If the new consensus document on radial-artery access for percutaneous coronary interventions, issued jointly by two major European cardiology societies on Jan. 28, seemed subtle in its promotion of the radial approach, several members of the consensus panel left no doubt in their comments.
"In the coming years we can expect the radial approach to be the preferred access route for PCI," said Dr. Jean Fajadet, a coauthor of the consensus document and president of the European Association of Percutaneous Cardiovascular Intervention, one of the sponsoring organizations.
Radial-artery access for PCI "offers multiple advantages: early ambulation, improved comfort, reduced bleeding risk, shorter hospital stay, and reduced cost," said Dr. Fajadet, codirector of the interventional cardiology unit at the Pasteur Clinic in Toulouse, France, in a written statement from the European Society of Cardiology, the second group that sponsored the consensus document.
"It is now clear, after the RIFLE and RIVAL trials, that radial access reduces major bleeding at the vascular access site, and as a consequence improves patient outcomes, including survival, especially in ST-elevation myocardial infarction. It is therefore essential that PCI centers use radial access as the strategy of choice in high-risk acute coronary syndrome patients," said Dr. Martial Hamon, a cardiologist at University Hospital in Caen, France, and lead author of the consensus document (EuroIntervention 2013 Jan. 28 [online publish ahead of print]).
The favorable comments by Dr. Fajadet and Dr. Hamon in support of radial-artery access contrasted with an unassertive tone in the document itself. The closest it comes to clearly endorsing radial access is when it says "a default radial approach is feasible in routine practice." The document also cites reduced access-site bleeding with a radial approach, and better outcomes, including survival, because of reduced access site–related bleeding in patients with ST-elevation myocardial infarctions.
It also includes some acknowledgement of a role for femoral-artery access, saying that "proficiency in the femoral approach is required because it may be needed as a bailout strategy or when large guiding catheters are required." The document also adds "all radial-proficient teams should aim to maintain optimal proficiency in femoral procedures as well."
The document also provides a summary of the steps needed to operate a radial-access program, technical recommendations, and advice for avoiding complications, but nowhere in the document is an outright, clearly stated vote for a radial-centric interventional practice. That part was left up to the panel members quoted by the European Society of Cardiology’s press office.
Another panel member who made his conclusion clear was Dr. Ferdinand Kiemeneij, an interventional cardiologist at the Onze Lieve Vrouwe Gasthuis in Amsterdam. "Although this technique [radial access] was introduced 20 years ago, there is still a lot going on to get everyone doing this procedure. It is taking off quite rapidly now, and I think this paper adds to the more general acceptance of the technique. It will improve patient care overall by providing more knowledge, more training, and better awareness."
Dr. Kiemeneij said that he receives royalties on catheter sales from Boston Scientific. Dr. Fajadet, Dr. Hamon, and the other members of the consensus document panel said they had no disclosures.
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