Distal Trans-radial Access Compared to Conventional Trans-radial Access in Coronary Interventions: A Meta-analysis

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Access

Background:

• Distal trans-radial access (dTRA) is an emerging arterial cannulation technique for coronary interventions.
• The comparative safety and efficacy of dTRA versus conventional trans-radial access (TRA) regarding peri-procedural complications remain largely uncharacterized.

Approach:

• A systematic review and meta-analysis of randomized clinical trials (RCTs) was conducted.
• Embase and PubMed/MEDLINE databases were searched up to June 25, 2022, for RCTs comparing dTRA and TRA.
• Outcomes included radial artery occlusion (RAO), spasm, hemostasis time, access time, cannulation success, crossover rates, and hematomas.

Key Points:

• The analysis included 6 RCTs with 3240 patients, predominantly male (73%) with a mean age of 66 years.
• dTRA demonstrated a significantly lower risk of RAO (RR 0.43) and shorter hemostasis time (MD -22.85 min).
• Conversely, dTRA showed a higher crossover rate (RR 3.04) and longer access time (MD 0.68 min), while TRA had a lower rate of unsuccessful cannulation (RR 0.81). No significant differences were observed for radial artery spasm or hematomas.

Conclusions:

• Distal trans-radial access (dTRA) presents a safe alternative to conventional trans-radial access (TRA) in coronary interventions, notably reducing the incidence of radial artery occlusion.
• Further research and randomized clinical trials are warranted to comprehensively evaluate and compare the procedural outcomes and long-term implications of both dTRA and TRA techniques.