Transradial access is now well established as the safest route for percutaneous coronary intervention. Nevertheless, its use is often restricted to “easy” cases, switch to the transfemoral route being too rapidly advocated/mandated. We will discuss the different challenges associated with a “TRA for everybody” strategy. (1) The vascular access per se is challenging. TRA failure is most of the time an operator failure to cannulate this vessel. There are some ways to overcome the technical problems and to improve the operator skill and his success rate. (2) TRA is systematically denied for some patient populations: patients with previous coronary artery bypass graft surgery are particularly at risk of not being catheterized by TRA despite excellent performance of this route for diagnostic or intervention. In the same way, MI patients in unstable condition are also at risk to be catheterized by TFA although, most of the time, their condition is addressable through TRA and will largely benefit from this route. (3) Frailty and small body-sized ill patients are also at risk of TFA for PCI when proximal coronary artery disease must be treated. There are alternatives to the use of large and very large catheters for treatment of proximal coronary artery disease. (4) The radial occlusion is a manageable problem, with simple and effective solutions.
Part of the book: Angiography