Distal radial versus conventional radial access: Feasibility and success

Abstract

The distal radial access has shown major interest for the past two years. This access in the anatomical snuffbox was suggested to have some benefits over the standard radial site in terms of lower risk of local complications and better comfort of both patient and operator. This study investigated the feasibility and safety of distal radial access in cardiac catheterization. We conducted a prospective bicentric trial, comparing distal and conventional radial catheterization approaches in 177 patients (82 versus 95 patients, respectively. There was no significant difference regarding the incidence of risk factors between the two study groups. Cannulation time was not significantly different in DRA and CRA groups ( P = 0.16). Successful catheterization was achieved in 93 of 95 (98%) patients in the CRA group and in 72 of 82 (88%) patients in the DRA group ( P = 0.008). Failed radial cannulation was occurred in 2 (2%) and in 4 (4.8%) patients randomized to undergo percutaneous transluminal catheterization through the CRA and DRA ( P < 0.001). Percutaneous intervention was done in 37% and 34% of cases via conventional and snuff box approaches, respectively ( P = 0.7). There were no major vascular or nerve complications. At hospital discharge, asymptomatic radial artery occlusion, detected by ultrasonography, was found in 3 patients (3.1%) in CRA group while at nobody in DRA group ( P = 0.25). The median diameter of the radial artery diameter was higher in DRA than CRA group (2.2 mm vs. 2.1 mm; P = 0.007). Abnormal peak systolic velocity was showed in 12 cases of CRA group and in 9 cases of DRA ( P = 0.73). Both cannulation and procedure failure were associated with abnormal peak systolic velocity ( P = 0.023 and 0.007 respectively). The distal radial approach seems to be an interesting approach in cardiac catheterization. It is feasible and safe for coronary angiography and interventions.