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Radial versus femoral access for primary percutaneous coronary intervention: is there a preferred route to the heart?
  1. Pascal Meier1,
  2. Stephan Windecker2,
  3. Alexandra J Lansky3
  1. 1The Heart Hospital, University College London Hospitals, Cardiology, London, UK
  2. 2Department of Cardiology, Bern University Hospital, Bern, Switzerland
  3. 3Division of Cardiology, Yale Medical School, New Haven, Connecticut, USA
  1. Correspondence to Dr Pascal Meier, UCL Device Development Program, University College London Hospitals (UCLH), The Heart Hospital, 16–18 Westmoreland Street, London W1G 8PH, UK; pascalmeier74{at}gmail.com

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In their paper published in Heart, Mamas et al report on a meta-analysis of studies comparing radial with the more traditional femoral access route for primary percutaneous coronary intervention (PCI) in patients presenting with ST elevation myocardial infarction (STEMI)1 (in press). Even though radial access PCI currently appears to be an evolving technique, this approach has in fact been in use for a long time. In the 1940s, the radial approach was used by Radner in Sweden for diagnostic aortographies.2 In 1960, Mason Sones Jr, a paediatric cardiologist at Cleveland Clinic, performed the first coronary angiography via a brachial artery cut-down. This technique was replaced by the femoral artery approach in the 1960s by Melvin Judkins, a radiologist at the University of Oregon in Portland. For the very first PCI, performed in 1977 by Andreas Gruntzig in Zurich, the femoral approach was also used. However, the ‘arm approach’ had a revival for diagnostic angiographies in the 1980s, using a percutaneous instead of the cut-down brachial approach.3 In the late 1980s, the French-Canadian Lucien Campeau (1927–2010) started using radial access for coronary angiographies.4 Soon thereafter, Ferdinand Kiemeneij performed the first PCI through a radial artery approach in Amsterdam in 1992, and the first radial access primary PCIs in STEMI patients were performed in Japan in 1998 by Ochiai.

The penetration of radial access for PCI has been variable among different countries and among cardiovascular centres. In France and Japan, the radial route is predominant. In Canada it is used in around 50% of cases, and in around 35% in the UK. On the other hand, the USA, …

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