Chapter 26
The Transradial Approach for STEMI Interventions
Tejas Patel, MD, DM, FACC, FESC, FSCAI and
Sanjay Shah, MD, DM

Historical Perspective
The transradial approach (TRA) is not new to the world. The first paper on TRA in coronary angiography was published by Campeau. In 1993, Kiemeneij published, for the first time, his TRA experience for coronary stent implantation. Subsequently, TRA for percutaneous coronary intervention (PCI) emerged as an effective alternative to transfemoral approach (TFA) for practically all subsets of PCI, including multivessel disease, left main disease, chronic total occlusions (CTOs), bifurcation lesions, calcified lesions and acute coronary syndromes (ACS) including acute myocardial infarction (AMI). Ochiai performed the first observational pilot study on TRA for AMI interventions. In last decade, several studies on TRA for AMI interventions and its randomized comparison with TFA have been published. Thus, TRA for AMI interventions is gradually being established as an effective alternative option for TFA.

Transradial PCI in ST-elevation Acute Myocardial Infarction (STEMI) Ochiai et al performed an observational pilot study to determine if risk-stratified AMI patients could experience reduced bleeding complications and earlier mobilization with TRA and primary stenting. Fifty-six patients with Killip Class I or II were subjected to TRA for AMI interventions, with 100% success in stent deployment and 97% success in normalization of distal coronary blood flow. No major vascular complications occurred in this experience.

Phillippe and colleagues observed similar result in their experience of 119 consecutive patients with AMI having primary PCI via radial (64 patients) or femoral (55 patients) approach with adjunctive abciximab therapy. Hospital length of stay was higher in the TFA group compared with the TRA group (5.9 versus 4.5 days respectively, p = 0.05). There were no vascular complications in the TRA group, but 3 (5.5%) in the TFI group (p = 0.04). They did observe longer radiation exposure times in the TRA cohort.

Cruden and associates expanded on their registry observations in 287 patients having rescue PCI in patients with unsuccessful thrombolysis for AMI. In this retrospective analysis, procedural success was similar for TRA and TFA (98% versus 93%, p = 0.3) patients. However, the vascular complication rate (0% versus 13%, p < 0.01) and length of stay (7.0 versus 7.9 days, p < 0.005) favored TRA over TFA.