International Symposium on Endovascular Therapy (ISET) 2014

Purpose: Radial access is being increasingly used for both diagnostic and interventional cardiac procedures. Prospective data comparing ultrasoundvs palpationguided radial catheterization are largely lacking. Materials and Methods: In this prospective single-center study, 183 consecutively enrolled patients scheduled for transradial cardiac catheterization by an experienced interventionalist were assigned 1:1 to either palpationor ultrasoundguided radial access. Demographic and procedure parameters were prospectively recorded. Results: Baseline demographic and clinical parameters did not differ significantly between the ultrasound (n=92) and palpation (n=91) groups. The initial radial catheterization success rate (87% vs 86.8%; P=0.999) and time to access (47 s [interquartile range (IQR) 20-90 s] vs 31 s [IQR 20-75 s]; P=0.179) did not differ between the ultrasound and palpation groups. Pulse quality (absent, weak, strong) was independently associated with access failure in both groups (P< 0.001). Obesity was associated with access failure in the palpation (P=0.005) group but not in the ultrasound group (P=0.544). In 3/12 cases (25%) in the ultrasound and 2/6 cases (33%) in the palpation group, the operator was able to establish radial access using the alternative method (P=0.710). If palpation-guided radial access failed, an additional ultrasound-guided attempt before cross-over to femoral access was associated with a shorter overall time to access (525 s [IQR 462-567 s] vs 744 s [722-788 s]; P=0.016). Conclusion: Ultrasound-guided radial access seems to provide no substantial additional benefit over palpation-guided access alone. Attempting the alternative guiding methods to establish radial access before cross-over to femoral access seems to be a reasonable approach.