Distal Versus Conventional Radial Access for Coronary Angiography and Intervention: The DISCO RADIAL Trial

Area of Science:

• Cardiology
• Vascular Surgery
• Interventional Radiology

Background:

• Transradial access (TRA) is standard for coronary procedures, but radial artery occlusion (RAO) is a frequent complication, especially for patients needing multiple interventions.
• Distal radial access (DRA) is an emerging alternative to mitigate RAO risk.
• A large-scale international trial comparing RAO rates between TRA and DRA was lacking.

Purpose of the Study:

• To evaluate if distal radial access (DRA) is superior to conventional transradial access (TRA) in reducing forearm radial artery occlusion (RAO).

Main Methods:

• The DISCO RADIAL trial was an international, multicenter, randomized controlled trial comparing DRA and TRA in patients undergoing percutaneous coronary procedures.
• Patients received either DRA or TRA using a 6-F Slender sheath, with strict adherence to best practices for RAO reduction.
• The primary endpoint was forearm RAO incidence assessed by vascular ultrasound post-procedure. Secondary endpoints included crossover rates, hemostasis duration, and access site complications.

Main Results:

• No significant difference in forearm RAO was observed between DRA (0.31%) and TRA (0.91%) (P=0.29).
• Crossover rates were higher in the DRA group (7.4%) compared to TRA (3.5%) (P=0.002).
• Median hemostasis time was shorter with DRA (153 minutes) versus TRA (180 minutes) (P < 0.001), while radial artery spasm was more frequent with DRA (5.4% vs 2.7%).

Conclusions:

• Implementing a rigorous hemostasis protocol results in equally low radial artery occlusion rates for both DRA and TRA.
• Distal radial access (DRA) is associated with a higher crossover rate but offers a shorter hemostasis time compared to transradial access (TRA).