This Article Figures Only Full Text Full Text (PDF) View Related Cardiosource Journal Scan Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (10) Citing Articles via Google Scholar Google Scholar Articles by Brueck, M. Articles by Tillmanns, H. Search for Related Content PubMed Articles by Brueck, M. Articles by Tillmanns, H. Related Collections Related Articles

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

Related Articles

Transradial Approach to All Interventional Procedures: A Matter of the Learning Curve

Tomasz Pawlowski, Tomasz Kulawik, and Robert J. Gil
J. Am. Coll. Cardiol. Intv. 2010 3: 463. [Full Text] [PDF]

This article has been cited by other articles:

				M. Uhlemann, S. Mobius-Winkler, M. Mende, I. Eitel, G. Fuernau, M. Sandri, V. Adams, H. Thiele, A. Linke, G. Schuler, et al. The Leipzig Prospective Vascular Ultrasound Registry in Radial Artery Catheterization: Impact of Sheath Size on Vascular Complications J. Am. Coll. Cardiol. Intv., January 1, 2012; 5(1): 36 - 43. [Abstract] [Full Text] [PDF]

				G. N. Levine, E. R. Bates, J. C. Blankenship, S. R. Bailey, J. A. Bittl, B. Cercek, C. E. Chambers, S. G. Ellis, R. A. Guyton, S. M. Hollenberg, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions J. Am. Coll. Cardiol., December 6, 2011; 58(24): e44 - e122. [Full Text] [PDF]

				G. N. Levine, E. R. Bates, J. C. Blankenship, S. R. Bailey, J. A. Bittl, B. Cercek, C. E. Chambers, S. G. Ellis, R. A. Guyton, S. M. Hollenberg, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions J. Am. Coll. Cardiol., December 6, 2011; 58(24): 2550 - 2583. [Full Text] [PDF]

				Writing Committee Members, G. N. Levine, E. R. Bates, J. C. Blankenship, S. R. Bailey, J. A. Bittl, B. Cercek, C. E. Chambers, S. G. Ellis, R. A. Guyton, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions Circulation, December 6, 2011; 124(23): e574 - e651. [Full Text] [PDF]

				Writing Committee Members, G. N. Levine, E. R. Bates, J. C. Blankenship, S. R. Bailey, J. A. Bittl, B. Cercek, C. E. Chambers, S. G. Ellis, R. A. Guyton, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions Circulation, December 6, 2011; 124(23): 2574 - 2609. [Full Text] [PDF]

				H. L. Dauerman, S. V. Rao, F. S. Resnic, and R. J. Applegate Bleeding Avoidance Strategies: Consensus and Controversy J. Am. Coll. Cardiol., June 28, 2011; 58(1): 1 - 10. [Abstract] [Full Text] [PDF]

				R. P. Giugliano and E. Braunwald The Year in Non-ST-Segment Elevation Acute Coronary Syndrome J. Am. Coll. Cardiol., December 14, 2010; 56(25): 2126 - 2138. [Full Text] [PDF]

				Y.-J. Yang, D. E. Kandzari, Z. Gao, B. Xu, J.-L. Chen, S.-B. Qiao, J.-J. Li, X.-W. Qin, M. Yao, Y.-J. Wu, et al. Transradial Versus Transfemoral Method of Percutaneous Coronary Revascularization for Unprotected Left Main Coronary Artery Disease: Comparison of Procedural and Late-Term Outcomes J. Am. Coll. Cardiol. Intv., October 1, 2010; 3(10): 1035 - 1042. [Abstract] [Full Text] [PDF]

				K. Ratib, A.-Y. Chong, H. Routledge, and J. Nolan Spasm and Occlusion in Contemporary Radial Practice J. Am. Coll. Cardiol. Intv., August 1, 2010; 3(8): 885 - 886. [Full Text] [PDF]

				T. Pawlowski, T. Kulawik, and R. J. Gil Transradial Approach to All Interventional Procedures: A Matter of the Learning Curve J. Am. Coll. Cardiol. Intv., April 1, 2010; 3(4): 463 - 463. [Full Text] [PDF]

				M. Brueck Reply J. Am. Coll. Cardiol. Intv., April 1, 2010; 3(4): 463 - 464. [Full Text] [PDF]

				M. J. Kern Cardiac Catheterization on the Road Less Traveled: Navigating the Radial Versus Femoral Debate J. Am. Coll. Cardiol. Intv., November 1, 2009; 2(11): 1055 - 1056. [Full Text] [PDF]