Abstract
Objective The previous meta-analysis has assessed that distal transradial access (dTRA) in anatomical snuffbox is safe and effective for coronary angiography and intervention and can reduce radial artery occlusion. However, since the publication of the previous meta-analysis, several observational studies have been added, so we performed an updated meta-analysis to include more eligible studies to compare distal transradial access in anatomical snuffbox with conventional transradial access (cTRA). Method Pubmed, Embase, and Cochrane Library databases were searched for relevant studies from the literature published until 5 January 2021 to evaluate catheterization/puncture failure, hematoma, radial artery spasm, radial artery occlusion (RAO), access time, fluoroscopy time, radiation dose area product, total procedure time, and hemostatic device removal time. The pooled odds ratio (OR), weighted mean difference (WMD), and standardized mean difference (SMD) with 95% confidence interval (95% CI) were calculated for dichotomous and continuous variables, respectively. Results A total of 9,054 patients from 14 studies were included in the meta-analysis, and we found no significant difference in catheterization/puncture failure (OR = 1.94, 95CI [0.97, 3.86], P=0.06), hematoma (OR = 0.97, 95CI [0.55, 1.73], P=0.926), radial artery spasm (OR = 0.76, 95CI [0.43, 1.36], P=0.354), total procedure time (SMD = 0.23, 95CI [−0.21, 0.68], P=0.308), or radiation dose area product (WMD = 216.88 Gy/cm2, 95CI [−126.24, 560.00], P=0.215), but dTRA had a lower incidence of RAO (OR = 0.39, 95CI [0.23, 0.66], P < 0.001), shorter hemostatic device removal time (WMD = −66.62 min, 95CI [−76.68, −56.56], P < 0.001), longer access time (SMD = 0.32, 95CI [0.08, 0.56], P=0.008), and longer fluoroscopy time (SMD = 0.16, 95CI [−0.00, 0.33], P=0.05) than cTRA. Conclusion Compared with the cTRA, the dTRA has a lower incidence of radial artery occlusion and shorter hemostatic device removal time, which is worthy of further evaluation in clinical practice.
Highlights
Compared with the transfemoral access, the transradial access is widely used in coronary angiography and intervention, with the advantage of reducing the risk of bleeding, lowering the incidence of postoperative adverse events, and improving postoperative comfort [1]
A total of 9,054 patients from 14 studies were included in the meta-analysis, and we found no significant difference in catheterization/puncture failure, hematoma, radial artery spasm, total procedure time (SMD 0.23, 95CI [−0.21, 0.68], P 0.308), or radiation dose area product (WMD 216.88 Gy/cm2, 95CI [−126.24, 560.00], P 0.215), but distal transradial access (dTRA) had a lower incidence of radial artery occlusion (RAO), shorter hemostatic device removal time (WMD −66.62 min, 95CI [−76.68, −56.56], P < 0.001), longer access time (SMD 0.32, 95CI [0.08, 0.56], P 0.008), and longer fluoroscopy time (SMD 0.16, 95CI [−0.00, 0.33], P 0.05) than conventional transradial access (cTRA)
Compared with the cTRA, the dTRA has a lower incidence of radial artery occlusion and shorter hemostatic device removal time, which is worthy of further evaluation in clinical practice
Summary
Compared with the transfemoral access, the transradial access is widely used in coronary angiography and intervention, with the advantage of reducing the risk of bleeding, lowering the incidence of postoperative adverse events, and improving postoperative comfort [1]. Since the method was proposed, a meta-analysis [5] and several observational studies comparing the advantages and Journal of Interventional Cardiology disadvantages of cTRA versus dTRA have emerged. E studies included in this meta-analysis were required to meet the following criteria: (1) adults undergoing coronary angiography or intervention; (2) randomized controlled trials or observational studies of dTRA in anatomical snuffbox versus cTRA; (3) studies that included one of the following indicators: catheterization/puncture failure, hematoma, radial artery spasm, radial artery occlusion, access time, fluoroscopy time, radiation dose area product, total procedure time, and hemostatic device removal time; (5) case reports, conference abstracts, letters, reviews, and comments were excluded; and (6) the language of the studies was restricted to English. If publication bias was present, effect sizes were recalculated using the trim and fill method
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