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Percutaneous coronary intervention (PCI) using radial arterial access is challenging and requires steep learning curve, but it is associated with significantly reduced morbidity and mortality, mainly due to reduced procedure related bleeding complications. PCI for left main stem (LMS) coronary artery disease is increasing over period of time.
We analyzed catheter laboratory data from University Hospital of Wales, Cardiff, UK from 2006 to 2010, assessing number of patients undergoing PCI to LMS with or without other vessel coronary intervention using different arterial access (radial vs. femoral arterial route) and procedure outcome.
Total 4972 PCIs were performed, of which 177 patients underwent PCI to LMS. Radial access was used in 109 patients, whereas femoral access was used in 68 patients. Their subject characteristics were similar. Patients with previous history of CABG required using left radial access.
During the procedures through radial or femoral access number of vessels (1.9 ± 0.1 vs. 2.2 ± 0.2) or lesions (2.4 ± 0.2 vs. 2.5 ± 0.1) intervened, as well as number of stents (1.9 ± 0.2 vs. 2.3 ± 0.2) used through both accesses were similar. There was no significant difference in procedure time, amount of contrast or radiation use in these groups. We used 7F system through radial access in 18 of our patients (6F system in rest of the patients). Immediate (in hospital) procedure related complications were low using radial vs. femoral access (coronary dissection: 2.8 vs. 3.2%; bleeding: 0.9 vs. 7.8% and shock 2.8 vs. 4.7%). Only 2 patients (1.8%) required changing of the vascular access from radial to femoral due to difficult vascular anatomy.
Proportion of patients undergoing PCI to LMS using radial access (than femoral access) has significantly increased over last 5 years in our institute.
LMS PCI can be safely performed using radial arterial access. Operator confidence to use radial access increases with period of time and experience.
- 2013 American College of Cardiology Foundation