Abstract
Background The transradial access has gained great prominence in interventional coronary procedures due to lower complication rates, especially when the radial artery is punctured distally, in the anatomical snuffbox. The objective of this study was to analyze the complication and crossover rates of the access routes in invasive coronary procedures, comparing the distal radial artery to the proximal transradial route in the styloid process and the transfemoral access. Methods This was a prospective, observational, and single-center cohort study. The results of access routes were compared, using the primary outcomes of puncture site-related complications and initial arterial access crossover. Results A total of 748 patients were included; in that, 152 (20.3%) in the Distal Transradial Access Group, 388 (51.9%) in the Proximal Transradial Access Group, and 208 (27.8%) in the Transfemoral Access Group. No complications were observed in the Distal Transradial Access Group, whereas two patients (0.5%) had mild local hematomas in the Proximal Transradial Access Group, and six participants (2.9%) had complications in the Transfemoral Access Group, with mild local hematomas in four patients (1.9%), a pseudoaneurysm in one (0.5%), and an active bleeding in one (0.5%) – all with no need for surgical intervention (p=0.01). The crossover rate was 9.2% in the Distal Transradial Access Group, 5.9% in the Proximal Transradial Access Group, and 0.9% in the Transfemoral Access Group (p=0.001). Conclusion The distal radial artery access had a lower rate of vascular/hemorrhagic complications when compared to the proximal transradial access in the styloid process and the transfemoral access. However, the crossover rate was higher when the distal radial artery access was the operator’s first choice.
Highlights
The use of vascular access routes for performing coronary angiography (CA) and percutaneous coronary interventions (PCI) has undergone significant changes over time worldwide
The transfemoral access (TFA) has accompanied the evolution of interventional cardiology for a long time, the transradial access (TRA) has gained prominence in the performance of percutaneous coronary procedures since the 1990s.1. Robust studies, such as the RIVAL2 and the RIFLE-STEACS,[3] have demonstrated greater safety using the TRA compared to TFA, with lower rates of bleeding complications and major adverse clinical events.[1,2,3,4,5]. These results were so consistent that they culminated in the modification of the guidelines, which were revised to recommend the preferential use of the TRA in patients admitted for acute coronary syndrome (ACS), in centers with expertise in this vascular access.[6,7,8,9]
The Distal Transradial Access, the Proximal Transradial Access and the Transfemoral Access Groups were defined according to the first arterial puncture attempt by the interventional cardiologist
Summary
The use of vascular access routes for performing coronary angiography (CA) and percutaneous coronary interventions (PCI) has undergone significant changes over time worldwide. The transfemoral access (TFA) has accompanied the evolution of interventional cardiology for a long time, the transradial access (TRA) has gained prominence in the performance of percutaneous coronary procedures since the 1990s.1 Robust studies, such as the RIVAL2 and the RIFLE-STEACS,[3] have demonstrated greater safety using the TRA compared to TFA, with lower rates of bleeding complications and major adverse clinical events.[1,2,3,4,5]. It is presumed that its technical mastery requires a longer learning curve
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
