Radial access

Summary

The radial artery has become the default access site for coronary angiography and intervention. Both European and American guidelines endorse a “radial first” strategy (Class of Recommendation I, Level of Evidence A), whenever feasible and regardless of clinical presentation, to be performed by proficient operators. The use of the radial artery, compared with the femoral artery, is associated with lower risks of mortality, major adverse cardiovascular events, access site related major bleeding and vascular complications. Mediation analyses suggest that the lower risk of mortality is only partially explained by the lower bleeding risk with radial access. Mitigation of postprocedural acute kidney injury with radial access seems likely to contribute to the mortality benefit. Radial access is preferred to femoral access by the majority of patients; it allows immediate mobilisation, favours same-day discharge and is, therefore, a cost-saving intervention compared with femoral access.

The radial artery is a small calibre vessel, prone to spasm and is sometimes tortuous, therefore requiring expertise when used as the access site for coronary angiography and intervention. 

Introduction and historical notes 

The first description, by Dr Campeau, of the use of the radial artery as the access site for percutaneous coronary angiography dates back to...