Vascular access and angiographic lesion morphology in elective percutaneous coronary intervention

Many coronary interventionists have a perception that the radial route may not facilitate complex PCI. This study evaluates the association between target lesion morphology, vessel characteristics and angiographic outcome in elective PCI cases carried out through radial versus femoral artery approach.MethodsElective PCI cases over a 23 month period at a tertiary care hospital were reviewed for this analysis. Modified ACC/AHA classification was used to ascertain the impact of different arterial accesses in elective PCI on the angiographic outcome with the complex angiographic lesion morphologies.Results343 Patients and 407 lesions were analyzed. Radial access was the final route in 253 procedures treating a total of 300 lesions, while femoral access was the final route in 90 PCI procedures for treating 107 lesions. Lesion complexity incidence in radial PCI group by using modified ACC/AHA classifications A, B1, B2, and C were 4.67%, 15%, 60.33% and 20%, respectively. While in the femoral PCI, the incidence of lesion types was 6.54%, 15.89%, 42.99%, and 34.58%, respectively. By summation of the complex end of the spectrum for ACC/AHA lesion types B2 plus C, the incidence was 241 lesions (80.33%) in radial PCI vs. 83 lesions (77.57%) in femoral PCI, P = 0.25. Angiographic successful outcome according to the combined end point was achieved in 283 lesions (94.33%) for radial PCI vs. 92 lesions (85.99%) in femoral PCI, P = 0.004.ConclusionThis study confirms that a default radial PCI is an effective strategy for the majority of complex lesions in elective PCI.