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Implementation of the Transradial Approach for Coronary Procedures is Not Associated with an Elevated Complication Rate and Elevated Radiation Patient Exposure.

Lehmann R, Ehrlich JR, Weber V,


The transradial approach for coronary procedures is associated Background: with a low complication rate, but specific training is considered mandatory. Procedural characteristics (contrast Methods: dye: CD; fluoroscopy time: FT, patient radiation dose: RD) and local complication rates were prospectively assessed in 784 consecutive patients who underwent transradial coronary procedures. The study was divided into an implementation (2008-IP) and an evaluation period (2009-EP). Transradial (N = 624) and transfemoral (N = 842) The amount of CD procedural characteristics were compared in the EP. Results: (mL) of transradial coronary angiography was similar between IP (75 [IQR 60-100]) and EP (70 [55-100]; P = 0.630). In contrast, FT (min) of transradial coronary angiography could be reduced from IP (4.4 [3.2-6.8]) to EP (4.1 [2.7-6.5]; P = 0.036), whereas RD (μGy * qcm) was similar (IP: 1623 [1042-3026]); EP (1576 [944-2530]; P = 0.149). Safety data showed a low complication rate: 0.2% access failure, 0.1% dissection, 0.7% vessel closure. Transfemoral procedures were followed by significantly more procedure- related transfusions (1.3% vs. 0%; P = 0.003). The comparison between transfemoral and transradial procedures demonstrated prolonged FT for transradial procedures (transfemoral 2.9 [1.7-5.5]; transradial 4.1 [2.7-6.5]; P = 0.002), whereas CD was similar (transfemoral 70 [55-100]; transradial 70 [55-100]; P = 0.248). The prolonged FT was restricted to coronary angiography but did not differ for PCI (transfemoral 9.7 [5.8-18.1]; transradial 8.9 [5.3-16.5]; P = 0.433). A transradial program can be implemented with safety; therefore,


The transradial approach should be preferred in suitable patients. Since spasm occurrence was the major determinant of procedural failure, further effort is need to develop better strategies for spasm prevention.

J Interv Cardiol. 2010 Oct 25.