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首页> 外文期刊>Der Kardiologe >Transradial percutaneous access for coronary intervention. Indications, technique, radiation protection and clinical outcome
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Transradial percutaneous access for coronary intervention. Indications, technique, radiation protection and clinical outcome

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Radial artery access for coronary interventions was initially introduced as a useful vascular access site for reducing vascular complications (e.g. bleeding) and to enhance patient comfort, reduce hospital staff workload and costs. Although earlier data indicated comparable procedural success rates but longer procedural and fluoroscopy times with radial as compared to femoral access, recent data from prospective multicenter studies and large meta-analyses even revealed significantly better immediate and long-term outcomes in contemporary, real world clinical settings of percutaneous cardiovascular procedures including acute coronary syndrome (ACS) and acute myocardial infarction (AMI). From this perspective, the better cardiac outcome after transradial percutaneous coronary interventions may be explained by the lower necessity of cessation of anticoagulation and antiplatelet therapy due to significantly less bleeding complications after radial access. Bleeding complications occur only very rarely with this technique but procedural success of transradial access is occasionally limited by anatomical circumstances or radial spasms and postinterventional occlusions, which seems to be strongly related to the mandatory adjuvant pharmacological therapy (e.g. 3,000 U heparin, verapamil and nitroglycerine) and the anatomical variations, which can possibly be reduced by the use of smaller catheters. The most likely reason for sometimes longer fluoroscopy times (even for very experienced interventionalists) could be explained by the mandatory use of fluoroscopy while retrogradely passing the great thoracic vessels but this does not necessarily mean higher radiation exposure to the interventionists due to the potentially better possibilities of effective protection measures against backscatter radiation.

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