Radial Access rates
To perform PCI, a tube (catheter) needs to be inserted into the patient’s arterial system (see ‘The PCI procedure’). This can be inserted into the artery at the top of the leg (called the femoral artery), or in the wrist (called the radial artery). During the early development of PCI, before full miniaturisation of equipment, large bore tubes had to be used, and so could only be inserted into a large artery (such as the femoral). Through advances in engineering, equipment has become ever smaller, and is now thin enough to be inserted into the smaller, radial artery.
There are several advantages to using the radial artery for access. For example, unlike the femoral artery it does not have other critical structures close by that could be damaged (the femoral artery on the other hand is surrounded by the femoral vein and nerve). It is easier to compress the radial artery to stop bleeding after the tubes are removed, and if any bleeding does occur it is more obvious and so can be corrected more quickly. Furthermore the use of the radial route enables quicker mobilisation after the procedure.
Complications are lower if it is possible to use the radial rather than the femoral route, and radial access results in better long term outcomes and lower mortality. Nevertheless, the radial route is technically more challenging especially if the operator’s previous training and experience has been limited to transfemoral access.
You can explore changes in UK radial rates by centre over recent years with interactive graphics at this link
In the public reports we give radial versus femoral access rates for all operators and PCI hospitals. However it is not possible to treat all patients using a radial approach. Some patient’s radial arteries are still too small, and some PCI techniques still require large bore equipment that cannot fit into a an average radial artery. As a result operators who attempt to use a radial route in all appropriate patients will not have 100% radial rates, but rather rates that are likely to be between about 80% and 95%.
|List of abbreviations|
|ACS||Acute Coronary Syndrome|
|BCIS||British Cardiovascular Intervention Society|
|CABG||Coronary Artery Bypass Grafting|
|CHD||Coronary Heart Disease|
|MACCE||Major Adverse Cardiovascular and Cerebrovascular Event|
|NSTEMI||Non ST elevation Myocardial Infarction|
|PCI||Percutaneous Coronary Intervention|
|STEMI||ST elevation Myocardial Infarction|