Distal Radial Artery Approach to Prevent Radial Artery Occlusion Trial.

Abstract

The aim of this study was to compare the rate of proximal radial artery occlusion (RAO) with Doppler ultrasound between distal and conventional radial access 24h and 30days after a transradial coronary procedure. The use of distal radial access to prevent proximal RAO (PRAO) in the proximal segment at 24h and 30days after a procedure, compared with conventional radial access, is unknown. This was a prospective, comparative, longitudinal, randomized study. A total of 282 patients were randomized to either proximal radial access (n=142) or distal radial access (n=140) to evaluate the superiority of the distal approach in the prevention of PRAO with Doppler ultrasound 24h and 30days after a transradial coronary procedure. In the per protocol analysis, the rates of PRAO at 24h and 30days were 8.4% and 5.6% in the proximal group and 0.7% and 0.7% in the distal group, respectively (24 h: odds ratio [OR]: 12.8; 95% confidence interval [CI]: 1.6 to 100.0; p=0.002; 30days: OR: 8.2; 95%CI: 1.0 to 67.2; p=0.019). In an intention-to-treat analysis, the 24-h and 30-day rates of PRAO were 8.8% and 6.4% for proximal radial access and 1.2% and 0.6% in the distal radial access group (24 h: OR: 7.4; 95%CI: 1.6 to 34.3; p=0.003; 30days: OR: 10.6; 95%CI: 1.3 to 86.4; p=0.007). Distal radial access prevents RAO in the proximal segment at 24h and 30days after the procedure compared with conventional radial access.