PCI & AimRadial 2018 | Radial vs Femoral: Review of the Evidence in 2018 - Ian C Gilchrist

1. Radial vs Femoral: Review of the
Evidence in 2018
Ian C Gilchrist, MD, FACC, FSCAI
Professor of Medicine
Penn State’s Hershey Medical Center
Heart & Vascular Institute
Hershey, PA
USA

2. icg2018
Class IA Recommendation
Class I:
Conditions for which there is evidence, general
agreement, or both that a given procedure or
treatment is useful & effective
Level of Evidence A:
Data derived from multiple randomized clinical trials

3. icg2018
Overwhelming Data
Major
Vascular
Mortality
Major
Bleeding
Circ Cardiovasc Interv. 2018;11:e000035.

4. icg2018
Vascular Complications TRA over TFA
Key
No complication
Vascular complication
Avoided avoided a complication
by using radial instead of
femoral access
NNT = 21 (95% CI 18-27)
Slide adapted from John A. Bittl, MD, AHA 2018 presentation

5. icg2018
Major Bleeding–TRA in ACS
Key
No bleeding
Major bleeding
Avoided bleeding with TRA
NNT = 47 (95% CI 35-79)
Slide adapted from John A. Bittl, MD, AHA 2018 presentation

6. icg2018
Mortality Reduction–TRA in ACS
Key
Alive
Dead
Avoided dying by using radial
instead of femoral access
NNT = 100 (95% CI 67-235)
Slide adapted from John A. Bittl, MD, AHA 2018 presentation

7. icg2018
Cost/Benefit to Radial
Bittl JA, Maron DJ. JACC 2017;70:1376-1378

8. icg2018
Guideline Changes
Circ Cardiovasc Interv. 2018;11:e000035.
Summary of Recommendations
• A radial-first approach is strongly recommended in
all patients, but a graduated level of center and
operator experience is recommended before TRA
is pursued in patients with ACS.
2018 AHA Scientific Statement
Update on Radial Artery Access
Circ Cardiovasc Interv. 2018;11:e000035.
2018 ESC/EACTS Guidelines
Myocardial Revascularization
European Heart Journal (2018) 00, 1–96

9. icg2018
142 Articles listed in PubMed
Patient preference
Radiation
Analgesia, anti-spasm, radial artery occlusion, safety
Complex disease
Dorsal radial
Endovascular & Non-cardiac Vascular Access
Progress in 2018

10. Thank you