Why is this study important?

Radial access for coronary intervention is established as superior for reducing bleeding risk and is the preferred approach in most patients. With the hope of realizing the same benefits with peripheral intervention, radial-to-peripheral (R2P) have evolved as an alternative to common femoral artery access (CFA). To date, there is minimal data comparing the two approaches.

What question did the study seek to answer?

Trial Design: 273 consecutive R2P cases were compared to CFA cases identified from the XLPAD registry (2006–2024, NCT01904851), matched with a 1.1 propensity score. Matching was based on patient factors and lesion factors. The study primary endpoint compared major adverse limb events (MALE), composite all-cause mortality, target vessel revascularization, stroke, and major amputation. Technical success was the secondary endpoint.

What did the study show?

Results: No significant difference in MALE. Technical success favored CFA, but was not significantly different and found to be noninferior (87% vs. 95%; noninferiority p=0.001). Fluoro time, procedure time, and contrast were similar. Procedural events, mainly non-flow-limiting dissections (~50%), were higher with R2P (11% vs. 0.4%; p<0.001). Duration of hospitalization stay was significantly less ( <0.001)

Perspective: The study shows that an R2P approach does not carry an increased risk of poor outcomes. Though the study was not adequately powered to demonstrate the superiority of either approach, it suggests that beginning with R2P is reasonable. Not surprisingly, the time to hospital discharge was much shorter, which may be one of the strongest reasons to consider an R2P approach if the expected outcome is similar. The trial is a significant contribution in an area that remains essentially “data-free” and will hopefully lead to larger studies.