A Randomized Comparison of Radial Artery Intimal Hyperplasia Following Distal Versus Proximal Transradial Access for...

Area of Science:

• Cardiovascular Interventions
• Vascular Ultrasound
• Radial Artery Physiology

Background:

• Distal transradial access (dTRA) offers an alternative to conventional forearm transradial access (fTRA) for coronary angiography (CAG).
• Limited data exists on the comparative healing of the radial artery (RA) between these two access strategies.
• The study aimed to evaluate differences in forearm RA intimal-medial thickening (IMT) following dTRA versus fTRA.

Purpose of the Study:

• To compare the mean difference in forearm radial artery intimal-medial thickening (IMT) between patients randomized to distal transradial access (dTRA) versus forearm transradial access (fTRA).
• To assess secondary outcomes including procedural characteristics, vascular injury, RA occlusion, and ipsilateral hand pain and function.

Main Methods:

• A single-center randomized clinical trial involving 64 patients undergoing nonemergent CAG.
• Patients were randomized (1:1) to either dTRA or fTRA.
• Ultra-high-resolution vascular ultrasound (55-MHz) assessed forearm and distal RA IMT pre-CAG and at 90 days.

Main Results:

• No significant difference was observed in the mean change of forearm RA IMT between the dTRA and fTRA cohorts (0.07 mm vs. 0.07 mm; P=0.37).
• Procedural characteristics, vascular injury, and RA occlusion rates were comparable between groups at 90 days.
• Ipsilateral hand pain and function scores were similar, with no significant differences reported.

Conclusions:

• Distal transradial access (dTRA) for CAG demonstrated no significant differences in forearm radial artery IMT, hand pain, or function compared to forearm transradial access (fTRA).
• Further research is needed to understand RA healing mechanisms and predictors.
• Identifying strategies to preserve RA integrity for future procedures is essential.