Título original: Transulnar versus transradial access for coronary angiography or percutaneous coronary intervention: A meta-analysis of randomized controlled trials. Khagendra Dahal. Et al. Catheterization and cardiovascular Intervention 2016:87;857-865
Courtesy of Dr. Carlos Fava.
Transradial access site (TRA) has been shown beneficial over the femoral (TFA), but there is little information on translunar access (TUA) that could offer the same benefits as TFA with no need for femoral cross-over.
5 randomized studies were included with a total 2744 patients undergoing coronary catheterization vs PCI. 1384 of these patients used TUA and 1360, TRA.
Follow up was at 30 days and one year.
MACE was similar between access sites (3.1% vs. 3.5%; RR 0.87, CI 95 0.56 to 1.36; p=0.5), There was no difference in access site related complications (14.9% vs. 15.4%; RR 0.92 (0.67-1.27); p=0.62) neither were there differences in spasm or occlusion rates. The presence of pseudoaneurysms, fistula or transradial /translunar nerve injury was similar and very low in both groups. TUA presented higher cross-over rate and number of punctures than TRA (14% vs. 3.8% p=0.003 and 1.57 vs. 1.4 p=0.0002 respectively) with no difference in access time, fluoroscopy time or contrast volume.
Conclusion
In patients that require coronary catheterization or PCI, translunar and transradial access sites have similar efficacy and safety except for a higher rate of punctures and femoral cross-over with TUA.
Editorial Comment
This analysis is very promising since it gives us the opportunity to count with another access site to do our procedures as safely and effectively as with TRA.
The higher number of punctures and cross-over may be related to the little use of this access site and the necessary learning curve, as was initially with TRA:
Courtesy of Dr. Carlos Fava.
Interventional Cardiologist
Favaloro Foundation – Buenos Aires