Distal transradial access for percutaneous coronary intervention: a single-center randomized controlled study (DRAGON...

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.