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Feasibility of Distal Radial Access for Coronary Angiography and Percutaneous Coronary Intervention: A Single Center
Lianna Xie1, Xianjing Wei1, Zezhou Xie1
1Cardiology Department, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
Insights
Distal transradial access (dTRA) is a safe and feasible alternative for coronary procedures, showing a high success rate and low complication incidence. This approach helps prevent radial artery occlusion, a common issue in traditional transradial interventions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Radial artery occlusion is the most frequent complication following transradial coronary interventions.
- Distal transradial access (dTRA) has emerged as a potential strategy to mitigate this risk.
Purpose of the Study:
- To evaluate the feasibility and safety of dTRA for routine coronary angiography (CAG) and percutaneous coronary intervention (PCI).
- To report procedural outcomes and complication rates associated with dTRA.
Main Methods:
- A retrospective analysis of 1,063 consecutive patients undergoing CAG or PCI via dTRA.
- Assessment of dTRA success rate, failure causes, hemostasis duration, and access-related complications.
Main Results:
- Successful dTRA cannulation was achieved in 89.7% of patients.
- The overall incidence of radial artery occlusion was 1.4% at the access site and 0.4% in the forearm.
- Other complications like hematoma (0.5%) and transient thumb numbness (0.2%) were infrequent.
Conclusions:
- Distal transradial access (dTRA) is a feasible and safe technique for coronary interventions.
- dTRA offers a rational alternative to traditional radial access, potentially reducing radial artery occlusion.
Objective:
Asymptomatic radial artery occlusion remains the most common complication in transradial coronary interventional procedure. To prevent radial artery occlusion, distal transradial access (dTRA) has been suggested recently. In this article, we aim to describe our experience and to assess feasibility and safety of this new access site for routine coronary angiography (CAG) and percutaneous coronary intervention (PCI).
Methods:
We retrospective analyzed 1,063 consecutive patients who were assigned to undergo CAG or procedural PCI through dTRA between 1 January 2018 and 31 December 2019 at Affiliated Zhongshan Hospital of Dalian University. The size of radial sheath used was 5 or 6 French. The sheath was removed at procedure termination, and hemostasis was obtained by compression bandage with gauze. The success rate of dTRA access defined by successful radial artery cannulation on the first dTRA side attempted, the cause of access failure, the hemostasis duration, the incidence of post-catheterization radial artery occlusion, and the other access-related complications including hematoma of forearm and thumb numbness were assessed.
Results:
Radial artery cannulation via dTRA was successful in 953 of 1,063 patients with a success rate of 89.7%. Mean age of successful cases was 64.6 ± 11.2 years (26-94 years) with 339 (35.6%) women. A total of 363 (38.1%) cases were PCI. Among them, 95 cases (10%) underwent urgent PCI, including primary PCI in 64 patients with ST-segment elevation myocardial infarction and immediate PCI (<2 h from hospital admission) in 31 patients with very high-risk non-ST-segment elevation acute coronary syndrome. A total of 269 (28.2%) cases were via left dTRA. The 6 French sheath was used in 602 (63.2%) cases. Hemostasis was obtained within 2 h in 853 (89.5%) patients. There were 110 (10.3%) procedural failures: 59 (5.6%) cases of artery puncture failure, 49 (4.9%) cases of guide wire insertion failure, and 2 (0.2%) cases of sheath insertion failure. Complications potentially related to distal radial access included radial artery occlusion at the access site (13 cases, 1.4%), forearm radial artery occlusion (4 cases, 0.4%), hematoma of forearm (5 cases, 0.5%), and transient thumb numbness (2 cases, 0.2%).
Conclusion:
dTRA is a feasible and safe access and can be used as a rational alternative to traditional radial access for routine coronary interventional procedure.
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