Right versus left distal radial access for coronary procedures in a large prospective multicenter registry: Insight
Chan Joon Kim1, Seonghyeon Bu1, Jun-Won Lee2
1Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, South Korea.
Insights
Right distal radial artery access (RDRA) has a higher crossover rate but comparable success and bleeding risks versus left DRA (LDRA). Procedural times were shorter with RDRA, influenced by operator preference.
Area of Science:
- Cardiology
- Vascular Access Procedures
- Interventional Cardiology
Background:
- Distal radial access (DRA) is a key technique in interventional cardiology.
- Both right (RDRA) and left (LDRA) distal radial arteries can be used for DRA.
- Limited comparative data exists for RDRA versus LDRA outcomes.
Purpose of the Study:
- To compare procedural outcomes between right distal radial artery access (RDRA) and left distal radial artery access (LDRA).
- To evaluate the primary endpoint of access-site crossover after successful puncture.
- To assess secondary endpoints including procedural success, crossover rates, bleeding, and procedure times.
Main Methods:
- Analysis of data from the KODRA registry.
- Comparison of procedural outcomes between RDRA and LDRA in 4977 patients.
- Statistical analysis of primary and secondary endpoints, including multivariable analysis.
Main Results:
- RDRA demonstrated a significantly higher rate of access-site crossover post-puncture (1.7% vs. 0.7%, p<0.001).
- Successful coronary angiography (CAG), puncture success, overall crossover, and bleeding rates were comparable between RDRA and LDRA.
- Arterial puncture and CAG procedure times were significantly shorter with RDRA (p<0.001).
Conclusions:
- RDRA is associated with a higher risk of access-site crossover compared to LDRA.
- Success rates for CAG and puncture, overall crossover, and bleeding are similar between RDRA and LDRA.
- Shorter procedural times with RDRA are influenced by operator preference for the access side.
Background:
Distal radial access (DRA) can be performed from either the right or left distal radial artery. However, comparative data between these two access routes remain limited.
Methods:
Using data from the KODRA registry, we compared procedural outcomes between right (RDRA) and left DRA (LDRA). The primary endpoint was access-site crossover after successful puncture. Secondary endpoints included successful coronary angiography (CAG) via the initial access site, puncture success, overall access-site crossover, DRA-related bleeding, and procedure-related times.
Results:
Among 4977 patients, RDRA showed a higher rate of access-site crossover (1.7% vs. 0.7%, p < 0.001). Rates of successful CAG (92.5% vs. 93.8%, p = 0.087), puncture success (94.2% vs. 94.5%, p = 0.670), overall access-site crossover (7.5% vs. 6.2%, p = 0.068), and DRA-related bleeding (3.0% vs. 3.4%, p = 0.446) were comparable between groups. The times for arterial puncture and CAG were significantly shorter with RDRA than with LDRA (88.2 ± 115.4 s vs. 107.9 ± 123.2 s; 8.6 ± 6.7 min vs. 10.9 ± 8.3 min; both p < 0.001), although procedural times were shorter when procedures were performed on the operators' preferred access side. In multivariable analysis, RDRA independently predicted access-site crossover after successful puncture (OR 2.156, 95% CI 1.184-3.926).
Conclusions:
Compared with LDRA, RDRA was associated with a higher risk of access-site crossover, whereas success rates of CAG and puncture, overall access-site crossover, and DRA-related bleeding were comparable. The shorter procedural times with RDRA were largely influenced by the operator's access-side preference.
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