Straight From the Wrist...

A review of recent transradial study data
Adhir Shroff, M.D., MPH


July 15, 2011

Impact of Transradial and Transfemoral Coronary Interventions on Bleeding and Net Adverse Clinical Events in Acute Coronary Syndromes
Martial Hamon, et al     EuroIntervention 2011, 7:91-97

Study design   

• Post-hoc analysis of the OASIS 5 trial for patients undergoing an early invasive strategy.
• Patients received enoxaparin or fondaparinux.
• 7,885 patients underwent PCI using either femoral or radial access included in the analysis

Primary endpoint: Composite ischemia and major bleeding endpoints at 9 days, 30 days and 6 months; Net adverse clinical events defined as combination of ischemic endpoints and major bleeding

Result: No difference in ischemic endpoints based on approach; Radial approach associated with significantly less bleeding with either anticoagulation strategy

Bottom line: Radial approach limits bleeding without impacting ischemic outcomes

Reduction of Scatter Radiation During Transradial Percutaneous Coronary Angiography: A Randomized Trial Using a Lead-free Radiation Shield
Luigi Politi, et al    Catheterization and Cardiovascular Interventions (Epub ahead of print)

Study design: Prospective, randomized study of a lead-free radiation shield
Primary endpoint: Radiation exposure to the operator during diagnostic cardiac catheterization; Exposure measured at chest, left eye, left wrist and thyroid

Results: Despite similar fluoroscopy times and total radiation dose, radiation exposure decreased by 23% relative to control;  Radiation exposure was lower at all measured points

Bottom line: Use of a radiation drape can dramatically decrease radiation exposure to the operator


A Single Center Experience With Same-Day Transradial-PCI Patients: A Contrast With Published Guidelines
Ian C. Gilchrist, et al    Catheterization and Cardiovascular Interventions (Epub ahead of print)

Study design: Retrospective review of 100 sequential patients who underwent same day discharge following TR-PCI

Primary endpoint: Adherence to SCAI/ACC appropriateness criteria for outpatient PCI

Results: Only 15% of patients met appropriateness criteria; The most common contraindications to discharge from the Consensus statement included advanced age (n=26), insulin dependent DM (n=5), contrast allergies (n=4), presence of COPD (n=8) and multivessel CAD (n=4); No patients were readmitted or experienced a post-PCI complication

Bottom line: Use of the transradial approach with a structured follow-up process can lead to a successful same day discharge program