Transradial Access in Primary PCI: A Call to Arms

Bernard J. Gersh, MB, ChB, DPhil; Malcolm R. Bell, MD; Mackram F. Eleid, MD


February 10, 2014

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In This Article

Radial vs Femoral Artery Access

Bernard J. Gersh, MB ChB, DPhil: Hello. I am Bernard Gersh from the Mayo Clinic, and we are here for a roundtable discussion with my colleagues, Dr. Malcolm Bell, who is Professor of Medicine at Mayo Clinic, and Dr. Mackram Eleid, who is a member of our Cardiovascular Fellowship Program.

Our topic today is radial vs femoral artery access in patients with ST-elevation myocardial infarction (STEMI), the subject of a recent review in JACC Cardiovascular Interventions.[1]

Malcolm, I was quite struck with the title and the subheading, "A Call To Arms." That is cute. The radial artery is in the arm, isn't it?

Malcolm R. Bell, MD: No coincidence there -- we actually gave that some thought. It was really an attempt to get people's attention. It often happens that a title catches your attention, and you read the article. We thought that it was very relevant.

Dr. Gersh: Is this a topic that has not received enough attention?

Dr. Bell: Absolutely. We are seeing more data published recently and more discussion, but in terms of bringing it into practice, we still have a long way to go. We thought that this was a great opportunity to showcase and highlight the technique and the data. Mack, you made a beautiful argument in favor of the transradial approach with STEMI.

Dr. Gersh: What are the advantages? I will also ask you about the disadvantages, but let's start with the advantages.

Mackram F. Eleid, MD: Several studies have now been done -- randomized controlled trials,[2,3] meta-analyses,[4,5] and registry studies.[6] All show that access site-related bleeding is reduced with the transradial approach in STEMI. Generally, that includes hematomas and vascular complications such as pseudoaneurysms. Several of the studies have shown that mortality is reduced, as well. In-hospital mortality is lower in patients with the transradial approach.


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