Modern transradial access (TRA) has evolved from a niche procedure undertaken by a few enthusiastic proponents to the default access site adopted across most of Europe and Asia, with data from the British Cardiovascular Interventional Society suggesting that over 75% of all primary percutaneous coronary intervention (PCI) procedures in the UK in 2014 were undertaken through the radial artery.1 TRA has been shown to be associated with a reduction in mortality, major adverse cardiac events (MACE) and major access site related bleeding complications in both randomised controlled trials and national registries in patients undergoing PCI at high risk from bleeding complications, particularly those in the setting of acute coronary syndromes (ACS), which has led to a Class IA recommendation for its use in the setting of ACS in the latest European Society of Cardiology Guidelines for ACS.2 Throughout this evolution, concerns about the generalisability of the transition from a default femoral to radial approach have been raised both from the question of learning curve, feasibility and access site failure rate. Confounding much of the earlier literature has been variable and heterogeneous operator experience between femoral and radial techniques resulting in uncertainty in interpretation, particularly around the feasibility and success rates of procedures undertaken through the radial approach.

Abdelaal et al3 from the Quebec Heart–Lung Institute have provided some insight into this question in patients referred for primary PCI. Their facility was one of the earliest adaptors of transradial approaches to catheterisation and provides a practice environment with extensive expertise in both radial and femoral techniques. From their experience in primary PCI, the investigators examined the outcome from a period of 2006–2011 corresponding to a time that reflected greater than a decade of prior institutional transradial experience. Out of 2020 patients who underwent primary PCI, 95% were attempted …