Distal or Traditional Transradial Access Site for Coronary Procedures: A Single-Center, Randomized Study
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Published on: September 20, 2020
Grigorios Tsigkas1, Angeliki Papageorgiou1, Athanasios Moulias1
1Department of Cardiology, University Hospital of Patras, Patras, Greece.
Insights
The distal transradial approach (dTRA) significantly reduces radial artery occlusion compared to the conventional transradial approach (TRA). However, dTRA requires more punctures and longer procedure times, but offers shorter hemostasis.
Area of Science:
- Cardiovascular Interventions
- Vascular Access Techniques
- Interventional Cardiology
Background:
- The conventional transradial approach (TRA) is standard for coronary angiography and interventions but can lead to radial artery occlusion (RAO).
- The distal transradial approach (dTRA) is proposed as an alternative to potentially reduce RAO incidence.
Purpose of the Study:
- To compare the efficacy and safety of dTRA versus TRA for coronary angiography and percutaneous coronary interventions.
- To evaluate the rate of radial artery occlusion (RAO) as a primary endpoint.
Main Methods:
- A randomized controlled trial involving 1042 patients allocated to either right dTRA or TRA.
- RAO was assessed by Doppler ultrasound at 60 days post-procedure.
- Key procedural metrics including sheath insertion success, time, hemostasis duration, and radiation dose were recorded.
Main Results:
- RAO rate was significantly lower with dTRA (3.7%) compared to TRA (7.9%) (P=0.014).
- dTRA had a lower successful sheath insertion rate (78.7% vs 94.8%), required more punctures, and had longer procedural times.
- Hemostasis time was shorter with dTRA (60 vs 120 minutes), and the dose area product was higher.
Conclusions:
- dTRA is associated with a reduced incidence of forearm RAO and shorter hemostasis times compared to TRA.
- Despite a higher crossover rate and increased procedural time, dTRA offers a viable alternative for radial access in coronary procedures.
Objectives:
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.
Background:
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.
Methods:
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 60 days after randomization.
Results:
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 120 minutes; 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).
Conclusions:
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.
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