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MINERVA CARDIOANGIOLOGICA

Rivista sulle Malattie del Cuore e dei Vasi


Official Journal of the Italian Society of Angiology and Vascular Pathology
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Minerva Cardioangiologica 2018 Feb 01

DOI: 10.23736/S0026-4725.18.04629-7

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Choice of vascular access in primary PCI

Francesco TOMASSINI 1 , Fabio TARANTINO 2, Enrico CERRATO 3, Giorgio QUADRI 1, Cristina ROLFO 1, Ferdinando VARBELLA 1

1 Department of Cardiology, Infermi Hospital, Rivoli, Italy; 2 Department of Cardiology, Morgagni Hospital, Forlì, Italy; 3 Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy


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Primary angioplasty (PPCI), introduced in the early ‘90s, has now become the preferred reperfusion strategy in ST-segment elevation myocardial infarction (STEMI). PPCI has traditionally been performed through transfemoral artery access (TFA) for about two decades. Such an access, however, has been associated to a not negligible rate of vascular complications and bleedings that, in turn, may significantly affect the overall prognosis. For this reason, transradial artery access (TRA), introduced by Campeau and coll. in 1989 for diagnostic and by Kiemeneij and coll. in 1993 for interventional procedures, and associated with significant reduction of vascular complications and bleedings in observational studies and registries, has been validated as alternative vascular access for PPCI procedures as well. However, because of its steep learning curve and for the smaller size of the radial artery compared with the femoral, concerns have been raised about its feasibility in urgent settings and in very complex cases. Despite these limitations, the advantages of TRA PPCI procedures have been confirmed by large nationwide registries and randomized trials, whose RIVAL, RIFLE-STEACS, STEMI RADIAL and MATRIX are the largest. All these studies showed that not only the vascular complications and bleedings, but the mortality and overall NACE (major cardiovascular events or major bleedings) were reduced as well. As a result, the TRA is now considered the “gold standard” access in the PPCI setting and has been endorsed by the european guidelines as the default access (class I, level of evidence A).


KEY WORDS: ST-segment elevation myocardial infarction - Primary percutaneous coronary intervention - Vascular access

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Publication History

Article first published online: February 01, 2018
Manuscript accepted: January 29, 2018
Manuscript received: January 23, 2018

Per citare questo articolo

Tomassini F, Tarantino F, Cerrato E, Quadri G, Rolfo C, Varbella F. Choice of vascular access in primary PCI. Minerva Cardioangiol 2018 Feb 01. DOI: 10.23736/S0026-4725.18.04629-7

Corresponding author e-mail

tomascard.tomassini@gmail.com