By Deborah Brauser
ORLANDO, Fla -- November 17, 2009 -- Performing percutaneous coronary interventions (PCI) with a radial access approach takes the same amount of time as the more conventional femoral puncture approach, with no additional radiation exposure, according to trial results presented here at the American Heart Association (AHA) Scientific Sessions 2009.
Results from the Radial Access Versus Conventional Femoral Puncture: Outcome and Resource Effectiveness in a Daily Routine (RAPTOR) trial also demonstrated that radial access was associated with only a small increase in performance time and radiation exposure for coronary angiography.
Plus, while the femoral approach required about 12 minutes to compress the access site for both diagnostic catheterisations and PCI, the radial access approach required virtually no manual compression time.
"This means that the radial approach can lead to a more economic use of hospital resources through less staff involvement," said lead investigator Tim G. Schäufele, MD, MediClin Heart Center, Lahr/Baden, Germany, during a podium presentation here on November 14. "It's also safe and well tolerated by patients."
The RAPTOR study was designed to evaluate whether busy practices could easily and quickly switch to radial access as a routine strategy, and whether this switch would affect patient safety, radiation exposure, and duration of the procedure.
A total of 421 patients (72% male; mean age, 65 years) were enrolled over 1 year at a busy, high-volume centre in Germany, and randomised to either femoral- or radial-access interventions. Dr. Schäufele and colleagues were able to evaluate 410 of these patients for the effects on diagnostic intervention (undergone by 75% of the patients) or PCI (undergone by 25%).
Physicians at the study centre, most of whom had extensive experience with the femoral approach but limited experience with radial access, were also randomised as to which procedure they would perform. "To our surprise, the learning curve was rather small," said Dr. Schäufele.
Results showed that switching to radial access led to mild procedural prolongation (of about 2 minutes) when diagnostic coronary angiography was performed, but those procedural time differences were no longer significant for the patients undergoing PCI.
While radiation times and doses were slightly higher for the diagnostic angiography patients who underwent radial access, these increases were similar between the 2 approaches for the PCI group.
"The RAPTOR Trial demonstrated that experienced invasive cardiologists can easily and rapidly shift their practice from femoral towards radial access as routine strategy," concluded Dr. Schäufele.
"We also noticed significantly less vascular and bleeding complications with the radial access procedure, and higher patient comfort reported through questionnaires," reported investigational team member Eberhard von Hodenberg, MD, also from MediClin, after the presentation.
[Presentation title: Radial Access Versus Conventional Femoral Puncture: Outcome and Resource Effectiveness in a Daily Routine: The RAPTOR Trial. Late Breaking Clinical Science: Interventional Presentation 2]
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