RADIAL APPROACH IN PERCUTANEOUS CORONARY INTERVENTIONS

Koronarografija je danas zlatni standard u dokazivanju i procjeni težine zahvaćenosti koronarnih arterija aterosklerotskim promjenama, a perkutane koronarne intervencije zajedno s farmakološkim mjerama temelj su liječenja ishemijske bolesti srca. Iako je transfemoralni pristup dominirao u eksplozivnom razvoju interventne kardiologije, transradijalni pristup danas sve češće zamjenjuje „klasični“ transfemoralni. Oba pristupa imaju pozitivne i negativne strane, no razlozi sve češćeg preferiranja radijalnog pristupa među intervencijskim kardiolozima smanjen je rizik vaskularnih komplikacija, krvarenja, rana vertikalizacija, veća ugoda za bolesnika, cjenovna prihvatljivost te niži rizik od morbiditeta i mortaliteta posebice u visoko rizičnih skupina. Potencijalno negativne strane, produljeno vrijeme trajanja zahvata i veća doza zračenja, mogu biti skoro u potpunosti nadvladane iskustvom, što i pokazuju centri s visokim udjelima transradijalnih intervencija. Unatoč svim prednostima TR pristupa, u svijetu postoji velika heterogenost njegovog udjela u kardiološkim interventnim postupcima, no omjer rizika i koristi pokazuje da korist daleko nadilazi moguće rizike.Coronary angiography is today the gold standard for diagnosis and evaluation of the coronary artery disease, and percutaneous coronary interventions, coupled with pharmacological strategies, form the basis of the treatment for ischaemic heart disease. Although transfemoral approach dominated in explosive development of interventional cardiology, transradial approach today replaces the “classical” transfemoral. Both access have positive and negative sides, but some of the reasons interventional cardiologists prefer transradial approach is because there are fewer vascular complications, less bleeding complications, early ambulation, improved patient comfort, lower hospital costs and reduced morbidity and mortality especially among high-risk groups. Potentially negative characteristics, like longer procedural duration and radiation exposure, can be almost completely eliminated by operator proficiency , which is seen in high-volume transradial centers. Despite all the benefits of the transradial approach, there is a high heterogenity of its use in cardiological interventions, but favorable risk-benefit ratio shows that advantages outweight the disadvantages