No Increased Risk of Neurologic Complications With Transradial PCI

January 04, 2013

STOKE-ON-TRENT, United Kingdom — Performing PCI via the radial artery does not increase the risk of neurological complications when compared with conventional transfemoral PCI, a new European analysis shows [1]. Researchers say the results are reassuring, given that more and more operators are beginning to switch over to the transradial approach for various procedures.

"This analysis of almost 350 000 PCI procedures has not found any increase in the risk of neurologic complications associated with transradial access via either the right (the predominant radial artery used) or left radial artery," write Dr Karim Ratib (University Hospital of North Staffordshire, Stoke-on-Trent, UK) and colleagues in their study, published online December 26, 2012 in the American Heart Journal. "The results are reassuring, as the data were collected over a transitional period in UK access-site practice, during which transradial access increased from 17.1% to 50.8% of all PCI cases."

To heartwire , Dr Sunil Rao (Duke University Medical Center, Durham, NC), who was not involved in the study but who is a proponent of transradial PCI, was also reassured by the data.

"There is concern by femoral operators that radial increases stroke risk because of catheter exchanges in the ascending aorta, and there is a belief among radial operators that it reduces stroke risk because of the routine anticoagulation given even for diagnostic cases," said Rao. "This study and others like the SCIPION trial reported in the American Heart Journal shows that the stroke risk is probably the same for radial and femoral, with the attendant benefits of radial on vascular complications."

The current study is a retrospective analysis of the British Cardiovascular Intervention Society database between 2006 and 2010. During this time, there were 124 616 procedures performed via the radial artery and 223 476 procedures performed via the femoral artery. Patients treated with the transradial approach were younger, had less diabetes, and were more likely to have prior cerebrovascular disease and peripheral vascular disease. Patients treated with transfemoral access were more likely to have a history of previous CABG surgery and renal impairment.

Overall, there were 247 neurologic complications in patients treated via the femoral artery (0.11%) and 139 neurologic complications in the transradial group (0.11%). In a multivariate-adjusted risk model, transradial PCI was not associated with an increased risk of complications compared with conventional PCI. The strongest predictors of neurologic complications were the use of an intra-aortic balloon pump, prior cerebrovascular events, pre-PCI shock, and PCI for acute coronary syndrome (ACS).

The researchers did observe an increase in rate of neurologic complications over time, increasing from 0.08% to 0.14% during the five-year period. This increase, they explain, might be related to the shift in patients undergoing PCI, such as more ACS patients undergoing the procedure. The increase in neurologic complications, such as cerebral bleeding events, might be associated with the more intensive antithrombotic regime in this population.

"For other interventional communities that are also undergoing rapid evolution in access-site practice, our data suggest that there is no neurologic hazard associated with rapid adoption of transradial access," conclude Ratib et al.