Top Things to Know: An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome
Published: September 04, 2018
- There is increasing evidence from both observational and randomized clinical trials that using a transradial artery access (TRA) approach versus a transfemoral artery access (TFA) approach in percutaneous coronary artery intervention (PCI) has many advantages.
- The purpose of this scientific statement is to examine the advantages of TRA compared to TFA in the setting in PCI and particularly in acute coronary syndrome (ACS).
- This statement reviews bleeding and vascular access complications and mortality related to the two access approaches.
- Specific issues about TRA in ACS are also reviewed, including reperfusion time and procedural success, access site crossover, contrast volume, and radiation exposure.
- The use of TRA in this patient population compared to TFA shows that TRA is associated with improved quality of life, reduced healthcare resources use and reduced healthcare costs.
- Several comfort measures as best practices are reviewed, including the administration of local anesthesia, mild to moderate sedation, and a warm environment to reduce patient anxiety, discomfort and radial artery spasm.
- Radial artery occlusion (RAO) is a common complication of radial access. Maintenance of patent hemostasis (MOPH) using procedural anticoagulation in combination with other best practices is critical to preventing RAO.
- Nursing best practices are discussed in this statement. Goals include patient comfort measures, monitoring of distal pulses and skin temperature and color.
- Operator proficiency, TRA technique including patient selection, preprocedural assessment of the patient, and access techniques are other considerations discussed in this scientific statement.
- A “radial-first” approach is considered a best practice in all patients, but a graduated level of center and operator experience is recommended before TRA is pursued in patients with ACS.
Citation
Mason PJ, Shah B, Tamis-Holland JE, Bittl JA, Cohen MG, Safirstein J, Drachman DE, Valle JA, Rhodes D, Gilchrist IC; on behalf of the American Heart Association Interventional Cardiovascular Care Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Peripheral Vascular Disease; and Council on Genomic and Precision Medicine. An update on radial artery access and best practices for transradial coronary angiography and intervention in acute coronary syndrome: a scientific statement from the American Heart Association. Circ Cardiovasc Interv. 2018;11:e000035. DOI: 10.1161/HCV.0000000000000035