Background

Percutaneous coronary intervention (PCI) has evolved significantly over the past two decades, with transradial access (TRA) increasingly replacing transfemoral access (TFA) due to lower bleeding complications and improved patient comfort. However, complex coronary interventions—including chronic total occlusions (CTO), left main disease, bifurcation lesions, heavily calcified vessels, and multivessel PCI—continue to raise concerns regarding access-site selection.

Objective

To compare procedural success, complications, and clinical outcomes of radial versus femoral access in complex coronary interventions.

Methods

A prospective multicenter observational study involving 1,840 patients undergoing complex PCI between January 2021 and December 2024 was conducted across tertiary cardiovascular centers in South Asia. Patients were divided into radial-access (n=1,210) and femoral-access (n=630) groups. Clinical, procedural, and follow-up outcomes were analyzed.

Results

Procedural success rates were comparable between radial and femoral groups (94.6% vs. 95.1%; p=0.61). Major bleeding occurred significantly less frequently in the radial group (1.8% vs. 6.7%; p<0.001). Thirty-day mortality was lower in the radial group (2.7% vs. 4.8%; p=0.02). Hospital stay was significantly shorter among radial-access patients.

Conclusion

Radial access provides comparable procedural success while significantly reducing bleeding complications, vascular complications, and short-term mortality. These findings support radial access as the preferred approach for most complex coronary interventions.