Radial vs. Femoral Access for Cardiac Catheterization Complications

(REBIRTH Trial)

Recruiting in Palo Alto (17 mi)

+5 other locations

Overseen by Emmanouil Brilakis, MD, PhD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Minneapolis Heart Institute Foundation

Must not be taking: Vitamin K antagonists

Disqualifiers: STEMI, Valvular disease, Hemodialysis, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

This trial compares two methods for inserting a tube into heart blood vessels in patients needing heart checks. One method uses the wrist, and the other uses the groin. The goal is to find out which method is better.

Will I have to stop taking my current medications?

The trial protocol does not specify if you need to stop taking your current medications. However, if you are taking oral factor Xa or IIa inhibitors, you should not have taken them within 24 hours before the procedure.

What data supports the effectiveness of the treatment Radial Access, State-of-the-art femoral access with 18 gauge needle, and State-of-the-art femoral access with 21 gauge needle for cardiac catheterization complications?

Research shows that radial access is generally safer than femoral access in terms of vascular complications during cardiac procedures. Additionally, using ultrasound guidance during femoral access can reduce the risk of complications, making it a safer option for high-risk procedures. ^{1 2 3 4 5}

Is radial or femoral access for cardiac catheterization generally safe?

Radial access for cardiac catheterization is generally considered safer than femoral access, with fewer and less severe complications. However, radial artery occlusion and rare complications like pseudoaneurysms can occur. Femoral access, while necessary for some procedures, may have more vascular complications, but using ultrasound guidance can help reduce these risks. ^{1 3 4 5 6}

How does radial access for cardiac catheterization differ from femoral access?

Radial access for cardiac catheterization is unique because it generally results in fewer bleeding complications compared to the traditional femoral access, although it may have a higher rate of access site failure. This approach is considered safer for patients at risk of femoral complications, and ongoing improvements in the technique are expected to enhance outcomes further. ^{3 5 7 8 9}

Research Team

Emmanouil Brilakis, MD, PhD

Principal Investigator

Minneapolis Heart Institute Foundation

Eligibility Criteria

Adults over 18 eligible for cardiac catheterization via both radial and femoral access, who consent to participate. Suitable for those needing diagnostic angiography or urgent/elective PCI, but not for patients with recent oral anticoagulant use, peripheral arterial disease affecting access sites, limited life expectancy, certain heart conditions or procedures within the next month.

Inclusion Criteria

I am 18 years old or older.

Has provided informed consent and agrees to participate

I am scheduled for a heart artery exam due to chest pain, possibly with treatment.

Exclusion Criteria

I took blood thinners less than 24 hours before the procedure.

I have a dialysis access point in my arm that can be used for a heart procedure.

Coexisting conditions that limit life expectancy to less than 30 days

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo cardiac catheterization using either radial or state-of-the-art femoral access

During procedure

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after the procedure, including evaluations of myocardial infarction and procedural success

4 weeks

Evaluations up to 30 days

Treatment Details

Interventions

• Radial Access (Procedure)
• State-of-the-art femoral access with 18 gauge needle (Procedure)
• State-of-the-art femoral access with 21 gauge needle (Procedure)

Trial Overview This phase IV trial compares two methods of accessing the heart during catheterization: through the wrist (radial access) and upper thigh (femoral access). Participants are randomly assigned to one method; those in the femoral group are further randomized to receive either a smaller (21 gauge) or larger (18 gauge) needle.

Participant Groups

Group I: State-of-the-art femoral access Active Control 2 Interventions

Femoral access for cardiac catheterization. Femoral access will be obtained using state-of-the-art techniques (ultrasound and fluoroscopic guidance for arterial puncture, immediate femoral angiography after obtaining access and use of a vascular closure device whenever possible).

Group II: Radial access Active Control 1 Intervention

Radial access for cardiac catheterization. Radial access will be performed using ultrasound guidance and a micropuncture needle or catheter-over-needle system, as per the local standard of care.

Who Is Running the Clinical Trial?

Minneapolis Heart Institute Foundation

Lead Sponsor

Trials

32

Recruited

15,700+

Findings from Research

In a study of 56 patients on uninterrupted warfarin therapy, radial access for cardiac catheterization was found to be as effective as femoral access, with procedural success achieved in all femoral patients and only one crossover in the radial group.

Radial access significantly reduced access-site complications during percutaneous coronary intervention (PCI), with 37.5% of femoral patients experiencing complications compared to none in the radial group, highlighting its safety advantage.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Radial versus femoral access for orally anticoagulated patients. Ziakas, AG., Koskinas, KC., Gavrilidis, S., et al.[2014]

Using ultrasound guidance during femoral artery catheterization significantly reduces the risk of vascular-access related complications, with a complication rate of 1.9% compared to 4.3% without ultrasound, based on a systematic review of 5 randomized-controlled trials involving 1553 patients.

The reduction in complications is mainly due to fewer local hematomas; however, when excluding hematomas, the significance of the results diminishes, indicating that further research is needed to fully understand the impact of ultrasound on major bleeding and other vascular complications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultrasound Guidance in Femoral Artery Catheterization: A Systematic Review and a Meta-Analysis of Randomized Controlled Trials. Rashid, MK., Sahami, N., Singh, K., et al.[2020]

Radial artery access for coronary catheterization is generally safer than femoral access, but there is a risk of complications such as pseudoaneurysms, as demonstrated in two reported cases.

Both patients who developed pseudoaneurysms after radial artery access underwent successful surgical exploration, highlighting the importance of monitoring for this rare but serious complication.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Radial artery pseudoaneurysm following coronary angiography in two octogenarians. Hamid, T., Harper, L., McDonald, J.[2021]

In a study of 499 patients undergoing transradial coronary procedures, the rate of radial artery occlusion at 90 days was low at 5%, with no significant difference between the new RY Stop device and the standard TR Band.

While both devices showed similar levels of discomfort and low rates of vascular complications, the RY Stop device was associated with a higher incidence of bleeding (12% vs. 3% for TR Band), indicating a potential safety concern.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is radial artery occlusion and local vascular complications following transradial coronary procedures affected by the type of haemostasis device used? A non-inferiority Randomized Controlled Trial (RadCom trial). Due-Tønnessen, N., Egeland, CH., Meyerdierks, OJ., et al.[2022]

In a study of 8,159 cardiac catheterizations, 3,369 (41.3%) were performed using the radial artery approach, which resulted in a low incidence of severe vascular complications (0.06%).

All 21 cases of severe complications, including hematomas and perforations, were managed conservatively without the need for blood transfusions, highlighting the effectiveness of non-invasive treatment strategies for these complications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Vascular complications associated with radial artery access for cardiac catheterization]. Sanmartín, M., Cuevas, D., Goicolea, J., et al.[2012]

The percutaneous transradial approach for coronary angiography and intervention is becoming more popular in the U.S. due to its better vascular safety compared to the traditional femoral approach.

Despite its advantages, there are still potential complications, such as pseudoaneurysm and radial artery occlusion, that can occur after transradial cardiac catheterization, highlighting the need for awareness and monitoring.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vascular Complications of Percutaneous Transradial Cardiac Catheterization. Patwardhan, M., Mehra, S., Movahed, A., et al.[2022]

Using radial access for catheterization leads to lower rates of bleeding and mortality compared to the traditional femoral approach, making it a safer option for patients.

Although radial access may have a higher rate of access site failure, this technique is still preferred as it reduces serious complications associated with femoral access, suggesting that improvements in radial techniques will enhance patient outcomes further.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sirens song or a bugle call to charge. Gilchrist, IC.[2019]

References

1. United States pubmed.ncbi.nlm.nih.gov

Radial versus femoral access for orally anticoagulated patients. [2014]

2. England pubmed.ncbi.nlm.nih.gov

Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Ultrasound Guidance in Femoral Artery Catheterization: A Systematic Review and a Meta-Analysis of Randomized Controlled Trials. [2020]

4. England pubmed.ncbi.nlm.nih.gov

Analysis of safety outcomes for radial versus femoral access for percutaneous coronary intervention from a large clinical registry. [2021]

5. Canada pubmed.ncbi.nlm.nih.gov

Radial artery pseudoaneurysm following coronary angiography in two octogenarians. [2021]

6. England pubmed.ncbi.nlm.nih.gov

Is radial artery occlusion and local vascular complications following transradial coronary procedures affected by the type of haemostasis device used? A non-inferiority Randomized Controlled Trial (RadCom trial). [2022]

7. Spain pubmed.ncbi.nlm.nih.gov

[Vascular complications associated with radial artery access for cardiac catheterization]. [2012]

8. Singapore pubmed.ncbi.nlm.nih.gov

Vascular Complications of Percutaneous Transradial Cardiac Catheterization. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Sirens song or a bugle call to charge. [2019]