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A Randomized Comparison of Transradial Versus Transfemoral Approach for Coronary Angiography and Angioplasty

Martin Brueck, MD^_*,_*, Dirk Bandorski, MD^_*, Wilfried Kramer, MD^_*, Marcus Wieczorek, MD, Reinhard Höltgen, MD, Harald Tillmanns, MD

^_* Department of Cardiology, Clinic of Wetzlar, Wetzlar, Germany
Department of Cardiology, Evangelisches und Johanniter Klinikum Niederrhein gGmbH, Duisburg, Germany
Department of Cardiology, University of Giessen, Giessen, Germany

^_* Reprint requests and correspondence: Dr. Martin Brueck, Department of Cardiology, Clinic of Wetzlar, Forsthausstrasse 1, 35578 Wetzlar, Germany (Email: Martin.Brueck{at}hkw.med.uni-giessen.de).

Objectives: The aim of the study was to evaluate the safety, feasibility, and procedural variables by the transradial approach compared with the transfemoral access in a standard population of patients undergoing coronary catheterization.

Background: Coronary catheterization is usually performed via the transfemoral approach. Transradial access may offer some advantages in comparison with transfemoral access especially under conditions of aggressive anticoagulation and antiplatelet treatment.

Methods: Between July 2006 and January 2008, a total of 1,024 patients undergoing coronary catheterization were randomly assigned to the transradial or transfemoral approach. Patients with an abnormal Allen's test, history of coronary artery bypass surgery, simultaneous right heart catheterization, chronic renal insufficiency, or known difficulties with the radial or femoral access were excluded.

Results: Successful catheterization was achieved in 494 of 512 patients (96.5%) in the transradial and in 511 of 512 patients (99.8%) in the transfemoral group (p < 0.0001). Median procedural duration (37.0 min, interquartile range [IQR] 19.6 to 49.1 min vs. 40.2 min, IQR 24.3 to 50.8 min; p = 0.046) and median dose area product (38.2 Gycm², IQR 20.4 to 48.5 Gycm² vs. 41.9 Gycm², IQR 22.6 to 52.2 Gycm²; p = 0.034) were significantly lower in the transfemoral group compared with the transradial access group. A median amount of contrast agent was similar among both groups. Vascular access site complications were higher in the transfemoral group (3.71%) than in the transradial group (0.58%; p = 0.0008)

Conclusions: The findings of the present study show that transradial coronary angiography and angioplasty are safe, feasible, and effective with similar results to those of the transfemoral approach. However, procedural duration and radiation exposure are higher using the transradial access. In contrast to the transfemoral route, the rate of major vascular complications was negligible using the transradial approach.

Key Words: access site complications • coronary angiography • transfemoral approach • transradial approach

Abbreviations and Acronyms   ACT = activated clotting time   CAD = coronary artery disease   DAP = dose area product   IQR = interquartile range   PCI = percutaneous coronary intervention   UFH = unfractionated heparin

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