System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Review Epublish

PubMed: 42865619 DOI: 10.3389/fcvm.2026.1883827

Vascular access options for complex high-risk indicated percutaneous coronary interventions: contemporary strategies, trade-offs, and practical algorithms.

Front Cardiovasc Med 13:1883827

Authors: Giuseppe Colletti, Chadi Ghafari, Zoltan Ruzsa, Olivier Gach, Pieter-Jan Palmers, Lucien Finianos, Tim Noterdaeme, Augustin Tchassem Dimdie, Quentin Trefois, Adrien Jossart, Laura Peter, Agostino Spanò, Nino Cocco, Marouane Boukhris, Claudiu Ungureanu

Affiliations

  • Department of Cardiology, Clinique St. Joseph-Groupe Vivalia, Arlon, Belgium.
  • Department of Internal Medicine, Hôpital Vivalia De Libramont, Arlon, Belgium.
  • Internal Medicine Department, Cardiology Center, University of Szeged, Szeged, Hungary.
  • Cardiovascular Center, Semmelweis University, Budapest, Hungary.
  • Department of Cardiology, CHC MontLégia, Liège, Belgium.
  • Department of Cardiology, Jolimont Hospital-CHU Helora, La Louvière, Belgium.
  • Department of Cardiology, Centre Hospitalier de Wallonie Picarde, Tournai, Belgium.
  • Department of Cardiovascular Sciences, Campus Bio-medico University Hospital, Rome, Italy.
  • Department of Cardiology, CHU Saint Etienne, Saint-Étienne, France.

Abstract

BACKGROUND

Vascular access is an important component of CHIP planning that influences procedural feasibility, safety, and completeness. It affects bleeding and vascular complications, guide-catheter support, compatibility with intravascular imaging and calcium-modification devices, chronic total occlusion techniques, closure and bailout options, and mechanical circulatory support (MCS) planning. Contemporary CHIP populations are increasingly older or frail and more often have chronic kidney disease, peripheral artery disease, reduced left ventricular ejection fraction, prior bypass surgery, calcification, or CTO; access choice should extend beyond radial vs. femoral.

SUMMARY

This review appraises proximal and distal radial, femoral, ulnar, and brachial access; sheathless, slender, and RailTracking strategies; large-bore femoral workflows; and access planning when MCS is considered. We discuss preprocedural arterial assessment, ultrasound and micropuncture, prior access footprint, closure feasibility, hostile femoral anatomy, alternative access, and complication prevention and rescue. The available literature supports a non-dogmatic approach in which access architecture is matched to patient vulnerability, arterial anatomy, lesion complexity, guide and device requirements, support needs, haemostasis feasibility, and bailout planning. Recent randomised evidence further reinforces selective rather than routine prophylactic MCS in nonemergent high-risk PCI.

CONCLUSIONS

Forearm access should remain central whenever it permits procedural success without compromising device delivery, imaging, guide support, or bailout flexibility. Femoral access remains indispensable when large-bore support, maximal guide stability, complex device delivery, or rapid escalation are anticipated. Within a comprehensive CHIP plan, the preferred access architecture is the smallest one that enables the intended revascularisation, safe haemostasis, and timely rescue.

MeSH

Percutaneous Coronary Intervention, Algorithms, Peripheral Arterial Disease, Anatomy, Mechanical Circulatory Support