Chapter 22. Radial Approach to Coronary Angiography
Which patient would benefit most from a radial procedure?
A. 67-year-old man with a body mass index (BMI) of 32 and unstable angina
B. 83-year-old woman with a BMI of 19 and ST-segment elevation myocardial infarction (STEMI)
C. 54-year-old man with a BMI of 28 and STEMI
D. 64-year-old woman with BMI of 33 and unstable angina
E. 85-year-old man with BMI of 23 and stable angina
Bleeding risk is higher in those who are older, female, and presenting with a more severe coronary syndrome. In addition, bleeding risk is highest in those with the lowest body mass index (BMI) (<22.5). Excess BMI does not start to increase bleeding risk until it reaches 40 (morbid obesity), and those with a BMI of 25 to 35 have the lowest risk. Therefore, “little old ladies” are at the highest risk of bleeding, especially when presenting with an ST-segment elevation myocardial infarction (STEMI), and will most benefit from a radial approach. However, these are the patients who are least likely to get a radial procedure. Operators tend to use radial access in younger, average-sized male patients with stable angina (risk–treatment paradox) because these patients are typically easier—larger vessels, less tortuosity, less urgency. In order to reap the bleeding and mortality benefits, operators need to master radial procedures in all patient subsets.
What is the primary driver of decreased cost with radial procedures?
A. Less expensive equipment
C. Shorter lengths of stay
E. Faster procedure times
While fewer complications contribute to the decreased cost of radial procedures compared with femoral procedures, the primary economic benefit comes from shorter lengths of stay. For any observational patient post-percutaneous coronary intervention (PCI) (radial or femoral), regardless of how long they stay during that observational period, the reimbursement is the same. As a consequence, the sooner a patient goes home, the less money is used on resources, especially nursing, and the sooner that bed can be filled with another revenue-generating patient.
What is the advantage of right radial access compared with left radial access?
B. Less radiation exposure
C. Shorter learning curve
D. Easier in post-coronary artery bypass graft (CABG) patients
The main advantage of right radial access is convenience. Left radial procedures require that the operator either go around or reach across the table for access, and then the left arm has to be positioned and secured on the patient’s torso, so that the operator can work from the right side of the table, which they are most familiar with, without leaning over. While less convenient, being able to do procedures from the left radial is still ...