This study sought to compare procedural and clinical outcomes of percutaneous transluminal
coronary angioplasty (PTCA) performed with 6F guiding catheters introduced through
the radial, brachial or femoral arteries.
Transradial PTCA has been demonstrated to be an effective and safe alternative to
transfemoral PTCA; however, no randomized data are currently available.
A randomized comparison between transradial, transbrachial and transfemoral PTCA with
6F guiding catheters was performed in 900 patients. Primary end points were entry
site and angioplasty related. Secondary end points were quantitative coronary analysis
after PTCA, procedural and fluoroscopy times, consumption of angioplasty equipment
and length of hospital stay.
Successful coronary cannulation was achieved in 279 (93.0%), 287 (95.7%) and 299 (99.7%)
patients randomized to undergo PTCA by the radial, brachial and femoral approaches,
respectively. PTCA success was achieved in 91.7%, 90.7% and 90.7% (p = NS) of patients,
with 88.0%, 87.7% and 90.0% event free at 1-month follow-up, respectively (p = NS).
Major entry site complications were encountered in seven patients (2.3%) in the transbrachial
group, six (2.0%) in the transfemoral group and none in the transradial group (p =
0.035). Transradial PTCA led to asymptomatic loss of radial pulsations in nine patients
(3%). Procedural and fluoroscopy times were similar, as were consumption of guiding
and balloon catheters and length of hospital stay ([mean +/- SD] 1.5 +/- 2.5, 1.8
+/- 3.8 and 1.8 +/- 4.2 days, respectively).
With experience, procedural and clinical outcomes of PTCA were similar for the three
subgroups, but access failure is more common during transradial PTCA. Major access
site complications were more frequently encountered after transbrachial and transfemoral
PTCA.