Radial artery access for coronary angiography and percutaneous coronary intervention

Introduction

The development of percutaneous procedures to diagnose and treat coronary artery disease has transformed the lives of many patients. Patients with limiting symptoms can now often be returned to full activity by percutaneous coronary intervention (PCI), with a low risk of procedure related cardiac events. PCI has obvious advantages over coronary artery bypass grafting, and, because increasingly complex disease can be treated in patients with previously prohibitive comorbidity, the demand for both diagnostic and interventional procedures increases every year.1

In percutaneous coronary procedures a sheath with a haemostatic valve is introduced into a peripheral artery under local anaesthetic. Preshaped catheters are passed through the sheath to the ostium of the relevant coronary artery, thus allowing the delivery of radiography contrast medium, angioplasty wires, balloons, and stents. After completion of the procedure, the catheter and sheath are removed and haemostasis is achieved by manual compression, an arterial closure device, or direct repair.

The femoral artery has traditionally been the preferred access site for coronary procedures, but this approach has several limitations. It is relatively contraindicated in the presence of severe peripheral vascular disease and in patients receiving anticoagulation treatment. A period of post-procedure recumbency is needed to avoid disruption of the arterial puncture site. This may be poorly tolerated by patients with left ventricular dys-function, lung disease, or back and hip pain. Despite bed rest, the rate of complications at the femoral access site (haematoma, pseudoaneurysm, arteriovenous fistula, or need for blood transfusion or surgical arterial repair) is 2-8% after transfemoral PCI.2 3 These factors together affect patients' satisfaction, morbidity, length of hospital stay, and costs and have driven the development of alternative vascular access for coronary procedures. In this review we summarise the literature on transradial coronary procedures and discuss the potential clinical implications and technical considerations of …