Distal transradial access as default approach for coronary angiography and interventions

Area of Science:

• Cardiovascular Interventions
• Vascular Access Techniques
• Interventional Cardiology

Background:

• Distal transradial access (dTRA) refines conventional transradial access, potentially improving patient comfort and reducing radial artery occlusion.
• A key consideration for dTRA is the successful puncture of a smaller distal artery.
• Preservation of the radial artery is crucial for patients who may require future interventions.

Purpose of the Study:

• To evaluate the real-world feasibility and safety of using distal transradial access (dTRA) as the default approach for coronary angiography (CAG) and percutaneous coronary intervention (PCI).
• To assess both right (rdTRA) and left (ldTRA) distal transradial access in routine procedures.

Main Methods:

• A prospective observational registry was conducted involving 435 consecutive patients undergoing 620 CAG and/or PCI procedures.
• Procedures were performed by two experienced transradial operators using either rdTRA or ldTRA between February and July 2019.

Main Results:

• Distal radial artery puncture was successful in all patients without ultrasound guidance, with most requiring 1-2 attempts for sheath insertion.
• Successful dTRA sheath insertion was achieved in 98.6% of patients, with only 3.0% requiring access site crossover.
• All patients had palpable distal and proximal radial artery pulses at discharge, with no major adverse cardiac/cerebrovascular events or complications recorded.

Conclusions:

• Distal transradial access (dTRA) is a safe and feasible default approach for routine CAG and/or PCI when performed by experienced operators.
• While promising, further large-scale randomized trials are necessary to confirm the clinical benefits and long-term safety of dTRA.