Abstract
Introduction: Distal radial access (dRA) has recently gained global popularity as an alternative access route for vascular procedures. Among the benefits of dRA are the low risk of entry site bleeding complications, the low rate of radial artery occlusion, and improved patient and operator comfort. The aim of this large multicenter registry was to demonstrate the feasibility and safety of dRA in a wide variety of routine procedures in the catheterization laboratory, ranging from coronary angiography and percutaneous coronary intervention to peripheral procedures. Methods: The study comprised 1240 patients who underwent coronary angiography, PCI or noncoronary procedures through dRA in two Hungarian centers from January 2019 to April 2021. Baseline patient characteristics, number and duration of arterial punctures, procedural success rate, crossover rate, postoperative compression time, complications, hospitalization duration, and different learning curves were analyzed. Results: The average patient age was 66.4 years, with 66.8% of patients being male. The majority of patients (74.04%) underwent a coronary procedure, whereas 25.96% were involved in noncoronary interventions. dRA was successfully punctured in 97% of all patients, in all cases with ultrasound guidance. Access site crossover was performed in 2.58% of the patients, mainly via the contralateral dRA. After experiencing 150 cases, the dRA success rate plateaued at >96%. Our dedicated dRA step-by step protocol resulted in high open radial artery (RA) rates: distal and proximal RA pulses were palpable in 99.68% of all patients at hospital discharge. The rate of minor vascular complications was low (1.5%). A threshold of 50 cases was sufficient for already skilled radial operators to establish a reliable procedural method of dRA access. Conclusion: The implementation of distal radial artery access in the everyday routine of a catheterization laboratory for coronary and noncoronary interventions is feasible and safe with an acceptable learning curve.
Highlights
Distal radial access has recently gained global popularity as an alternative access route for vascular procedures
The site of arterial access for coronary angiography and intervention has been the focus of research for decades as it is the source of major complications, especially bleeding
We aimed to undertake a systematic protocol with the inclusion of all comers in our study and collect a solid cohort of at least 1000 patients in order to evaluate the real-world feasibility and safety of both right and left Distal radial access (dRA) as default access sites for routine coronary angiography and all percutaneous coronary (PCI) and noncoronary interventions
Summary
Distal radial access (dRA) has recently gained global popularity as an alternative access route for vascular procedures. Among the benefits of dRA are the low risk of entry site bleeding complications, the low rate of radial artery occlusion, and improved patient and operator comfort. The aim of this large multicenter registry was to demonstrate the feasibility and safety of dRA in a wide variety of routine procedures in the catheterization laboratory, ranging from coronary angiography and percutaneous coronary intervention to peripheral procedures. We aimed to undertake a systematic protocol with the inclusion of all comers in our study and collect a solid cohort of at least 1000 patients in order to evaluate the real-world feasibility and safety of both right and left dRA as default access sites for routine coronary angiography and all percutaneous coronary (PCI) and noncoronary interventions. The main study motto was the transition to dRA access as part of a contemporary, quality improvement project suitable for all patients arriving at our catheterization laboratories
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