Transradial coronary stenting: Comparison with femoral access closed with an arterial suture device

The purpose of this study was to determine if closure of the femoral artery access site using a percutaneous arterial suture device (Perclose, Menlo P ark, CA) in patients undergoing coronary stenting can result in the same be nefits as seen with radial artery access. A total of 218 consecutive patien ts underwent coronary stenting (109 femoral, 109 radial) by investigators e xperienced with each technique. The two groups were matched in terms of sex , age, clinical presentation (50% acute), number of vessels and lesions ste nted, and lesion morphology. The relative costs of the femoral and radial p rocedures were examined using a decision analytic model and sensitivity ana lysis. The suture device was not used in 20/109 patients (18%) for anatomic reasons and failed to obtain hemostasis in 9/89 patients (10%). One radial patient had an occluded radial artery postprocedure, but this was recanali zed at follow-up a month later. Primary success, procedural complications, postprocedure length of stay, and the percentage of patients discharged the same day were the same in both groups. Because of the added time to deploy Perclose, total procedure time was significantly longer in the femoral gro up (57 +/- 22 min femoral vs. 44 +/- 22 min radial, P < 0.01). Access site complications occurred only in the femoral group. More patients were ambula tory the same day of the procedure in the radial group (95% radial vs. 56% femoral, P < 0.01). The cost of the radial approach was substantially less than the femoral approach because of lower supply costs and fewer access co mplications. The transradial approach is a dominant strategy for coronary s tenting, offering better outcomes at lower cost. (C) 2000 Wiley-Liss, Inc.