PCI Approaches

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]


To perform percutaneous coronary intervention (PCI), there are two main methods to access the artery; radial artery and femoral artery. Studies have shown that access through radial artery has lower rate of vascular, and bleeding complications, with higher chance of early amubulation and better outcome. However, femoral artery remains the default PCI access in centers where expertise in the transradial approach is unavailable or if the patient has any anatomic or clinical limitations.

PCI Approaches

ACA 2021 Revascularization Guideline for PCI Approaches

Class 1 Recommendation, Level of Evidence: A[1]
1.Radial artery approach is recommended over the femoral artery access in patients with acute coronary syndromes (ACS) undergoing PCI due to lower rate of death, vascular and bleeding complications.

2.Radial artery approach is recommended over the femoral artery access in patients with stable ischemic heart disease (SIHD) undergoing PCI due to lower rate access site bleeding and vascular complications.


  1. 1.0 1.1 1.2 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check |pmid= value (help).
  2. Masoudi FA, Ponirakis A, de Lemos JA, Jollis JG, Kremers M, Messenger JC; et al. (2017). "Trends in U.S. Cardiovascular Care: 2016 Report From 4 ACC National Cardiovascular Data Registries". J Am Coll Cardiol. 69 (11): 1427–1450. doi:10.1016/j.jacc.2016.12.005. PMID 28025065.
  3. Jolly SS, Yusuf S, Cairns J, Niemelä K, Xavier D, Widimsky P; et al. (2011). "Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial". Lancet. 377 (9775): 1409–20. doi:10.1016/S0140-6736(11)60404-2. PMID 21470671.
  4. Ferrante G, Rao SV, Jüni P, Da Costa BR, Reimers B, Condorelli G; et al. (2016). "Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials". JACC Cardiovasc Interv. 9 (14): 1419–34. doi:10.1016/j.jcin.2016.04.014. PMID 27372195.

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