A randomized comparison of the transradial and transfemoral approaches for coronary artery bypass graft angiography and intervention: The RADIAL-CABG Trial (RADIAL versus femoral access for coronary artery bypass graft angiography and intervention)

Tesfaldet T. Michael, Mohammed Alomar, Aristotelis Papayannis, Owen Mogabgab, Vishal G. Patel, Bavana V. Rangan, Michael Luna, Jeffrey L. Hastings, Jerrold Grodin, Shuaib Abdullah, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

64 Scopus citations

Abstract

Objectives This study sought to compare and contrast use and radiation exposure using radial versus femoral access during cardiac catheterization of patients who had previously undergone coronary artery bypass graft (CABG) surgery. Background Limited information is available on the relative merits of radial compared with femoral access for cardiac catheterization in patients who had previously undergone CABG surgery. Methods Consecutive patients (N = 128) having previously undergone CABG surgery and referred for cardiac catheterization were randomized to radial or femoral access. The primary study endpoint was contrast volume. Secondary endpoints included fluoroscopy time, procedure time, patient and operator radiation exposure, vascular complications, and major adverse cardiac events. Analyses were by intention-to-treat. Results Compared with femoral access, diagnostic coronary angiography via radial access was associated with a higher mean contrast volume (142 ± 39 ml vs. 171 ± 72 ml, p < 0.01), longer procedure time (21.9 ± 6.8 min vs. 34.2 ± 14.7 min, p < 0.01), greater patient air kerma (kinetic energy released per unit mass) radiation exposure (1.08 ± 0.54 Gy vs. 1.29 ± 0.67 Gy, p = 0.06), and higher operator radiation dose (first operator: 1.3 ± 1.0 mrem vs. 2.6 ± 1.7 mrem, p < 0.01; second operator 0.8 ± 1.1 mrem vs. 1.8 ± 2.1 mrem, p = 0.01). Fewer patients underwent ad hoc percutaneous coronary intervention (PCI) in the radial group (37.5% vs. 46.9%, p = 0.28) and radial PCI procedures were less complex. The incidences of the primary and secondary endpoints was similar with femoral and radial access among PCI patients. Access crossover was higher in the radial group (17.2% vs. 0.0%, p < 0.01) and vascular access site complications were similar in both groups (3.1%). Conclusions In patients who had previously undergone CABG surgery, transradial diagnostic coronary angiography was associated with greater contrast use, longer procedure time, and greater access crossover and operator radiation exposure compared with transfemoral angiography. (RADIAL Versus Femoral Access for Coronary Artery Bypass Graft Angiography and Intervention [RADIAL-CABG] Trial; NCT01446263).

Original languageEnglish (US)
Pages (from-to)1138-1144
Number of pages7
JournalJACC: Cardiovascular Interventions
Volume6
Issue number11
DOIs
StatePublished - Nov 1 2013

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Keywords

  • contrast
  • coronary artery bypass graft surgery
  • radiation
  • transfemoral approach
  • transradial approach
  • utilization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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