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Distal Radial Access for Coronary Procedures in a Large Prospective Multicenter Registry: The KODRA Trial
Jun-Won Lee1, Yongcheol Kim2, Bong-Ki Lee3
1Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea.
Insights
Distal radial access (DRA) shows high success in coronary angiography and intervention, with low complication rates. Weak pulse and limited operator experience predict puncture failure in this large registry.
Area of Science:
- Interventional Cardiology
- Vascular Access Techniques
- Clinical Trials
Background:
- Distal radial access (DRA) is an emerging alternative vascular access route.
- Limited evidence currently exists regarding the safety and efficacy of DRA in routine practice.
Purpose of the Study:
- To evaluate the safety and feasibility of distal radial access (DRA) in daily clinical practice.
- To assess the success rates of coronary angiography (CAG) and percutaneous coronary intervention (PCI) using DRA.
Main Methods:
- Prospective, multicenter registry (KODRA trial) involving 4,977 patients across 14 hospitals.
- Primary endpoints: CAG and PCI success rates. Secondary endpoints: puncture success, crossover rates, access-site complications, bleeding events, and puncture failure predictors.
Main Results:
- High success rates for CAG (100%) and PCI (98.8%) via DRA.
- Successful distal radial artery puncture achieved in 94.4% of cases.
- Low rates of distal radial artery occlusion (0.8%), radial artery occlusion (0.8%), and DRA-related bleeding (3.3%) with no serious hematomas.
Conclusions:
- Distal radial access (DRA) is safe and effective for coronary procedures, demonstrating high success and low complication rates.
- Predictors of puncture failure include a weak pulse and less than 100 prior DRA cases for the operator.
Background:
Distal radial access (DRA) as an alternative access route lacks evidence, despite its recent reputation.
Objectives:
The aim of this study was to evaluate the safety and feasibility of DRA on the basis of daily practice.
Methods:
The KODRA (Korean Prospective Registry for Evaluating the Safety and Efficacy of Distal Radial Approach) trial was a prospective multicenter registry conducted at 14 hospitals between September 2019 and September 2021. The primary endpoints were the success rates of coronary angiography (CAG) and percutaneous coronary intervention (PCI). The secondary endpoints included successful distal radial artery puncture, access-site crossover, access site-related complications, bleeding events, and predictors of puncture failure.
Results:
A total of 4,977 among 5,712 screened patients were recruited after the exclusion of 735 patients. The primary endpoints, the success rates of CAG and PCI via DRA, were 100% and 98.8%, respectively, among successful punctures of the distal radial artery (94.4%). Access-site crossover occurred in 333 patients (6.7%). The rates of distal radial artery occlusion and radial artery occlusion by palpation were 0.8% (36 of 4,340) and 0.8% (33 of 4,340) at 1-month follow-up. DRA-related bleeding events were observed in 3.3% of patients, without serious hematoma. Multilevel logistic regression analysis identified weak pulse (OR: 9.994; 95% CI: 7.252-13.774) and DRA experience <100 cases (OR: 2.187; 95% CI: 1.383-3.456) as predictors of puncture failure.
Conclusions:
In this large-scale prospective multicenter registry, DRA demonstrated high success rates of CAG and PCI, with a high rate of puncture success but low rates of distal radial artery occlusion, radial artery occlusion, bleeding events, and procedure-related complications. Weak pulse and DRA experience <100 cases were predictors of puncture failure. (Korean Prospective Registry for Evaluating the Safety and Efficacy of Distal Radial Approach [KODRA]; NCT04080700).
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