Compared with femoral arterial access, transradial access for stent implantation can result in less bleeding, less down time, lower costs and less risk overall, particularly for obese patients, according to Ramon Quesada, MD, medical director of interventional cardiology at Baptist Cardiac & Vascular Institute in Miami, Fla.
Quesada said that data on more than 5,000 transradial procedures performed at Baptist show the approach significantly reduces the risk of bleeding and nerve damage. “The radial approach also is easier on patients because they can sit up after the procedure and walk away almost immediately,” he said.
To reduce patient risk while undergoing femoral access, patients must lie down for two to six hours after treatment. In addition, accessing the femoral artery in the groin is particularly challenging and risky in obese people. Currently, only about two percent of all minimally invasive heart treatments are performed through the wrist, Quesada said.
“I believe 75 percent of patients would be candidates for the radial approach if it were an option,” he said. “The radial approach is a bit more technically challenging for physicians, but once they master it, I think most would prefer it. One of the main barriers is a lack of training opportunities.”
When the femoral access approach is used, there is a 2.8 percent risk of bleeding or nerve damage, according to studies. Most patients spend at least one night in the hospital after the procedure. Although rare, the bleeding can lead to kidney failure, blood infection and death. At Baptist, the complication rates for the radial approach are extremely low—only 0.3 percent, according to Quesada. None suffered nerve damage. An overnight stay may be advisable, depending on the complexity of the intervention performed, not because of the access approach.
The radial approach isn’t appropriate for all patients, including those who have very small or twisted arteries or are extremely thin, Quesada said.
“Patients who are ideal candidates for the radial approach are those who are obese or have severe peripheral arterial disease,” he said.
Quesada lectured at the International Symposium on Endovascular Therapy (ISET) meeting in January.