New data from a single center suggest that transradial-access PCI can
be performed successfully in complex patients and complex lesions,
such as in acute-MI patients and those older than 80 years of age
[1].

Presenting the data at the International Symposium of Endovascular
Therapy, researchers also showed that radial-access interventions can
be successfully performed in patients with complex lesions, including
chronic total occlusions and bifurcated branches.

"We feel very strongly that the radial approach is the way to go,"
lead investigator Dr Ramon Quesada (Baptist Cardiac and Vascular
Institute, Miami, FL) told heartwire. "It is good for the patient,
results in fewer complications, decreases hospital length of stay,
and the patients love it. Importantly, with these subgroups, we're
showing that everything we do with the femoral approach can also be
done radially."

Presenting data this week on their experience with transradial
interventions at Baptist Cardiac and Vascular Institute, Quesada
noted that the group has performed nearly 700 complex transradial
interventions since 2003. The procedural success rates range from as
high as 98.5% in patients with complex B2-C lesions to 78.9% in
patients with chronic total occlusions. Among acute-MI patients, the
procedural success rate is 97%.

Bleeding risks also remained low, said Quesada, with resolved radial-
access site hematomas occurring in 2.2% of patients with complex
lesions and 5.6% of patients with bifurcated branches. Of the 134
acute-MI patients treated with radial access since 2003, there were
three small hematomas that were resolved.

The group also notes that octogenarians also fare well with the
transradial approach, although tortuosity of the vessels is the
biggest complication in this patient population. Among these
patients, vascular complications declined from 15% via the femoral
approach to less than 2% with radial-access PCI, Quesada told
heartwire.

Proponents of the transradial approach, like Quesada, who has been
performing radial-access PCI for 10 years and who now does 80% of his
cases via the radial artery, point to recent studies and meta-
analyses showing that the technique is associated with equivalent
procedural success to femoral access. Along with the equivalent
success, however, are lower rates of bleeding and vascular
complications, even among high-risk patients.

Still, despite the arguments in favor of the approach, radial-access
PCI is rarely performed. One of the largest and most recent studies
identified nearly 600 000 patients who underwent PCI between January
2004 and March 2007, with only 1.32% treated using radial-artery
access. Despite the limited use of radial PCI, the approach was
associated with a similar rate of success and a 58% lower risk of
bleeding complications.

"The biggest drawback to the procedure is the learning curve," said
Quesada. "It's a more difficult technique to master, but when you get
it down you are able to have the same success as when you use the
femoral approach. We're not saying that every interventionalist
should rush out and start doing these, or start doing them on MI
patients. That would be stupid. Start with a diagnostic and work your
way from there."


Quesada R. Complex transradial interventions for CTOs and STEMI.
International Symposium on Endovascular Therapy; January 19, 2009;
Hollywood, FL.