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| ==[[Risks stratification and benefits of PCI|Risk Stratification and Benefits of PCI]]== | | ==[[Risks stratification and benefits of PCI|Risk Stratification and Benefits of PCI]]== |
| ==[[PCI Approaches|PCI Approaches]]== | | ==[[PCI Approaches|PCI Approaches]]== |
| *[[Radial artery]] and [[femoral artery]] are two main methods to access the [[artery]] in [[percutaneous coronary intervention]] ([[percutaneous coronary intervention|PCI]]).<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
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| *The rate of [[PCI]] through [[radial artery]] [[catheterization]] has been increased over the past decade and [[patients]] usually prefer this approach more that the [[femoral artery]] access.<ref name="pmid28025065">{{cite journal| author=Masoudi FA, Ponirakis A, de Lemos JA, Jollis JG, Kremers M, Messenger JC | display-authors=etal| title=Trends in U.S. Cardiovascular Care: 2016 Report From 4 ACC National Cardiovascular Data Registries. | journal=J Am Coll Cardiol | year= 2017 | volume= 69 | issue= 11 | pages= 1427-1450 | pmid=28025065 | doi=10.1016/j.jacc.2016.12.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28025065 }} </ref><ref name="pmid21470671">{{cite journal| author=Jolly SS, Yusuf S, Cairns J, Niemelä K, Xavier D, Widimsky P | display-authors=etal| title=Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. | journal=Lancet | year= 2011 | volume= 377 | issue= 9775 | pages= 1409-20 | pmid=21470671 | doi=10.1016/S0140-6736(11)60404-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21470671 }} </ref>
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| *The following are the advantages of [[radial artery]] compared to the [[femoral artery]] approach:<ref name="pmid27372195">{{cite journal| author=Ferrante G, Rao SV, Jüni P, Da Costa BR, Reimers B, Condorelli G | display-authors=etal| title=Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials. | journal=JACC Cardiovasc Interv | year= 2016 | volume= 9 | issue= 14 | pages= 1419-34 | pmid=27372195 | doi=10.1016/j.jcin.2016.04.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27372195 }} </ref>
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| **Earlier [[ambulation]]
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| **Lower rate of [[Blood vessel|vascular]] [[complications]]
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| **Lower rate of [[bleeding]] [[complications]]
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| **Better [[Circulatory system|cardiovascular]] outcomes
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| *It is recommended to evaluate the possibility of future need to [[radial artery]] for [[Coronary artery bypass surgery|bypass grafting]] before using it for [[PCI]]. In cases that there is a high likelihood of future [[CABG]], discussion with the [[patient]] and the [[cardiac surgeon]] is required.<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
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| *[[Femoral artery]] remains the default [[PCI]] access in centers where expertise in the [[radial artery|transradial]] approach is unavailable or if the [[patient]] has any [[anatomy|anatomic]] or clinical limitations.
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| ===ACA 2021 Revascularization Guideline for PCI Approaches===
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| {|class="wikitable"
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| | colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: A<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
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| | bgcolor="LightGreen"|1.[[Radial artery]] approach is recommended over the [[femoral artery]] access in [[patients]] with [[acute coronary syndromes]] ([[acute coronary syndromes|ACS]]) undergoing [[PCI]] due to lower rate of death, [[Blood vessel|vascular]] and [[bleeding]] [[complications]].
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| 2.[[Radial artery]] approach is recommended over the [[femoral artery]] access in [[patients]] with [[Chronic stable angina|stable ischemic heart disease]] ([[Chronic stable angina|SIHD]]) undergoing [[PCI]] due to lower rate access site [[bleeding]] and [[Blood vessel|vascular]] [[complications]].
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| ==[[Preparation of the patient for PCI|Preparation of the Patient for PCI]]== | | ==[[Preparation of the patient for PCI|Preparation of the Patient for PCI]]== |