Will 'femoral-aholics' ever have a change of heart?
While radial access may not reduce mortality, stroke or major bleeding in acute coronary syndromes (ACS) patients, the RIVAL trial did show the procedure to be associated with lower access site complications and improved patient satisfaction compared to the more commonly used transfemoral approach.
Jolly et al reported a 60 percent reduction in major vascular complication rates with the transradial approach. The researchers also noted that higher volume centers had higher success rates. In fact, during a press conference at ACC.11 Jolly said, “We know that the more you do, the better you get, particularly with the radial approach.”
Jolly acknowledged that operator experience and case volume may make a difference and can improve outcomes, but he offered that there was no “distinguishable number of procedures that makes an operator proficient.” However, a study published recently in Circulation: Cardiovascular Interventions may have found that magic number.
During the study, Ball et al said that transradial PCI use is not widespread due to inadequate operator training, which could lead to lower procedural success rates. To identify a case volume that could allow operators to reach optimal success rates, Ball et al looked at four case volume tiers: one to 50 cases, 51 to 100 cases, 101 to 150 cases and 151 to 300 cases. Operators who performed more than 50 cases using the transradial approach had a higher success rate, used less contrast and had shorter fluro times.
The researchers concluded that a case volume of 50 or more is necessary to achieve optimal outcomes.
While cost-effectiveness data is still needed, many say that operators should consider this procedure due to the potential for lower vascular complication rates. However, some may be hesitant to adopt because cases may be longer, they are not willing to change access routes and some are not well educated on the procedure's benefits. Pinak B. Shah, MD, during a presentation at this year’s Society for Cardiovascular Angiography and Interventions (SCAI) symposium, outlined a 12-step plan for “femoral-aholics,” urging colleagues to get onboard and stay committed.
The transradial approach has gained some traction in the field, yet its usage is still less than 5 percent. Will we see a boom in the radial approach to PCI or will transfemoral and transradial approaches continue to be rivals?
How often do you use transradial PCI? Email us and let us know.
Cardiovascular Business, senior writer