Distal Transradial Access Research Articles

Distal Trans-radial Access Compared to Conventional Trans-radial Access in Coronary Interventions: A Meta-analysis.

Distal trans-radial access (dTRA) is a novel technique of arterial cannulation in coronary interventions. The comparative efficacy of dTRA and conventional trans-radial access (TRA) in attenuating peri-procedural complications is unknown. Embase and PubMed/MEDLINE were searched from their inception until June 25, 2022, for randomized clinical trials. Outcomes included were radial artery occlusion (RAO), radial artery spasm, hemostasis time, access time, unsuccessful cannulation, crossover rate, and early discharge after trans-radial stenting of coronary arteries (EASY) type I-III hematomas. Statistical analysis was conducted using the random effects model to derive risk ratios (RRs) and mean differences (MDs) with their corresponding 95% confidence intervals (CIs). A total of 6 randomized clinical trials comprising 3240 patients were included. Subjects were predominantly male (73%) and had a mean age of 66 years. The dTRA group had a lower risk of RAO [RR 0.43 (95% CI, 0.26-0.69); P = 0.0005; I 2 = 0%] and had a shorter hemostasis time [MD -22.85 min (95% CI, -39.06 to -6.65); P = 0.006; I 2 = 99%]. The dTRA group had a higher crossover rate [RR 3.04 (95% CI, 1.88-4.91); P = 0.00001; I 2 = 56%] and a longer access time [MD 0.68 min (95% CI, 0.17-1.18); P = 0.009; I 2 = 99%]. The TRA group had a lower rate of unsuccessful cannulation [RR 0.81 (95% CI, 0.70-0.95); P = 0.01; I 2 = 92%]. There was no significant difference between the groups for radial artery spasm and EASY type I-III hematomas. dTRA is a safe alternative to conventional TRA for coronary interventions with a lower risk of RAO. Future trials are required to further compare both approaches.

经远端桡动脉入路行数字减影血管造影的临床效果研究 Clinical Evaluation of Distal Transradial Artery Access for Cerebral Angiography

经远端桡动脉入路行数字减影血管造影的临床效果研究 Clinical Evaluation of Distal Transradial Artery Access for Cerebral Angiography

Safety and feasibility of a 7F thin-walled sheath via distal transradial artery access for complex coronary intervention

BackgroundCompared with traditional trans-radial artery access (TRA), there are limited data that can confirm the efficacy and safety of a 7F thin-walled sheath placed via distal TRA (dTRA) for percutaneous coronary intervention (PCI).ObjectiveThis study aims to analyze the safety and efficacy of the placement of a 7F thin-walled sheath via dTRA for PCI.MethodsThis was a single-center retrospective observational study in which 102 patients who received complex PCIs with a 7F thin-walled sheath placed via dTRA in the catheter room of our hospital from May 2020 to October 2021 were included. The basic information, puncture success rate, radial artery occlusion (RAO) rate, radial artery lumen diameter and area, surgical data, pain score, and complication rate were observed and recorded.ResultsThe puncture success rate was 90.2% in the 102 patients, and the success rate of the operation was 97.8% among 92 patients with a successful puncture. The PCIs for patients included emergency PCIs and all types of complex PCIs. Color Doppler ultrasound performed at 1 and 30 d after the procedure showed that the RAO rate was 2.2%, the distal RAO rate was 3.3%, the postoperative average pain score was 2.2 points, and there were five patients (5.4%) with local hematoma, all of which were grade 1–2. Radial artery spasm and nervous injury occurred in two patients (2.2%), and arteriovenous fistula occurred in one patient (1.1%). Radial artery perforation, radial artery dissection, pseudoaneurysm, and sheath kinking did not occur.ConclusionThe placement of a 7F thin-walled sheath via dTRA for PCI showed a high puncture and procedural success rate, a low postoperative RAO rate, and a low incidence of local hematoma and other complications. The placement of a 7F Glidesheath Slender® via dTRA for PCI is safe and feasible.

Distal transradial access. Initial experience. Results

Introduction: Conventional access through the radial artery (cTRA) is a standard approach in coronary interventions. Unfortunately, it carries a risk of long-term complications such as radial artery occlusion (RAO) and local complications, usually hematomas. Aim: Sharing initial experience in the application of distal transradial access (dTRA) on 134 patients, from single operator in one center and its applicability on patients with STEMI. Number of procedures required to get experience with this access, assessed by the degree of reduction of failed procedures. Materials and methods: From 08.03.21 to 18.11.21, 134 patients with dTRA (110 successful, 24 unsuccessful) were included in the study. dTRA is comsidered to be an access to the anatomical snuffbox. Completion of the entire procedure, not just a successful puncture or insertion of an introducer, was considered the access successful. Results: It was found that the success of the method was 82% of the criteria preset. Among the successful procedures, 48% were interventions. Of these, 71% had ACS and 43.6% had STEMI. The access was used on 3 patients who had CTO. Two patients underwent rotablation using a 7 in 6 Fr introduser. On 98% of the patients a 6 Fr introducer was used. Right dTRA was used on 93% of patients. From the 134 procedures performed, it was found that 92% of failures were up to the 80th procedures. After the 80’th procedures the frequency of failures decreased significantly. Complications ‒ 3 small hematomas and 2 numbness in the thumb, which did not require additional interventions. Conclusion: The procedure with dTRA was successfully completed by high percentage of patients, including the high-risk patients with ACS and STEMI. After the 80th dTRA procedure was reached level of skills with a low frequency of failed procedures. This suggests that dTRA can be an alternative to standard radial access to prevent radial artery occlusion, which has been confirmed by previous studies, better patient comfort, and lower risk of complications. The results were achieved without the need of reduction of the introducer’s diameter or use of special devices for hemostasis.

Efficacy and Safety of Coronary Intervention via Distal Transradial Access (dTRA) in Patients with Low Body Mass Index.

The study aimed to investigate the efficacy and safety of coronary intervention via distal transradial access (dTRA) in patients with low body mass index (BMI). A total of 67 patients with low BMI who underwent coronary intervention, comprising 29 patients via dTRA and 38 patients via conventional transradial access (cTRA), were retrospectively included. There was no significant difference in the puncture success rate between the two groups (dTRA 96.6%, cTRA 97.4%, P=0.846). Compared with the cTRA group, the success rate of one-needle puncture in the dTRA group was lower (51.7% vs. 81.6%, P=0.020). The compression haemostasis time in the dTRA group was shorter than that in the cTRA group (P < 0.001). However, the incidence of radial artery occlusion was lower in the dTRA group than in the cTRA group (4.0% vs. 33.3%, P=0.007). In conclusion, coronary intervention via dTRA was safe and effective in patients with low BMI.

Biochemical and clinical evaluation of endothelial injury after distal or traditional transradial access in percutaneous interventions.

Distal transradial access (dTRA) has been proposed as an alternative to traditional transradial access (TRA) in cardiac catheterization. The study aimed to compare these two transradial approaches: TRA and dTRA in terms of clinical and biochemical aspects. Two hundred patients who qualified for the elective coronary procedure were included. The patients were assigned to one of the groups depending on their vascular access. The groups were compared in terms of perceived pain using the Visual Analogue Scale (VAS), time of gaining access, need for conversion, and local complications. Additionally, in forty patients circulating endothelial injury markers: endothelin 1 (ET-1), interleukin 8 (IL-8), and soluble vascular cell adhesion molecule-1 (sVCAM-1) were assessed. Successful cannulation was obtained in 84 (100%) in the TRA group and in 98 (84%) subjects in the dTRA (P <0.001). dTRA was associated with higher level of pain perceived at the time of gaining vascular approach than TRA; median VAS score (interquartile range [IQR]): 4 (2-5) vs. 2 (2-4) (P = 0.04). The mean time (standard deviation [SD]) needed to cannulate the artery in dTRA was longer than in TRA: 81 (8) seconds vs. 50 (4) seconds (P = 0.04). ET-1 concentration was (SD) 2.08 (0.19) pg/ml [dTRA] vs. 2.00 (0.29) [TRA] pg/ml (P = 0.83); sVCAM-1: 12.71 (3.97) ng/ml vs. 12.86 (4.29) ng/ml (P = 0.98); IL-8: 8.81 (0.42) ng/ml vs. 9.15 (0.52) ng/ml (P = 0.62). Th number of complications after procedures did not differ between these two approaches. Cannulation of dTRA is associated with a lower success rate and higher pain perceived. dTRA is not inferior to TRA when safety issues and vascular injury are considered.

Distal Transradial Access for Recanalization of Chronic Occlusions of the Radial Artery

Background. The current state of interventional cardiology is aimed at reducing the number of probable complica-tions of procedures and increasing patient comfort. That is why there was a stage evolution of changing endovascular ap-proaches from transfemoral to transradial. But despite the significant benefits of transradial access, it leaves behind some important complications. One such complication is occlusion of the radial artery. The frequency of this situation ranges from 1 to 30%. That is why the world’s leading interventionists are increasingly using distal transradial access, which is associated with fewer cases of postoperative occlusion of the radial artery.&#x0D; The aim. Occlusion of the radial artery is not an obstacle to changing access to the contralateral artery or more dan-gerous transfemoral access. With distal transradial access it is possible to recanalize artery and provide target procedure.&#x0D; Materials and methods. The study included 318 patients who were scheduled for re-intervention. Among these patients, 12 had a radial artery occlusion, which is 3.7% of the total control group. Successful recanalizations with distal access were performed in 9 patients (75%), and in 3 patients (25%) the attempts were unsuccessful. The technique of recanalization of chronic occlusion included selection of hydrophilic, both non-coronary and coronary wires. At the end of the procedure, hemostasis was performed according to standard procedures using aseptic bandages. Complications of hemostasis were not detected in any patient in the control group. The postoperative period was unremarkable.&#x0D; Conclusions. The study showed the possibility of using distal transradial access to recanalize chronic occlusions of the radial artery, which allows not to waste time on replacement of the contralateral radial artery or life-threatening transfemoral access and perform the necessary amount of the intervention. Besides, this preserves the radial artery for further use in bypass surgery or hemodialysis arteriovenous fistula.

Could radiation exposure be the Achilles’ heel of distal transradial artery access?

Distal transradial access for vascular interventions has gained ground recently. While the novel approach is associated with reduced radial artery occlusion and faster hemostasis, it could be related with prolonged procedural time, higher crossover rate and increased radiation, comparing to conventional transradial approach. Whether the radiation is increased in the procedures performed by the novel approach remains unambiguous. In the specific article, we aim to review the current literature and to propose possible explanations for this phenomenon. Could radiation be the Achilles’ heel of distal transradial artery access?

Feasibility and Safety of Transradial Aneurysm Embolization: A Systematic Review and Meta-Analysis

Use of the transradial access (TRA) approach for neuroendovascular procedures has been increasing in recent years. Our aim is to assess the feasibility, success rate, and complications associated with TRA for intracranial aneurysm embolization. PubMed, Scopus, and Embase were systematically searched for studies using TRA for intracranial aneurysm embolization. Random-effects models were used to obtain pooled rates of procedural success and complications. Twenty-four studies comprising 1283 (85.9%) TRA and 122 (8.2%) distal TRA aneurysm embolization procedures were included. The pooled success rate of the 18 studies in the meta-analysis was 93.5% (95% confidence interval [CI], 91.1%-95.8%). The pooled thromboembolic complication rate was 0.5% (95% CI, 0.1%-0.9%), the hemorrhagic complication rate was 0.5% (95% CI, 0.1%-0.9%), and the access site complication rate was 0.8% (95% CI, 0.3%-1.3%). One study (4.3%) used exclusively a 7-French guide catheter, and most used a 6-French guide catheter (22 of 23 studies, 95.7%), which was further incorporated as part of a triaxial configuration through a sheathless 8-French system in 4 studies (17.4%), 7-French guide catheter in 2 studies (8.7%), and 8-French sheath in 1 study (4.3%). The embolization techniques used were flow diverter placement in 451 cases (39.1%), coiling in 376 (32.6%), stent-assisted coiling in 127 (11.0%), balloon-assisted coiling in 104 (9.0%), Woven EndoBridge system in 50 (4.3%), and flow diverter placement plus coiling in 42 (3.6%). Treating intracranial aneurysms using various embolization techniques through TRA is feasible and associated with low access site and intraoperative complications.

Distal transradial access for targeted spinal angiography and embolization.

Spinal catheter angiography is commonly performed in the evaluation and treatment of spinal vascular lesions. The typical approach to spinal angiography consists of access through the femoral artery with the use of suitably shaped catheters for selective catheterization of the spinal segmental vasculature. The purpose of our study was to evaluate the safety and feasibility of distal transradial access through the "anatomical snuffbox" for targeted spinal angiography, for the investigation and treatment of selected spinal lesions. A retrospective review of patients who underwent transradial spinal angiography and embolization was performed from August 2019 to January 2022. A total of eight patients were identified, who underwent targeted spinal angiography through distal transradial access. Outcome measures were documented in a tabular manner. Radial access was successful in all patients. Seven patients had vascular tumors of the spinal column and underwent tumor embolization followed by segmental artery occlusion prior to surgery. One patient had a spinal dural AV fistula that could not be embolized due to feeding vessel tortuosity and eventually went on to have a laminectomy. Mean fluoroscopy time was 31.4 min. There were no access site hemorrhagic complications. One patient experienced transient mild hand numbness during the period of hemostasis with the vascular compression device that resolved completely within 24 h. Distal transradial access is a feasible and safe option for targeted spinal angiography and treatment in selected patients.

Distal transradial access for coronary procedures: a prospective cohort of 3,683 all-comers patients from the DISTRACTION registry.

Distal transradial access (dTRA) as an improvement of the traditional transradial approach has several potential advantages including operator and patient comfort, faster hemostasis, and lower risk of proximal radial artery occlusion (RAO). We aim to describe our real-world experience with dTRA as default approach for routine coronary angiography and percutaneous coronary interventions (PCI) in a broad and prospective cohort of all-comers patients. In the DISTRACTION registry, a total of 3,683 consecutive all-comers patients who underwent coronary procedures via dTRA were included. The mean patient age was 63.3±13.5-year-old, 66.1% were male, 39.7% had diabetes, and 50.2% presented with acute coronary syndromes (ACS). Overall, 20% of patients had non-ST-elevation myocardial infarction (NSTEMI), 22.9% had ST-elevation myocardial infarction (STEMI), and 2.6% presented in cardiogenic shock. There were 2.5% access site crossovers, 16% of those were performed via contralateral dTRA; thus, in only 77 (2.1%) patients dTRA sheath insertion could not be obtained. Right dTRA (rdTRA) was the most frequent access (80.2%), followed by redo ipsilateral dTRA (10.5%), left dTRA (ldTRA) (8.6%) and simultaneous bilateral dTRA (0.7%). PCI was performed in 60.4% of all cases, and left anterior descending was the most treated vessel (29%). No access site-related hematoma type ≥2, according to EASY classification was recorded. No hand/thumb dysfunction after any procedure was documented. One patient developed a pseudoaneurysm, and one had guidewire-induced forearm radial artery perforation. There were neither major complications nor major adverse cerebrovascular and cardiac events directly related to dTRA. In this large, prospective, all-commers patients registry the adoption of dTRA as standard for routine coronary interventions appears to be safe and feasible.

Analysis of the Risk Factors Related to the Success Rate of Distal Transradial Artery Access in Patients with Coronary Heart Disease.

ObjectiveThe aim of this study was to explore the factors influencing the success rate of distal transradial access (dTRA) for coronary intervention.MethodsA total of 246 patients who underwent either coronary angiography or percutaneous coronary intervention in the Xuzhou Central Hospital were enrolled in this study. Access via the distal radial artery was the first choice for the procedure, and the success rate of this approach was recorded. All patients underwent color Doppler ultrasonography of the distal radial artery at the right anatomical snuff box in order to measure the artery diameter. The patients were divided into two groups depending on the success of the dTRA; 44 patients with unsuccessful punctures were assigned to the observation group and 202 patients with successful punctures acted as the control group. The basic clinical data of the two groups were recorded, and the differences between the two groups with respect to various indices were evaluated. Logistic regression analysis was carried out to explore the factors influencing the success rate of dTRA.ResultsOf the 246 patients, dTRA was achieved in 202, giving a puncture success rate of 82.11%. Logistic regression analysis showed that the success rate of dTRA was positively correlated with the diameter of the distal radial artery (odds ratio [OR] = 3.381, P = 0.005) and hypertension (OR = 2.427, P = 0.016), and negatively correlated with female gender (OR = 0.429, P = 0.036) and diabetes mellitus (OR = 0.325, P = 0.002).ConclusionThe results of this study suggest that hypertension and distal radial artery diameter have a positive effect on the success rate of dTRA, while diabetes and female gender have a negative effect.

Distal Transradial Access: a Safe and Feasible Approach for Coronary Catheterization in Cases of Total Radial Artery Occlusion.

Radial artery occlusion (RAO) is still a major complication of coronary catheterization (CC) via transradial access (TRA). Recently, coronary angiography (CAG) and percutaneous coronary intervention (PCI) through distal transradial access (dTRA) have been proven to be safe and feasible, but RAO recanalization and complete CC via dTRA have been rarely reported. Twenty-nine consecutive patients with RAO were enrolled in the present study. RAO was first confirmed by ultrasonography and after puncture of the distal radial artery (RA) in the anatomical snuffbox; cannula angiography was conducted to confirm total RAO. With the exception of two patients, we successfully recanalized the occluded RA in 27 patients. After RAO recanalization, subsequent CAG and PCI were successful, and no complications occurred. RAO recanalization and complete coronary catheterization via dTRA are safe and feasible.

Advancement in Coronary Angiography or Percutaneous Coronary Intervention Using the Distal Transradial Artery Access in Acute Coronary Syndrome and Complex Coronary Artery Disease.

As the incidence of coronary heart disease increases annually, coronary angiography and percutaneous coronary intervention procedures are also increasing. The femoral artery and radial artery paths are commonly used for percutaneous coronary intervention, but their clinical application is limited to a certain extent due to many postoperative complications. The distal transradial access path is a new surgical path for coronary angiography and percutaneous coronary intervention. In this study, we reviewed the most relevant and recent articles related to distal transradial access and found that coronary angiography or interventional therapy using the distal transradial access path is safe and effective in patients with acute coronary syndrome and complex coronary artery disease. The distal transradial access path is expected to be the first choice for coronary angiography or percutaneous coronary intervention in patients with acute coronary syndrome and complex coronary artery disease.

Safety and efficacy of coronary angiography and percutaneous coronary intervention via distal transradial artery access in the anatomical snuffbox: a single-centre prospective cohort study using a propensity score method

BackgroundThis study investigated the safety and efficacy of coronary angiography (CAG) and percutaneous coronary intervention (PCI) via distal transradial artery access (d-TRA).MethodsFor this single-centre prospective cohort study, a total of 1066 patients who underwent CAG or PCI procedures from September 2019 to November 2020 were included. Patients were divided into two groups: the d-TRA group (346) and the conventional transradial artery access (c-TRA) group (720) based on access site. A total of 342 pairs of patients were successfully matched using propensity score matching (PSM) for subsequent analysis.ResultsNo significant differences in puncture success rate, procedural method, procedural time, sheath size, contrast dosage or fluoroscopy time were noted between the two groups. The puncture time in the d-TRA group was longer than that in the c-TRA group (P < 0.01), and the procedure success rate was lower than that in the c-TRA group (90.94% vs. 96.49%, P = 0.01). The haemostasis time in the d-TRA group was shorter than that in the c-TRA group (P < 0.01), and the visual analogue scale (VAS) was lower than that in the c-TRA group (P < 0.01). In addition, the prevalence of bleeding and haematoma in the d-TRA group was lower than that in the c-TRA group (1.75% vs. 7.31%, P < 0.01; 0.58% vs. 3.22%, P = 0.01, respectively). No significant difference in the incidence of numbness was noted between the two groups. No other complications were found in two groups.Conclusiond-TRA is as safe and effective as c-TRA for CAG and PCI. It has the advantages of improved comfort and fewer complications.Trail registration Chinese Clinical Trial Registry, ChiCTR1900026519.

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.

Distal radial approach between theory and clinical practice.. Time to go distal!

BackgroundTransradial access (TRA), which has a minimal risk of problems such as radial artery occlusion (RAO), hemorrhage, spasm, and so on, is now considered the standard procedure for cardiac catheterization. The aim of the study is to present the distal transradial access (d-TRA) as a possible promising novel technique in the field of cardiac coronary interventions comparing it to the standard conventional TRA using primary and secondary endpoints, exploring its benefits and drawbacks as a new experience in Alexandria University. One hundred cases with variable indications for coronary interventions were randomized to two arms using systematic random sampling method, coronary interventions in the first one were done via d-TRA (50 patients) and in the second arm via conventional TRA group (50 patients).ResultsTechnically, there were highly statistically significant differences between the two arms in favor of TRA regarding procedural success, number of punctures taken, Access time, Total procedural time, vasodilator used, and crossover to another access site; meanwhile safety profile parameters have showed statistically significant differences in favor of d-TRA regarding post-operative hematoma, AV fistula, post-operative pain and compression time, and there were no statistically significant differences regarding RAO although it occurred more in TRA group.ConclusionsIn the realm of cardiac intervention, the distal radial approach is a promising technique. When compared to TRA, we found it to be a viable and safe method for coronary angiography and interventions and it could be a real option for the interventionists in the near future, with a lower risk of radial artery blockage and no significant differences in wrist hematoma and radial artery spasm. The success rate of d-TRA is proportional to the steepness of the operator's learning curve and the quality of the examples chosen.

Percutaneous mechanical thrombectomy for acute superior mesenteric artery embolism via left distal transradial access in the anatomical snuffbox.

Percutaneous mechanical thrombectomy for acute superior mesenteric artery embolism via left distal transradial access in the anatomical snuffbox.

Conventional transradial access versus distal transradial access for coronary angiography and interventions

IntroductionFor so many years, femoral access has been the standard access for all interventional cardiologists performing coronary angiography and percutaneous coronary interventions. In the past 15 years, radial access gained more fame over femoral access as it has a lower risk of bleeding and it is more convenient to patients due to early mobilization and less hospital stay. Recently, the distal transradial access in the anatomical snuffbox has emerged as a new access for coronary procedures that carries some advantages over the standard proximal transradial access. These advantages include radial artery preservation in patients who may use radial artery graft for coronary bypass surgeries and those with end-stage renal disease who may use the radial artery for arterio-venous fistula.AimThe aim of this study is to compare the feasibility, safety, and complications of coronary angiography and intervention between distal transradial and conventional transradial access.Patients and methodsThis study was conducted between January 2019 and June 2020 on 100 patients who presented with chronic coronary syndrome previously known as stable angina to the outpatient clinic of our center who were scheduled for coronary angiography with possible coronary angioplasty if indicated. These patients were categorized into two groups, group A that consisted of 50 in which coronary angiography was done by conventional transradial route and group B that consisted of 50 in which coronary angiography was done by distal transradial route. Their demographic features and complications were recorded.ResultsOur results showed that patients who had their procedures through conventional radial access had more hematoma, bleeding, hand ischemia, and loss of radial artery than those who had their procedures done through distal transradial access.ConclusionFrom our results, we can conclude that distal transradial access in the anatomical snuffbox for coronary angiography and intervention is a better alternative, safe, and feasible option in comparison to conventional transradial access for both patients and operators.

Distal or Traditional Transradial Access Site for Coronary Procedures: A Single-Center, Randomized Study.

This study aimed to compare the efficacy and safety of the distal transradial approach (dTRA) versus the conventional transradial approach (TRA) for coronary angiography and percutaneous coronary interventions. The recommended approach for coronary procedures is TRA. However, it is associated with radial artery occlusion (RAO). The dTRA could potentially decrease the incidence of RAO. One thousand forty-two consecutive patients were randomized (1:1) to right dTRA or TRA. The primary endpoint was the rate of RAO, which was evaluated by Doppler ultrasound at 60days after randomization. Five hundred eighteen and 524 patients were randomized to dTRA and TRA, respectively. Follow-up Doppler evaluation of the radial artery was accomplished in 404 (78.0%) patients in the dTRA group and 392 (74.8%) in the TRA group. The rate of RAO was significantly reduced in the dTRA group compared with TRA group (3.7% vs 7.9%, respectively; P=0.014). The rate of successful sheath insertion was lower in the dTRA group compared with the TRA group (78.7% vs 94.8%, respectively; P< 0.001). More punctures (median=2 [IQR: 1-3] vs median=1 [IQR: 1-2]; P< 0.001) and a longer time (120 vs 75 seconds; P< 0.001) were required for sheath insertion in the dTRA group compared with the TRA group. The hemostasis time was shorter in the dTRA group compared with the TRA group (60 vs 120minutes; P< 0.001). The dose area product was higher in the dTRA group (median=32,729 in the dTRA vs 28,909 cGy/cm2 in the TRA group; P=0.02). No significant differences were observed in the secondary safety endpoints (bleeding [Bleeding Academic Research Consortium≥2] and severe radial artery spasm). According to our study, dTRA was associated with a lower rate of forearm RAO, a shorter time of hemostasis, a higher crossover rate and dose area product, and a longer procedural time compared with TRA.