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Predictors of success and puncture site complications in the distal radial approach

Akihiro Ikuta1, Shunsuke Kubo1, Kohei Osakada1

  • 1Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-11 Miwa, Kurashiki, 710-8602, Japan.

Heart and Vessels
|August 16, 2022
PubMed

Insights

The distal radial approach (DRA) for coronary procedures has a 90.4% success rate. Ultrasonography guidance improves DRA success and reduces puncture site complications, making it a safer option.

Area of Science:

  • Cardiology
  • Vascular Access
  • Interventional Cardiology

Background:

  • The distal radial approach (DRA) is an alternative to traditional radial artery access for coronary angiography (CAG) and percutaneous coronary intervention (PCI).
  • Predictors for DRA failure and associated puncture site complications remain unclear, necessitating further investigation.

Purpose of the Study:

  • To identify predictors of distal radial approach failure.
  • To determine factors associated with puncture site complications during coronary procedures.
  • To evaluate the impact of ultrasonography guidance on DRA outcomes.

Main Methods:

  • Retrospective analysis of 3610 patients undergoing CAG or PCI via DRA between November 2018 and January 2021.
  • Primary endpoint: procedural success. Secondary endpoint: puncture site complications (major/minor bleeding, fistula, pseudoaneurysm, neuropathy).
  • Statistical analysis to identify predictors of success and complications.

Main Results:

  • The overall DRA success rate was 90.4%, with a 7.7% puncture site complication rate.
  • Predictors of DRA failure included low body weight and dual antiplatelet therapy.
  • Ultrasonography-guided DRA was associated with higher success rates and fewer complications, particularly previous PCI.
  • Low body weight and dual antiplatelet therapy were negative predictors for DRA success without complications.

Conclusions:

  • Low body weight and dual antiplatelet therapy predict DRA failure and complications.
  • Ultrasonography-guided DRA is associated with improved procedural success and reduced puncture site complications.
  • DRA is a viable approach, with ultrasonography guidance enhancing its safety and efficacy in coronary interventions.

Keywords:
ComplicationDistal radial approachPredictorSuccessUltrasonography

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