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Apr 05, 2011

Study Shows Benefits in Alternative Access for Coronary Intervention

Accessing arteries through access points, like the wrist, are safe and effective for patients undergoing PCI.

Percutaneous coronary intervention (PCI) is often recommended for patients diagnosed with diseased arteries of the heart or coronary arteries. PCI includes a variety of procedures developed to compress fat and cholesterol build-up in the arteries, known as plaque deposits, to help increase the size of narrowed or blocked arteries to improve blood and oxygen flow to the heart.

With such high rates of heart disease in the US population, PCI has become increasingly common through the development of less-invasive procedures with higher success and lower complication rates. In fact, PCI has become so minimally-invasive that procedures use only a very small puncture in the groin to access the femoral artery, where a catheter is then threaded into coronary arteries to compress plaque build-up. While femoral access for PCI is common, it is still a medical procedure that has serious risks, such as bleeding, which occur in a small percentage of patients.

To help minimize risk for patients undergoing PCI, researchers have begun to investigate the use of alternative access points, such as the radial artery found in the wrist, for catheterization. A recent study know as the RIVAL Study (Radial Vs Femoral Access for Coronary Intervention) is the largest of its type, investigating outcomes in patients undergoing PCI through femoral access in comparison with radial access. With over 3,500 participants, initial findings suggest that while complications, including death, heart attack, stroke and non-coronary artery bypass grafting (CABG) bleeding were similar in radial and femoral access, site complications and non-CABG major bleeding were significantly reduced in PCI performed with radial access. Patient comfort was also significantly higher in those with radial access, with 90% reporting that they would use the same access site for the next procedure, in comparison with only 49% of those with femoral access. The only significant drawback associated with radial access seemed to be increased fluoroscopy times (an x-ray procedure used with PCI), the medical effects of which are unknown.

Overall, these findings are extremely helpful in guiding best-practices for PCI. Compared with femoral access, radial has numerous benefits included decreased incidence of major vascular access site complications and some bleeding in addition to increased patient comfort. While fluoroscopy times were higher in radial access, other health benefits of this procedure may outweigh the risks. As data also showed increased benefits associated with radial access in hospitals with higher experience in these procedures, findings suggest that as radial access becomes more common in PCI, it will become increasingly safe over time. 

Questions for You to Consider

  • Why is femoral access currently used more often than radial access for percutaneous coronary intervention (PCI)?

  • Many medical professionals believe that radial access may have significant medical benefits over femoral access. However, there has not been substantial research comparing the two access points on a larger-scale until now, through the RIVAL study. As a result, a lack of research and practice with radial access has led most surgeons to favor femoral access for PCI.
  • How do femoral and radial access differ when it comes to angioplasty (percutaneous coronary intervention)?

  • The procedures for PCI remain the same, aside from access points for catheterization. However, by utilizing radial access, the patient does not need to lay down for the procedure, which helps decrease discomfort and pain. Also, femoral access can be complicated by excess fat in overweight patients, whereas the wrist remains thin in all patients, making radial access less difficult, particularly in overweight and obese patients.

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