Dispelling Myths and Discussing Unresolved Issues in Transradial vs Transfemoral Access in PCI

Despite a comparable number of percutaneous coronary intervention (PCI) procedures performed in the United States and in Europe, European countries have much higher rates of transradial PCI -- an approach associated with decreased vascular complication risk, improved outcomes, shorter hospital stays, lower costs, and increased patient satisfaction compared with transfemoral PCI. But barriers to a radial-first strategy remain. Interventional cardiologists may be hesitant to embrace the radial approach for a number of reasons, including concerns about the difficulty of learning or performing the procedure, reluctance of cath lab staff, risk for arterial spasm, arterial puncture failure, challenges in manipulating the guide catheter, procedural success, time to revascularization, or fluoroscopy time. For other clinicians, the radial approach is viewed as a fall back for patients with conditions that hinder femoral access (eg, peripheral artery disease, obesity) or after a failed femoral approach. In many cases, the perceived limitations of radial access are not substantiated by clinical data. Increasing exposure to radial interventions during interventional cardiology fellowships is viewed as a means to improve use of the transradial approach among US physicians. Join our panel of experts, Drs. Rao, Popma, Kandzari, and Kern, as they discuss how they have implemented the transradial approach to PCI as a standard in their cath labs.