New Review: Transradial versus transfemoral approach for diagnostic coronary angiography and percutaneous coronary intervention in patients with coronary artery disease

Coronary artery disease contributes to half of deaths caused by cardiovascular (heart and blood vessels) disease. Restoration of adequate blood flow through the coronary arteries can be achieved by introducing a catheter through a peripheral artery. This allows the introduction of balloons through the aorta (major artery of the heart) to dilate coronary artery narrowing or place arterial scaffolds (tubes called stents) to keep the coronary arteries open. Two main peripheral arteries can provide access; traditionally, the femoral (groin) artery, and more recently, the radial artery (one of two major arteries in the forearm). While gaining popularity, the transradial approach can be more challenging than the transfemoral approach, which may translate to longer procedural durations and technical failures. In addition, this raises concerns regarding radiation exposure to patients and physicians being higher with the transradial approach. We sought to compare the advantages and disadvantages of both approaches to help inform healthcare decisions.

This new Cochrane Review from Cochrane Heart  found that the transradial approach for diagnostic CA or PCI (or both) in CAD may reduce short-term NACE, cardiac death, all-cause mortality, bleeding, and access site complications. There is insufficient evidence regarding the long-term clinical outcomes (i.e. beyond 30 days of follow-up).