Use of Prospective Radiobrachial Angiography in Transradial Cardiac Catheterization and Intervention

Background
Despite evidence supporting the transradial approach (TRA) as superior to the transfemoral approach (TFA), TRA exhibits a higher failure rate compared to TFA. This study examined the utility of prospective radiobrachial angiography (pRBA) in transradial coronary angiography and intervention as a method for reducing in-procedure complications.

Methods
This was a retrospective, single center, case-control analysis of coronary angiography procedures performed by two experienced operators at the University of Chicago Medical Center between 2015 and 2017. Operator 1 began using pRBA during the study, whereas Operator 2 used pRBA in all TRA procedures. 567 patients were stratified into three groups based on operator and pRBA use (Operator 1: Group 1 (non-pRBA), Group 2 (pRBA); Operator 2: Group 3 (pRBA)).

Results
pRBA was associated with reduced overall procedural complication rate (10.4% vs 1.9%, p=0.0007), driven primarily by retrospective radiobrachial angiography (8.6% vs 0, p=0.0001) in Operator 1. No significant difference in adverse procedural outcomes between the pRBA groups of Operator 1 and Operator 2 were observed (Any Procedure Complications, p=0.1101; Catheter Failure, p=0.8999; Crossover, p=0.2102). Multivariate regression showed a negative relationship between pRBA and procedure complications (hazard ratio 0.917, 95% CI, 0.865 - 0.970, p=0.002).

Conclusions
pRBA may be a useful tool for mitigating TRA procedural complications and reducing the need for retrospective radiobrachial angiography.