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Comparing distal and proximal radial access for percutaneous coronary intervention and angiography: a comprehensive
Mostafa Adel T Mahmoud1,2, Nada G Hamam2,3, Thoria I Essa Ghanm2,4
1Faculty of Medicine, Beni Suef University, Beni Suef, Egypt.
Insights
Distal radial access (DRA) offers a safer alternative for coronary procedures, reducing complications like radial artery occlusion. However, DRA presents challenges with access time and failure rates compared to proximal radial access (PRA).
Area of Science:
- Cardiovascular Interventions
- Vascular Access Techniques
- Interventional Cardiology
Background:
- Distal radial access (DRA) is an emerging technique for coronary procedures.
- Evidence suggests DRA may lower complication risks compared to proximal radial access (PRA).
Purpose of the Study:
- To systematically review and compare clinical and procedural outcomes of DRA versus PRA.
- To evaluate the safety and efficacy of DRA for coronary angiography and percutaneous coronary intervention.
Main Methods:
- Systematic review of randomized controlled trials (RCTs).
- Searched PubMed, Web of Science, Cochrane, and Scopus.
- Included 23 RCTs with 10,062 patients.
Main Results:
- DRA significantly reduced radial artery occlusion, bleeding, and hand clumsiness.
- DRA demonstrated a shorter time to hemostasis.
- DRA had higher access failure rates, longer access times, and increased pain.
- Major adverse cardiac events and hand function were comparable between DRA and PRA.
Conclusions:
- Distal radial access (DRA) is a safe alternative to proximal radial access (PRA) for coronary procedures.
- DRA offers reduced complication rates, notably radial artery occlusion.
- Access-related challenges, including failure rates and pain, are limitations of DRA.
Background:
Distal radial access (DRA) through the anatomical snuff-box is a novel technique for coronary procedures. Emerging evidence suggests that DRA is associated with a lower risk of certain complications compared to proximal radial access (PRA).
Methods:
A systematic review was conducted to compare clinical and procedural outcomes between both access sites for coronary angiography and percutaneous coronary intervention. We searched PubMed , Web of Science , Cochrane , and Scopus to identify relevant randomized controlled trials.
Results:
We included 23 randomized controlled trials enrolling 10 062 patients (DRA group: 5042; PRA group: 5020) in this review. DRA was associated with a lower risk for radial artery occlusion (RAO) at the longest reported follow-up [risk ratio (RR): 0.30, P < 0.00001], in-hospital RAO (RR: 0.28, P < 0.00001), any bleeding (RR: 0.40, P = 0.04), hand clumsiness (RR: 0.05, P < 0.00001), and shorter time to hemostasis [mean difference (MD): -40.93, P < 0.00001]. However, DRA showed a higher access failure rate (RR = 2.64, P < 0.00001), longer access time (MD = 0.77, P < 0.00001), more puncture attempts (MD: 0.60, P < 0.0001), and greater access-related pain [standardized mean difference (SMD) = 0.23, P = 0.02]. Both approaches were comparable in terms of major adverse cardiac events (RR = 0.74, P = 0.60), and hand function (SMD = -0.05, P = 0.68).
Conclusion:
DRA is a safe alternative to PRA for coronary procedures, with a lower risk of complications, including RAO. However, it is limited by access-related challenges.
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