What are the guidelines on access route selection for percutaneous coronary intervention (PCI)?

Updated: Nov 27, 2019
  • Author: George A Stouffer, III, MD; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Answer

The European Society of Cardiology (ESC) guidelines on STEMI patients recommend preference of radial over femoral access, if it is performed by an experienced radial operator (class IIa, level B). The Society for Cardiovascular Angiography and Interventions released a consensus statement on best practices for the use of radial access for diagnosing and treating coronary artery disease (CAD), focusing on avoiding radial artery occlusion, reducing radiation exposure, and using the transradial approach in STEMI. [86]

Recommendations for STEMI patients include the following:

  • Before integrating the radial approach into practice, clinicians should gain experience with at least 100 elective radial procedures and have a femoral crossover rate lower than 4%
  • Practitioners should start with easier cases and ensure that all laboratory personnel are comfortable with the procedure
  • A bailout approach to either contralateral radial or femoral access should be prepared in advance

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