Supervisors info:
Σπυρίδων Δευτεραίος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Χρήστος Παππάς, Επιμελητής Α' ΕΣΥ, B' Πανεπιστημιακή Κλινική, ΠΓΝ "Αττικόν"
Φώτιος Κολοκάθης, Επιμελητής Α' ΕΣΥ, B' Πανεπιστημιακή Κλινική, ΠΓΝ "Αττικόν"
Summary:
Introduction: Transradial access of coronary arteries in order to perform diagnostic angiography or operation on the suffering vessels is a technique which was introduced in conventional medicine about 20 years ago. Since then, there has been noted substantial progress and improvement of the technique resulting in its being considered effective and safe even for high-risk patient categories, like patients of acute coronary syndromes, elderly or even obese patients in anticoagulant therapy.
Aim: Reviewing modern bibliography concerning the increasing interest for transradial access where it is vital to perceive the disadvantages, the technical difficulties and the persisting challenges of the particular technique.
Methodology: There has been conducted a search of review articles and research studies in English in the last 5 years, in the electronic data base “Pubmed” and “Cinahl” for the topic in question.
Results: The femoral artery is predominant, whereas lately, an increase in the use of radial artery has been observed. In two big, randomized studies, lower mortality was reported in the radial access of the coronary vessels compared with the femoral on STEMI-type infarction patients who had undergone angioplasty (PCI). In the RIFLE STEACS study (Radial Versus Femoral Randomizes Investigation in ST-Elevation Acute Coronary Syndrome), a substantially lower mortality rate was recorded 5.2 versus 9.2% respectively in radial and femoral access, and similarly lower bleeding rates (7.8% versus 12.2% respectively) (Romagnoli et al, 2012). In RIVAL study (Radial Versus Femoral Access for Coronary Intervention) lower mortality was acknowledged (1.3 versus 3.2%) and decreased infarction/stroke rates (2.7 versus 4.6%) on STEMI-type infarction patients but not on non-STEMI patients (Jolly et al, 2011). In both patient categories though, substantially reduced major bleeding and major vascular complications rates were reported. Based on the scientific evidence, the European Society of Cardiology recommends the use of transradial access provided there is familiarization and experience on the part of the operator.
Results: Transradial access of coronary arteries for diagnostic as well as therapeutic purpose has shown a growing trend probably due to the elements that favor the safety and effectiveness of the method and the existence of advantages compared with the femoral access which used to be the preferable choice for many years. It is, therefore, important to recognize the advantages as well as the challenges of both techniques (radial and femoral access) and their application procedure.
