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Distal versus conventional radial access for coronary angiography and intervention: Design and rationale of DISCO
Adel Aminian1, Gregory A Sgueglia2, Marcus Wiemer3
1Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium.
Insights
Distal radial access (DRA) may reduce radial artery occlusion (RAO) compared to traditional transradial access (TRA). The DISCO RADIAL trial will compare RAO rates between DRA and TRA in coronary procedures.
Area of Science:
- Cardiovascular Interventions
- Vascular Access Techniques
- Clinical Trials
Background:
- Transradial access (TRA) is standard for coronary procedures due to safety and patient benefits.
- Radial artery occlusion (RAO) is the most common TRA complication, limiting future procedures and interventions.
- Distal radial access (DRA) shows promise in reducing RAO risk.
Purpose of the Study:
- To compare the incidence of RAO between DRA and TRA.
- To provide the first large-scale multicenter randomized evidence on DRA versus TRA for RAO rates.
Main Methods:
- The DISCO RADIAL trial is a prospective, multicenter, randomized controlled superiority trial.
- 1300 patients undergoing coronary angiography or PCI will be randomized to DRA or TRA.
- The primary endpoint is RAO incidence assessed by ultrasound at discharge.
Main Results:
- The DISCO RADIAL trial is designed to provide definitive evidence on RAO rates.
- Results will inform best practices for radial access in cardiology.
Conclusions:
- The study will establish whether DRA is superior to TRA in preventing RAO.
- Findings will guide the adoption of DRA as a potentially safer alternative access method.
Background:
Transradial access (TRA) has become the default access method for coronary diagnostic and interventional procedures. As compared to transfemoral access, TRA has been shown to be safer, cost-effective and more patient-friendly. Radial artery occlusion (RAO) represents the most frequent complication of TRA, and precludes future coronary procedures through the radial artery, the use of the radial artery as a conduit for coronary artery bypass grafting or as arteriovenous fistula for patients on hemodialysis. Recently, distal radial access (DRA) has emerged as a promising alternative to TRA, yielding potential for minimizing the risk of RAO. However, an international multicenter randomized comparison between DRA, and conventional TRA with respect to the rate of RAO is still lacking.
Trial Design:
DISCO RADIAL is a prospective, multicenter, open-label, randomized, controlled, superiority trial. A total of 1300 eligible patients will be randomly allocated to undergo coronary angiography and/or percutaneous coronary intervention (PCI) through DRA or TRA using the 6 Fr Glidesheath Slender sheath introducer. Extended experience with both TRA and DRA is required for operators' eligibility and optimal evidence-based best practice to reduce RAO systematically implemented by protocol. The primary endpoint is the incidence of forearm RAO assessed by vascular ultrasound at discharge. Several important secondary endpoints will also be assessed, including access-site cross-over, hemostasis time, and access-site related complications.
Summary:
The DISCO RADIAL trial will provide the first large-scale multicenter randomized evidence comparing DRA to TRA in patients scheduled for coronary angiography or PCI with respect to the incidence of RAO at discharge.
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