Distal Radial Artery Access Research Articles

Retrospective single centre experience in distal radial puncture from Gleneagles Kota Kinabalu

Distal radial artery access for coronary angiogram has been introduced since 2017. It is known to have good success rate and low risk of complication. There are few advantages for this procedure compared to the conventional radial puncture.

Distal Radial Artery Access for Recanalization of Radial Artery Occlusion and Repeat Intervention: A Single Center Experience

Background: Once occluded, the radial artery becomes unsuitable for repeat interventions and obligates the need for alternative vascular access, such as the femoral approach, which is not encouraged by current guidelines. With the dissemination of distal radial access (DRA), which allows the cannulation of the artery in its distal segment and which remains patent even in the case of radial artery occlusion (RAO), the option to perform angioplasty at this level becomes feasible. Methods: Thirty patients with RAO were enrolled in this pilot study. Recanalization was performed through DRA using hydrophilic guidewires. The feasibility endpoint was procedural success, namely the successful RAO recanalization, the efficacy endpoint was patency of the artery at 30 days, and the safety endpoint was the absence of periprocedural vascular major complications or major adverse cardiac and cerebrovascular events. Results: The mean age of the patients was 63 ± 11 years, and 15 patients (50%) were men. Most patients had asymptomatic RAO (n = 28, 93.3%), and only two (6.6%) reported numbness in their hands. The most common indication for the procedure was PCI (19, 63.2%). Total procedural time was 41 ± 22 min, while the amount of contrast used was 140 ± 28 mL. Procedural success was 100% (n = 30). Moreover, there were no major vascular complications (0%); only two small hematomas were described (10%) and one had an angiographically visible perforation (3%). One case of periprocedural stroke was reported (3%), with onset immediately after the procedure and recovering 24 h later. Twenty-seven radial arteries (90%) remained patent at the one-month follow-up. Conclusions: RAO recanalization is feasible and safe, and by using dedicated hydrophilic guidewires, the success rate is high without significantly increasing procedural time or the amount of used contrast.

Default distal radial approach for all coronary procedures – a prospective study

Abstract Background Radial artery approach for coronary interventions has substantially improved the outcome especially in acute coronary syndrome patients. However, radial artery occlusion is the achilles' heel of such an approach. Purpose To obviate such problems, distal radial artery (DRA) approach is evolving but technical challenge is the small size of the artery. We looked at the feasibility, safety and advantages of it. Methods Patient population included any patient requiring a diagnostic or percutaneous coronary interventions (PCI) in our catheterization laoratory from March 2020 to March 2022. A primary operator performed all procedures as default, if the patient had a palpable DRA. After local anaesthesia infiltration, using seldinger technique and micropuncture kit, 5 to 7F hydrophilic sheaths were introduced and a cocktail of verapamil and heparin was given routinely. Sheaths were removed immediately after procedure but dedicated side specific compression devices were used but removed 45 min after diagnostic and 2 hours after PCI. Clinical patency of radial artery was assessed at discharge and follow up. Results A total of 682 procedures were performed (50% were diagnostic). Out of all PCIs 59% were for ACS). Elective PCIs included very complex cases including PCI for bifurcation, left main and rota assisted complex PCIs. 651 patients had right distal radial approach and 28 had left. Mean age of patients were 66.8±12.9 years (26 to 97). Females constituted 218 (32%). Mean time from 1st needle puncure to successful vascular access took 1.2±0.8 min (20 sec to 6 min). Average attempts to obtain successful vascular access was 1.3±0.7 (1 to7 attempts). There were 15 failures (2%) to obtain DRA access requiring change over to 6 ipsilateral radial, 2 ulnar, 4 contralateral distal radial, 2 femoral and 1 brachial access. Interestingly, in 5 different occaisions previous procedure related occluded radial arteries were recanalized through this access. Most importantly, no case of radial artery occlusion was encountered at discharge or at follow up by clinical examinations. No other vascular complications were encountered except mild transient bruising in 6 cases and early small hematoma in 3 cases. Patient's comfort, nursing staffs' satisfaction and trend towards early discharges were also noticed. There was a distinct improvement in obtaining faster access with lower failure rates by the operator after initial 90, especially after 150 procedures. Conclusions A default approach through distal radial artery in anatomical snuff box for all coronary interventions is feasible, safe and possibly superior to conventional radial access with better patient comfort and caring staff's satisfaction. Though learning curve is longer and more challenging, success rates were much higher and vascular access was faster after initial phase. Clinically radial artry occlusion was not seen but needs further study and more objective evidence. Funding Acknowledgement Type of funding sources: None.

TCT-584 Distal vs Traditional Radial Artery Access for Coronary Catheterization: A Systematic Review of Randomized Controlled Trials

TCT-584 Distal vs Traditional Radial Artery Access for Coronary Catheterization: A Systematic Review of Randomized Controlled Trials

The distal radial artery: Versatile vascular access for transcatheter interventions.

Conventional transradial access has been established as the gold standard for invasive coronary angiography and percutaneous interventions by the current European and American guidelines. The distal or snuffbox radial artery access represents an alternative transradial access site that allows radial sheath insertion with the patient's hand pronated. Firstly described 40 years ago, it exploded in popularity only recently. Promising additional benefits, the distal radial access is increasingly being adopted in various types of percutaneous interventions, being preferred by many interventional cardiologists and radiologists for its reduced vascular complications and time to hemostasis, and improvement of patient and operator comfort. Other centers consider it a fad, waiting for solid clear evidence and benefits. The evidence is dynamic and discrepant, depending on the center, the operator, and how it was collected (randomized controlled vs observational studies). Another essential aspect raised by "skeptics" was whether distal radial access, by its smaller diameter and more angled course, can support all types of interventions. The aim of this review is to gather all the scenarios where distal radial access has been utilized and to conclude whether this vascular access is feasible across all transcatheter interventions.

Distal Radial Artery Access in comparison to Forearm Radial Artery Access for Cardiac Catheterization: A Randomized Controlled Trial (DARFORA Trial).

Background In our clinical practice, conventional radial access has been employed routinely for coronary procedures. The distal radial artery (DRA) access site has recently emerged as a novel technique in cardiac procedures. Objectives This study compares distal radial access to standard forearm radial access (FRA) in terms of feasibility, outcomes, and complications. Method This prospective, randomized trial was conducted at a single center. The patients were chosen from An-Najah National University Hospital's catheterization laboratory between December 2019 and November 2020. A total of 209 patients were randomized into two groups: DRA group (n = 104) and FRA group (n = 105). Results Access was successful in 98% of patients in both the groups. The DRA group had a longer puncture duration and a higher number of attempts (duration: 56.6 ± 61.1 s DRA vs. 20.0 ± 18.4 s FRA, p < 0.001, attempts: 1.9 ± 1.3 DRA vs. 1.2 ± 0.60 FRA, p < 0.001). Puncture-associated pain was greater in the DRA group (4 ± 2.2 DRA vs. 3 ± 2.1 FRA, p=0.001). There were two radial artery occlusions in the FRA group and none in the DRA group (p=0.139). Percutaneous coronary intervention (PCI) was performed in 26% of the DRA group and 37.1% of the FRA group. The DRA group had significantly shorter procedure times (p=0.006), fluoroscopy times (p=0.002), and hemostasis times (p=0.002). Over time, the learning curve demonstrated improved puncture duration and a decrease in the number of puncture attempts. Conclusions DRA is a safe and practical alternative to FRA for coronary angiography and intervention. The overtime learning curve is expected to improve puncture-related outcomes.

The effect of right conventional radial artery access site and left distal radial artery access site on quality of life in coronary angiography: Which route is more appropriate?

Objectives: There are not many studies comparing the right conventional and left distal radial (anatomical snuffbox) access in coronary angiography (CAG) or percutaneous coronary intervention (PCI) in terms of patient satisfaction and complications; therefore, in this study, we planned to compare these two approaches and determine the ideal radial access site for the patients. Patients and methods: A total of 120 patients (80 males, 40 females; mean age: 59.2±11.7 years; range, 18 to 90 years) who underwent CAG or PCI via the radial artery between February 2022 and April 2022 were included in the prospective observational study. The patients were divided into right conventional radial artery access (Group 1; n=68) and left distal radial artery (access (Group 2; n=52) groups. Results: The rate of minor bleeding was higher in the right conventional access group compared to the left distal access group (16.2% vs. 3.8%; p=0.031). Major bleeding, hand ischemia, and radial artery occlusion were not observed in the study population. The rate of patients who had pain that disrupts daily activities was statistically higher in Group 1 than in Group 2 (17.6% vs. 5.8%). The patients in Group 2 were more satisfied with the transradial CAG/PCI compared to Group 1 (94.3% vs. 66.2%; p=0.001). Conclusion: Left distal radial artery access from the anatomic snuffbox was a safer method than right conventional radial artery access for CAG or PCI. Patients were more satisfied with the left distal radial access than the right conventional radial access.

Left Distal Radial Artery Access for Coronary Angiography and Interventions: A 12-Month All-Comers Study.

Interventional cardiologists prefer the right radial artery (RA) approach for coronary angiography and interventions, mainly for ergonomic reasons. However, the use of the left RA presents certain advantages, and the snuffbox approach has further potential advantages, including lower probability for RA occlusion, avoidance of direct puncture of the RA (thus maintaining its suitability for use as a graft), as well as easier and faster hemostasis. Consecutive patients scheduled for coronary catheterization were included, using the left distal RA (ldRA) in the anatomical snuffbox as the default vascular access site. Out of 2034 consecutive cases, the ldRA was used as initial vascular access in 1977 patients (97.2%). The procedural failure rate was 9.9% (21.9% inability to puncture the artery, 75.0% inability to advance the wire, 3.1% other reasons). There was a sharp decrease in failure rate after about the first 200 cases (20.8% in the first decile vs 8.7% throughout the rest of the caseload; P<.001). No or very weak palpable pulse was the most important predictor of failure (odds ratio, 16.0; 95% confidence interval, 11.2-23.1; P<.001), in addition to older age, small stature, and female gender (although, after adjustment for height, the latter was no longer significant). In a large series of consecutive patients scheduled for left heart catheterization, through a period of 12 months, with virtually no exclusions except those few imposed by anatomy or compelling clinical needs, the ldRA arterial access approach was shown to be highly effective, feasible, and safe.

Distal Radial Artery Access for Coronary Catheterization

Distal Radial Artery Access for Coronary Catheterization

Switching From Proximal to Distal Radial Artery Access for Coronary Chronic Total Occlusion Recanalization.

BackgroundDistal radial access (DRA) was recently introduced in the hopes of improving patient comfort by allowing the hand to rest in a more ergonomic position throughout percutaneous coronary interventions (PCI), and potentially to further reduce the rate of complications (mainly radial artery occlusion, [RAO]). Its safety and feasibility in chronic total occlusion (CTO) PCI have not been thoroughly explored, although the role of DRA could be even more valuable in these procedures.MethodsFrom 2016 to 2021, all patients who underwent CTO PCI in 3 Hungarian centers were included, divided into 2 groups: one receiving proximal radial access (PRA) and another DRA. The primary endpoints were the procedural and clinical success and vascular access-related complications. The secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE) and procedural characteristics (volume of contrast, fluoroscopy time, radiation dose, procedure time, hospitalization time).ResultsA total of 337 consecutive patients (mean age 64.6 ± 9.92 years, 72.4% male) were enrolled (PRA = 257, DRA = 80). When compared with DRA, the PRA group had a higher prevalence of smoking (53.8% vs. 25.7%, SMD = 0.643), family history of cardiovascular disease (35.0% vs. 15.2%, SMD = 0.553), and dyslipidemia (95.0% vs. 72.8%, SMD = 0.500). The complexity of the CTOs was slightly higher in the DRA group, with higher degrees of calcification and tortuosity (both SMD >0.250), more bifurcation lesions (45.0% vs. 13.2%, SMD = 0.938), more blunt entries (67.5% vs. 47.1%, SMD = 0.409). Contrast volumes (median 120 ml vs. 146 ml, p = 0.045) and dose area product (median 928 mGy×cm2 vs. 1,300 mGy×cm2, p < 0.001) were lower in the DRA group. Numerically, local vascular complications were more common in the PRA group, although these did not meet statistical significance (RAO: 2.72% vs. 1.25%, p = 0.450; large hematoma: 0.72% vs. 0%, p = 1.000). Hospitalization duration was similar (2.5 vs. 3.0 days, p = 0.4). The procedural and clinical success rates were comparable through DRA vs. PRA (p = 0.6), moreover, the 12-months rate of MACCE was similar across the 2 groups (9.09% vs. 18.2%, p = 0.35).ConclusionUsing DRA for complex CTO interventions is safe, feasible, lowers radiation dose and makes dual radial access more achievable. At the same time, there was no signal of increased risk of periprocedural or long-term adverse outcomes.

LB-2 | Distal versus Proximal Radial Artery Access for Cardiac Catheterization and Intervention: 30-day Outcomes of The DIPRA Study

Proximal radial artery (PRA) access for cardiac catheterization has been shown to be safe and with a mortality benefit compared to femoral access.However, it can jeopardize subsequent use of the artery due to occlusion. Distal radial artery access (DRA) in the anatomical snuffbox has the potential of preserving the RA but its safety and potential detrimental effects on hand function is unknown. We sought to assess access feasibility, and complications including hand function post distal or proximal radial access.

Radial Artery Access for Acute Coronary Syndromes: a Review of Current Evidence.

To review the evidence supporting the use of transradial access (TRA) for percutaneous coronary intervention (PCI) in acute coronary syndromes (ACS). There have been five major randomized controlled trials (RCTs) and two recent meta-analyses comparing outcomes of TRA and femoral access (FA) in ACS. Additional studies have explored the impact of TRA on STEMI door-to-balloon (D2B) times, TRA in high-risk ACS patients, the potential conflict between TRA and coronary artery bypass graft (CABG) surgery employing the radial artery, and distal radial artery (DRA) access. TRA is associated with a reduction in net adverse clinical events, major bleeding, acute renal injury, and access site complications compared to FA in ACS patients undergoing PCI. TRA is not associated with significant delays in STEMI D2B times that impact patient outcomes. Further studies are needed to evaluate the role of TRA in high-risk ACS patients, the interplay between TRA and radial artery CABG, and use of DRA in ACS.

Acesso transradial distal na tabaqueira anatômica: comparação com os acessos transradial proximal no processo estiloide e transfemoral

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.

Randomized comparison of proximal and distal radial access for coronary angiography and interventions

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Vascular access for coronary procedures is of paramount important not only for successful procedure but also to prevent complications. In comparison to femoral access, proximal radial artery (PRA) access at wrist is associated with decreased bleeding complications and mortality. The most important complication of PRA access is radial artery occlusion Use of the proximal radial artery (PRA) approach at wrist has several limitations: the need to supinate the hand, which can exacerbate chronic joint pain, the depth of the radial artery in large arms, which could make arterial puncture challenging even under ultrasound guidance, the risk of sporadic bleeding in the forearm, and the risk of radial artery occlusion. All above limitations can be overcome by distal radial artery (DRA) access in anatomical snuff box. Randomized Studies are lacking for the comparison between DRA and PRA approach in coronary procedures. Aims and objective To compare safety, efficacy and feasibility between PRA and DRA approach in randomized fashion. Material and methods This was single center randomized controlled trial. 320 patients were randomized in PRA and DRA groups. PRA approach was in wrist and DRA approach was in anatomical snuff box. Primary endpoint was cannulation failure (failure to achieve radial access) and transradial failure (failure to complete procedure after successful access). Secondary safety outcome includes major (compartment syndrome, need for vascular surgery, hand dysfunction, nerve palsy ,arteriovenous fistula, hematoma requiring blood transfusion, proximal radial artery occlusion) and minor (radial artery spasm, hematoma not requiring transfusion or causing compartment syndrome, ecchymosis, local edema, paresthesia, pseudoaneurysm) complications; secondary efficacy outcome were puncture attempts, cannulation time, procedure time, radiation dose, hemostasis time and quality of life endpoint was pain score . Results Each group was having 160 patients. In DRA group 73.9 % were CAG and 26.1 % were PCI; in PRA group and 75.7 were CAG and 24.3 were PCI. Cannulation failure was more in DRA group (7.5 % vs 2.5 %, P &amp;lt; 0.001) without difference in transradial failure (n = 3 vs 4, p =0.764). There were no major complications in both groups except PRAO which was significantly less in DRA group (0 % vs 5.2 %, p= 0.007). Puncture attempts, cannulation time, pain score were more in DRA (1.65 vs 1.29, P &amp;lt; 0.001;3.23 vs 2.62 minutes, p &amp;lt; 0.001;25.5 vs 21.6 minutes, p = 0.039 respectively). There was no significant difference for minor complications in both groups. Conclusion DRA approach is as safe and feasible as PRA approach and causes significantly less PRAO. DRA approach may be advocated as default approach where radial access is chosen for coronary procedures. Abstract Figure. primary outcome Abstract Figure. Procedural characteristic

Reference diameter and characteristics of the distal radial artery based on ultrasonographic assessment.

Background/AimsWhile distal radial artery (DRA) access is increasingly being used for diagnostic coronary angiography, limited information is available regarding DRA size. We aimed to determine the DRA reference diameters of Korean patients and identify the predictors of DRA diameter < 2.3 mm.MethodsThe outer bilateral DRA diameters were assessed using a linear ultrasound probe in 1,162 consecutive patients who underwent transthoracic echocardiography. The DRA diameter was measured by the perpendicular angle in the dorsum of the hand, and the average values were compared by sex. DRA diameter < 2.3 mm was defined as unsuitable for routine diagnostic coronary angiography using a 5 Fr introducer sheath.ResultsThe mean DRA diameters were 2.31 ± 0.43 mm (right) and 2.35 ± 0.45 mm (left). The DRA was smaller in women than men (right: 2.15 ± 0.38 mm vs. 2.43 ± 0.44 mm, p < 0.001; left: 2.18 ± 0.39 mm vs. 2.47 ± 0.45 mm, p < 0.001). The DRA diameter was approximately 20% smaller than the radial artery diameter. A total of 630 (54.2%) and 574 (49.4%) patients had DRA diameter < 2.3 mm in the right and left hands, respectively. Female sex, low body mass index (BMI), and low body surface area (BSA) were significant predictors of DRA diameter < 2.3 mm.ConclusionsWe provided reference DRA diameters for Korean patients. Approximately 50% of the studied patients had DRA diameter < 2.3 mm. Female sex, low BMI, and low BSA remained significant predictors of DRA diameter < 2.3 mm.

Distal Radial Artery Access for Coronary and Peripheral Procedures: A Multicenter Experience.

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.

Meta-Analysis Comparing Distal Radial Artery Approach Versus Traditional for Coronary Procedures

Distal radial artery access (DRA) is recommended as the preferred approach over the traditional proximal radial artery access (TRA) for coronary procedures; however, there are limited randomized controlled trials (RCTs) that compared the 2. We conducted an updated meta-analysis of all RCTs from inception to July 26, 2021, that compared DRA versus TRA in patients who underwent coronary procedures. The statistical analysis was performed using a random effect model to calculate risk ratios (RRs) with 95% confidence intervals (CIs). A total of 5 RCTs were included with a total of 1,005 patients. A pooled analysis of the data showed that the rate of successful cannulation was similar between the 2 arms (RR 0.85, 95% CI 0.68 to 1.07, p=0.16, I2=94%). The rate of radial artery spasm significantly favored the DRA arm as compared with TRA (RR 0.51, 95% CI 0.34 to 0.75, p=0.0007, I2=0%). Significantly more patients from the DRA arm required alternative arterial access. Moreover, the DRA group had an insignificantly decreased rates of radial artery occlusion (RR 0.24, 95% CI 0.05 to 1.20, p=0.08, I2=46%) and early discharge after transradial stenting of coronary arteries access-site hematomas (RR 0.52, 95% CI 0.18 to 1.149, p=0.22, I2=0%). The mean time for hemostasis was significantly shorter in the DRA arm (mean difference -6.64, 95% CI -10.37 to -2.90, p=0.0005, I2=88%). In conclusion, DRA should be considered as a viable, effective, and safe arterial access method for patients who underwent coronary procedures.

TCT-397 Distal Radial Versus Conventional Radial Artery Access: An Updated Meta-Analysis

TCT-397 Distal Radial Versus Conventional Radial Artery Access: An Updated Meta-Analysis

Distal radial artery access in the anatomical snuffbox for coronary angiography and percutaneous coronary intervention

Objective: Compared with transfemoral access, transradial access (TRA) has been shown to reduce major adverse cardiac events, major bleeding, and access site-related vascular complications. This study aimed to investigate the safety and feasibility of the novel distal TRA in the anatomical snuffbox (AS) for coronary angiography and percutaneous coronary intervention (PCI). Materials and methods: This cross-sectional study included a total of 102 consecutive patients (67 male; mean age: 56.1±13.2 years) who underwent coronary angiography and/or PCI via distal TRA in the AS. Results: Distal TRA was successfully performed in 98% of the patients. The crossover rate was very low (2%). The right distal TRA was the preferred approach and was used in 90.2% of the patients. Mean artery puncture time was 3.9±1.6 min. Mean compression time to achieve hemostasis at puncture site was 17.0±6.9 min. The post-procedural hematoma rate was very low (1%). One-month follow-up Doppler ultrasound showed zero cases of arteriovenous fistula and pseudo-aneurysm. However, proximal radial artery occlusion was observed in 1 patient (1%) and it was asymptomatic. Artery puncture time, unfractionated heparin dose, time to sheath removal, procedural numerical rating scale (NRS) score and post-procedural NRS score at 6 h were significantly different between diagnostic catheterization and PCI procedures (p<0.001). Conclusion: The distal TRA in the AS is safe and feasible for coronary angiography and PCI. However, further studies are warranted.

АНАЛИЗ ПРОМЕЖУТОЧНЫХ РЕЗУЛЬТАТОВ СРАВНИТЕЛЬНОГО МНОГОЦЕНТРОВОГО РАНДОМИЗИРОВАННОГО ИССЛЕДОВАНИЯ TENDERA ПО ИЗУЧЕНИЮ ДИСТАЛЬНОГО ЛУЧЕВОГО ДОСТУПА

Objective. To prove the safety and efficacy of distal radial artery (DRA) puncture for endovascular interventions versus the traditional forearm radial artery (RA) puncture site by comparing immediate and long-term results. Methods. In 2017, a multicenter, open, randomized (1:1) study TENDERA (Comparison between Traditional Entry Point and Distal Puncture of Radial Artery) was started. During 2 years, 520 patients were included, mean age 63.4±10.0 years. The observation group (DRA puncture) included 271 patients, the comparison group (RA puncture) - 249 patients. The study included both stable patients and those with NSTEMI: the observation group - 39 (14.4%), the comparison group - 34 (13.7%), p=0.809. The primary endpoint is immediate (hospital) or late radial thrombosis. Secondary endpoints are: 1 - composite point, complications from the access artery; 2 - puncture parameters. Results. The average difference in the diameters of the RA and DRA was 0.3 mm and 0.4 mm, in some patients the DRA diameter corresponded to the RA or even exceeded it. The diameter of RA and DRA in men and women significantly differs, 2.65±0.44 mm and 2.36±0.36 mm (p=0.001), 2.31±0.39 mm and 2.13±0.38 mm (p=0.001). Technical success of DRA access requre the number of attempts. 94.1% - the percentage of successful cardiac catheterization performed through the distal radial artery approach, which is significantly less than via RA - 100% (p&lt;0.001). In the observation group, significantly fewer rebleedings and rehemostasis were occured. In the long-term period, there were registered outstandingly more hematomas in the observation group at the time of discharge and after 1 week. Conclusion. Intermediate analysis of the results of the TENDERA study shows that there is no significant difference in the primary endpoint, but the number of complications in the observation group associated with the puncture markedly - hematoma more than 5 cm to the day of discharge and after 7 days. What this paper adds Intermediate results of the first multicenter open randomized (1:1) study devoted to the comparison of distal puncture of the radial artery versus the traditional entry point of puncture of the radial artery on the forearm during the endovascular interventions have been presented. A significant reduction of the number of local complications has been revealed in the group of distal puncture of the radial artery and the absence of differences according to the primary endpoint: early and late radial artery thrombosis.