to failure - inability to cannulate, severe radial artery spasm (RAS) and anatomical variations. In some of these difcult transradial cases, ulnar artery cannulation has been proposed as a reasonable and useful alternative to the TRA if performed by an experienced radial operator, before crossover to the TFA.15,16