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Distal radial access for coronary procedures in an all-comer population: the first 1000 patients in a prospective
Kristian Rivera1,2, Diego Fernández-Rodríguez1,2, Marcos García-Guimarães1,2
1Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lleida, España Servei de Cardiologia Hospital Universitari Arnau de Vilanova Lleida España.
Insights
Distal radial access (DRA) is a safe and effective alternative for coronary procedures, showing high success rates and low complications. Ultrasound guidance enhances DRA feasibility in diverse patient groups.
Area of Science:
- Cardiology
- Vascular Access
- Interventional Cardiology
Background:
- Distal radial access (DRA) offers advantages over traditional transradial access for coronary procedures, mainly concerning fewer access-related complications.
- Widespread adoption of DRA as a primary approach is limited despite its benefits.
Purpose of the Study:
- To evaluate the initial experience and outcomes of distal radial access (DRA) for coronary procedures.
- To assess the safety, feasibility, and performance metrics of DRA in a real-world clinical setting.
Main Methods:
- A prospective cohort study involving 1000 DRA procedures in 943 patients over 3 years.
- Utilized pre- and postprocedural ultrasound for radial artery assessment and ultrasound-guided puncture.
- Primary endpoint: DRA success; Secondary endpoints: coronary procedure success, performance metrics, and complications.
Main Results:
- High DRA success rate (97.4%) and coronary procedure success rate (96.9%).
- Median DRA time was 40 seconds; 64% diagnostic, 36% percutaneous coronary intervention (PCI).
- Ultrasound guidance used in 85% of cases, with a low access-related complication rate of 2.9%.
Conclusions:
- Distal radial access (DRA) is safe and feasible for coronary procedures, especially with ultrasound guidance.
- Achieved high success rates for both access and coronary interventions with minimal complications.
- Findings support DRA as a viable alternative approach in diverse patient populations.
Introduction And Objectives:
Distal radial access (DRA) for coronary procedures is currently recognized as an alternative to conventional transradial access, with documented advantages primarily related to access-related complications. However, widespread adoption of DRA as the default approach remains limited. Therefore, this prospective cohort study aimed to present our initial experience with DRA for coronary procedures in any clinical settings.
Methods:
From August 2020 to November 2023, we included 1000 DRA procedures (943 patients) conducted at a single center. The study enrolled a diverse patient population. We recommended pre- and postprocedural ultrasound evaluations of the radial artery course, with ultrasound-guided DRA puncture. The primary endpoint was DRA success, while secondary endpoints included coronary procedure success, DRA performance metrics, and the incidence of access-related complications.
Results:
The DRA success rate was 97.4% (n = 974), with coronary procedure success at 96.9% (n = 969). The median DRA time was 40 [interquartile range, 30-60] seconds. Diagnostic procedures accounted for 64% (n = 644) of cases, while 36% (n = 356) involved percutaneous coronary intervention (PCI), including primary PCI in 13% (n = 128). Pre-procedure ultrasound evaluation and ultrasound-guided DRA were performed in 83% (n = 830) and 85% (n = 848) of cases, respectively. Access-related complications occurred in 2.9% (n = 29).
Conclusions:
This study shows the safety and feasibility of DRA for coronary procedures, particularly when performed under ultrasound guidance in a diverse patient population. High rates of successful access and coronary procedure outcomes were observed, together with a low incidence of access-related complications. The study was registered on ClinicalTrials.gov (NTC06165406).
Related Concept Videos
01:11Assessment of radial pulse
The radial pulse, located at the wrist, is often the preferred site for assessing peripheral pulse because of its accessibility and dependability. The process of determining the radial pulse involves several steps:
01:25Assessment of apical radial pulse
The A-R pulse assessment involves simultaneous evaluation of the apical and radial pulses. When the apical and radial pulse rates vary, this assessment helps identify a pulse deficit.
Pre-Procedural Preparation
01:24Cardiac Catheterization III: Left Heart Catheterization
01:27Coronary Artery Disease V: Interprofessional Care
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:21Cardiac Catheterization II: Right Heart Catheterization