**3. Trials that compared radial and femoral access in primary PCI**

We summarize the most important trials that compared radial and femoral access in primary PCI (**Table 1**).

These trials strongly suggest benefits from the radial approach in terms of reduction of bleed‐ ing and possible mortality. There still remain some concerns on the longer door to balloon times with the radial approach.



**2. Vascular access in acute myocardial infarction; radial or femoral**

can provide a bleeding and mortality advantage.

PCI (**Table 1**).

4 Interventional Cardiology

TEMPURA [4]

RADIAL‐AMI

[5]

times with the radial approach.

2003 Prospective

2005 Multicenter pilot trial

randomized study

There is ongoing debate about which of the two commonly used primary percutaneous coro‐ nary intervention (PCI) methods, the traditional femoral artery access, or the radial artery access should physicians use. Some physicians support use of the femoral artery method because of concerns on the adequacy of support with the radial route. The claim is that femo‐ ral approach can provide stronger support for more complex procedures that require bulkier hardware; kissing balloons, crush techniques, and rotablation. However, most PPCI proce‐ dures do not entail densely calcific lesions or complex bifurcations. Most of the trials show that using radial access is feasible in the PPCI procedure and compared with femoral access;

ST‐segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) are likely to benefit from the bleeding reduction by using the radial approach as these patients have more risk for access site bleeding and bleeding‐related complica‐ tions as in primary percutaneous intervention we use aggressive antiplatelet and antithrombotic therapies [1]. Using the radial approach may allow higher doses of anticoagulants to be used for further ischemic reduction with minimal bleeding incidence in comparison with using the femo‐ ral approach [2]. In addition, the use of the radial approach in STEMI patients has been associated with a significant reduction in major adverse cardiac events (MACE) during follow‐up [3].

We summarize the most important trials that compared radial and femoral access in primary

These trials strongly suggest benefits from the radial approach in terms of reduction of bleed‐ ing and possible mortality. There still remain some concerns on the longer door to balloon

**Study name Year Study design No. of patients Endpoints Comments (other outcomes)**

**(TRI vs. TFI) Results (TRI vs. TFI) P value**

> 5.2 vs. 8.4% *P* = 0.444

32 vs. 28 min *P* = 0.04

77 vs. 72 MACE Characteristics of coronary

25 vs. 25 Procedure time Despite longer procedure

intervention were similar in both groups except total procedure time, which was significantly shorter in the TRI

time, Contrast use or fluoroscopy time shows no significant difference.

group.

**3. Trials that compared radial and femoral access in primary PCI**



TRI, transradial intervention; TFI, transfemoral intervention; D2B, door to balloon; MACE, major adverse cardiac events; NARC, net adverse clinical events; BARC, Bleeding Academic Research Consortium.

**Table 1.** Trials of (TRI) vs. (TFI) in acute myocardial infarction.

### **4. Right vs. left radial artery access**

Transradial cardiac catheterization can be performed either by using right or left radial access. But the catheterization laboratory setup, patient preparation, and overall techniques are dif‐ ferent from using right radial access to left radial access. The transradial operator should be proficient with both right and left radial accesses. The modern cardiac catheterization labora‐ tory and its support staff should also be proficient to handle these differences efficiently in order to maximize the advantages gained by using either right or left radial in transradial procedures.
