A Simple Tool to Predict Transradial Access Fai lure for Coronary Angiography

Based on multiple large clinical trials, the transradial access (TRA) approach has been widely accepted as the preferred method of vascular access for coronary angiography and percutaneous coronary intervention [1-3]. However, it is not without its limitations and complications. The major concern with the radial approach is access failure, requiring crossover to the traditional transfemoral access (TRA) approach. The rate of TRA failure requiring TFA crossover has been documented in the literature to occur in up to 11% of cases [4-7]. Unfortunately, the need for TFA crossover due to TRA failure can negatively affect patient care. For example, patients experience the discomfort associated with two needle punctures and are exposed to the potential complications of both radial and femoral artery access, which includes infection, bleeding, thrombosis, and arterial aneurysm. Additionally, TRA failure requiring TFA crossover can delay emergent coronary interventions in patients presenting with STsegment elevation myocardial infarctions, where every minute is valuable time to the myocardium [8].