In a randomized trial, a radial approach by experienced operators was similar in efficacy to a femoral approach and resulted in a lower rate of vascular complications.

Findings from small trials and observational studies suggest that rates of vascular and bleeding complications of percutaneous coronary intervention (PCI) are lower with radial than with femoral arterial access. In a randomized, unblinded trial at 158 hospitals in 32 countries, investigators assigned 7021 patients (mean age, 62; 14% aged >75) with acute coronary syndromes (28% ST-segment-elevation myocardial infarction [STEMI]) to either radial or femoral access for coronary angiography and planned PCI between 2006 and 2010.


At 30 days, the rate of the primary outcome (a composite of death, MI, stroke, and major bleeding unrelated to coronary artery bypass grafting) was similar in the radial and femoral groups (3.7% and 4.0%, respectively). Prespecified subgroup analysis showed significant interaction between radial access and both STEMI (P=0.026) and location (P=0.015) at sites in the highest tertile of radial procedure volume. Large hematomas and pseudoaneurysms needing closure occurred significantly less often in the radial group than in the femoral group (1.2% vs. 3.0% and 0.2% vs. 0.7%, respectively). However, rates of access site crossover for failure of initial strategy (spasm, vessel tortuosity, or peripheral vascular disease) were substantially higher in the radial group than in the femoral group (7.0% vs. 0.9%). Moreover, fluoroscopy time was significantly longer in the radial than in the femoral group (9.8 minutes vs. 8.0 minutes, P<0.001).


Citation(s):

Jolly SS et al. for the RIVAL trial group. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): A randomised, parallel group, multicentre trial. Lancet 2011 Apr 4; [e-pub ahead of print].