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Distal transradial versus conventional transradial access in acute coronary syndrome
Kenan Erdem1, Ertuğrul Kurtoğlu2, Mehmet Alparslan Küçük3
1Department of Cardiology, Selçuk University School of Medicine, Konya, Turkey.
Insights
Distal transradial access (TRA) for coronary angiography (CAG) shows fewer vascular complications and shorter hemostasis time than conventional TRA. However, it requires longer sheath emplacement and may increase patient discomfort, necessitating further research.
Area of Science:
- Interventional Cardiology
- Vascular Access Techniques
Background:
- Distal transradial access (TRA) is a novel approach for coronary angiography (CAG).
- It offers potential advantages over conventional TRA, including reduced risk of arterial occlusion.
Purpose of the Study:
- To compare procedural outcomes and complications of distal TRA versus conventional TRA.
- To share clinical experiences with both transradial access methods.
Main Methods:
- Retrospective review of 70 patients undergoing distal TRA and 63 patients undergoing conventional TRA for CAG.
- Comparison of procedural characteristics, success rates, and complication profiles.
Main Results:
- No significant difference in CAG success rates between distal TRA (94.2%) and conventional TRA (98.4%).
- Distal TRA had longer sheath emplacement time but shorter hemostasis time.
- Lower incidence of radial spasm and occlusion in distal TRA compared to conventional TRA.
Conclusions:
- Distal TRA demonstrates potential benefits with reduced vascular complications and shorter hemostasis.
- Longer sheath insertion time and potential for increased pain with distal TRA may impact efficiency.
- Large-scale studies are warranted to fully evaluate distal TRA efficacy and patient experience.
Objective:
Distal transradial access (TRA) has been recently introduced as an alternative access site for coronary angiography (CAG). Both procedures can be performed in cardiology clinics by interventional cardiologists. Although distal TRA is considered to be more difficult as it requires artery puncture and experienced cardiologists, it seems to be more advantageous because of the limited risk of arterial occlusion. In this study, we share our experiences with distal TRA and conventional TRA.
Methods:
Seventy patients undergoing CAG via distal TRA and 63 patients via conventional TRA were included in this study. The patients' data were reviewed retrospectively and compared in terms of procedural characteristics and complications.
Results:
There was no significant difference between the distal TRA group (94.2%) and the conventional TRA group (98.4%) in terms of success rate (p=0.217). In the distal TRA group, the total sheath emplacement time was longer (p<0.001), and hemostasis time was shorter (p<0.001) compared with conventional TRA. Total procedural time and hospitalization period were not statistically different between the groups (p>0.05). Radial spasm and radial occlusion were more common in the conventional TRA group than in the distal TRA group (7.9% vs 1.4% and 3.1% vs 1.4%, respectively), and hematomas were not statistically different between the groups.
Conclusion:
Although distal TRA seems more advantageous in terms of less hemostasis time and less vascular complications, it takes a longer time for sheath insertion and may cause more pain, which may diminish its efficiency. Large-scale studies are needed to address this issue.
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