Radial versus femoral approach for left ventricular endomyocardial biopsy

Tawfiq Choudhury, Philipp Lurz, Tim G. Schäufele, Miguel Nobre Menezes, Shahar Lavi, Nikolaos Tzemos, Philipp Hartung, Thomas Stiermaier, Katsutoshi Makino, Olivier F. Bertrand, Ian C. Gilchrist, Mamas A. Mamas, Rodrigo Bagur

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Aims: Despite the widespread use of the radial approach in coronary interventions, left ventricular endomyocardial biopsy (LV-EMB) is most frequently performed via the femoral artery. We sought to assess the feasibility and safety of radial compared to femoral access in a large cohort of patients undergoing LV-EMB. Methods and results: Data from 264 patients who underwent LV-EMB in Germany, Portugal, Japan and Canada were collected. Clinical, procedural, safety and feasibility data were evaluated and compared between the two groups. LV-EMB was successfully performed by the radial approach in 129 (99%) of 130 and in 134 (100%) patients by the femoral access. Patients in the radial group were older (mean age 55.7 versus 44.3 years) and were more likely to have moderate-severe mitral regurgitation (27.7% versus TF 0%). Sheathless guides were used in 108 (83.1%) of the radial and 2 (1.5%) of the femoral patients, so the mean guiding catheter size (radial 7.0±1.0 Fr versus femoral 8.0±0.0 Fr) was significantly smaller in the radial group (p<0.001). Mild or moderate radial artery spasm occurred in 13 (10.0%) patients but only one (0.8%) patient required conversion to femoral access due to severe spasm. No access site-related complications were reported in the radial group, while 11 (8.2%) patients in the femoral group had access-site haematomas (p=0.001). There were no major complications (mitral valve injury, pericardial tamponade requiring intervention, cerebrovascular accidents, persistent high-degree atrioventricular block, major bleeding or death) in either group. Conclusions: The radial approach for LV-EMB appears to be safe and associated with a high success rate while possibly leading to fewer access-site bleeding complications compared to the femoral access. The results of this international multicentre study support the radial approach for LV-EMB and further inspire the expansion of "radial first"in the field of interventional cardiology.

Original languageEnglish (US)
Pages (from-to)678-684
Number of pages7
Issue number8
StatePublished - Oct 2019

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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