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Distal transradial access for percutaneous coronary intervention: a single-center randomized controlled study (DRAGON
Minghao Liu1, Yuan Du1, Cheng Cui1
1Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Insights
Distal transradial access (dTRA) significantly reduces radial artery occlusion (RAO) after percutaneous coronary intervention (PCI) compared to traditional transradial access (TRA). This approach also shortens hemostasis time without impacting procedural success.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Cardiology
Background:
- Transradial access (TRA) is standard for coronary interventions due to lower bleeding risk and better patient comfort.
- Radial artery occlusion (RAO) limits re-use of the radial artery for future procedures.
- Distal transradial access (dTRA) is investigated to decrease RAO while maintaining procedural efficacy.
Purpose of the Study:
- To evaluate if distal transradial access (dTRA) reduces early and mid-term radial artery occlusion (RAO) compared to conventional transradial access (TRA).
- To assess the impact of dTRA on procedural success, hemostasis time, radiation exposure, and hand/wrist function in patients undergoing percutaneous coronary intervention (PCI).
Main Methods:
- A single-center, prospective, randomized superiority trial included 426 patients undergoing elective PCI.
- Patients were assigned 1:1 to either dTRA (n=213) or TRA (n=213).
- Radial artery occlusion (RAO) was assessed using duplex ultrasonography at 24 hours and 30 days post-procedure.
Main Results:
- The 24-hour RAO rate was significantly lower in the dTRA group (0.5%) versus the TRA group (8.7%; p<0.001).
- At 30 days, RAO remained significantly lower with dTRA (1.6%) compared to TRA (8.2%; p<0.001).
- Median hemostasis time was shorter with dTRA (3.0 hours) versus TRA (6.0 hours; p<0.001), with comparable procedural success and radiation exposure.
Conclusions:
- Distal transradial access (dTRA) significantly reduces RAO incidence and shortens hemostasis time compared to TRA in elective PCI.
- dTRA does not compromise procedural success or increase radiation exposure.
- The findings support the routine adoption of dTRA for coronary interventions, with modest improvements in early hand function.
Background:
Transradial access (TRA) is the standard vascular approach for coronary interventions because it lowers bleeding risk and improves patient comfort. Nevertheless, radial artery occlusion (RAO) remains an important limitation, preventing re-use of the radial artery for subsequent procedures. Distal transradial access (dTRA) has been proposed as a strategy to further reduce RAO while preserving procedural efficacy.
Aims:
To assess whether dTRA reduces early and mid-term RAO compared with conventional TRA in patients undergoing percutaneous coronary intervention (PCI).
Methods:
In this single-center, prospective, randomized, open-label superiority trial, 426 consecutive patients scheduled for elective PCI between July 2023 and January 2024 were assigned 1:1 to dTRA (n = 213) or TRA (n = 213). Duplex ultrasonography was used to assess RAO at 24 h and 30 days.
Primary Endpoint:
24-hour RAO; secondary endpoints: 30-day RAO, procedural success, hemostasis time, radiation exposure, and hand/wrist function scores.
Results:
One patient withdrew consent, leaving 425 patients (dTRA 213, TRA 212) for analysis. The 24-hour RAO rate was significantly lower in the dTRA group compared to the TRA group (0.5% vs. 8.7%, p < 0.001). At 30 days, RAO remained lower in the dTRA group (1.6% vs. 8.2%, p < 0.001). Median hemostasis time was 3.0 h with dTRA versus 6.0 h with TRA (p < 0.001). Procedural success was comparable between groups (82.2% vs. 80.2%; p = 0.72), as was the fluoroscopy dose (1630.0 mGy [1069.0-2481.0] vs. 1598.0 mGy [1039.0-2512.0], p = 0.73). Early wrist function scores were marginally better in the dTRA group (p = 0.048).
Conclusions:
In elective PCI patients, dTRA significantly reduces RAO incidence and shortens hemostasis time compared to TRA, without compromising procedural success or increasing radiation exposure, while modestly improving early hand function. These data support routine adoption of dTRA for coronary interventions.
Trial Registration:
Chinese Clinical Trial Registry: ChiCTR2300073902 (registered on 25 July 2023).
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