Comparison of Radial Artery Patency Rates One Month Post-intervention: Distal vs. Proximal Radial Access for Coronary...

Background Traditionally, transfemoral and conventional trans-radial access sites have been used in coronary interventions. While the former is prone to complications like bleeding, hematoma, arteriovenous (AV) fistula, and increased morbidity and mortality, the latter is associated with instances of spasm and occlusion of the artery and compartment syndrome. Distal radial and ulnar access have recently been explored as alternative access sites. Therefore, this study was conducted to evaluate and compare its safety and efficacy with the conventional proximal radial access with a special focus on patency of the proximal radial artery at 30 days post-intervention and preserve proximal radial access for future coronary interventions. Methodology This prospective, randomized controlled study was conducted after obtaining approval from the Institutional Ethics Committee. A total of 150 patients suspected to have coronary artery disease and undergoing coronary interventions were included after obtaining voluntary, written, and informed consent, provided they met the inclusion and exclusion criteria. They were randomly divided into two groups: Group P (proximal radial access) and Group D (distal radial access [DRA]). Demographic details and relevant histories were noted. Under aseptic conditions, access was secured as per the assigned group. Intraoperative findings were noted. The patients were followed up on postoperative days 1, 7, and 30, and a Doppler study was done to assess for any occlusion at the proximal radial artery access site. Results In the present study, it was noted that both groups were similar in terms of demographic details and personal histories. The sheath insertion time (P-value = 0.039) and time to hemostasis (P-value < 0.001) were significantly less in Group D as compared to Group P. The number of attempts (P-value = 0.034) and the number of crossovers (P-value = 0.04) were higher in Group D as compared to Group P, with successful sheath insertion rates being higher in Group P (P-value = 0.04). Radial artery occlusion was significantly less in Group D as compared to Group P on days 7 and 30 (P-value = 0.004). However, the postoperative pain was significantly more in Group D (P-value < 0.001). Conclusions DRA is a safe and effective alternative to the conventional proximal radial access technique for coronary interventions. DRA is also useful as it preserves the patency of the proximal radial artery, which is useful for access during future interventions.