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Feasibility and Safety of Distal Transradial Access in Patients With Out-of-Hospital Cardiac Arrest Undergoing
Shiori Kawakami1, Norimasa Taniguchi1, Takeshi Yamada1
1Department of Cardiology, Sakurakai Takahashi Hospital, Kobe, Japan.
Insights
Distal transradial access (dTRA) is feasible and safe for emergency percutaneous coronary intervention (PCI) in out-of-hospital cardiac arrest (OHCA) patients. Careful selection and monitoring are crucial due to potential ischemic complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Distal transradial access (dTRA) offers potential vascular complication benefits over conventional transradial access (TRA).
- Its utility in out-of-hospital cardiac arrest (OHCA) patients undergoing emergency percutaneous coronary intervention (PCI) is not well-established.
Purpose of the Study:
- To assess the feasibility, safety, and clinical outcomes of using dTRA in OHCA patients requiring emergency PCI.
- To identify potential complications and success rates associated with this approach.
Main Methods:
- Retrospective single-center study of 48 OHCA patients undergoing emergency PCI.
- dTRA was the primary access strategy in 44 patients.
- Data on procedural success, access-site complications, and clinical outcomes were analyzed.
Main Results:
- Successful dTRA in 97.7% of attempted cases (43/44).
- High utilization of mechanical circulatory support (38/43 patients).
- Low rate of major bleeding (BARC 3-5), but one case of limb ischemia requiring amputation and minor hematomas occurred.
Conclusions:
- dTRA is a feasible and safe strategy for emergency PCI in most OHCA patients, even with mechanical support.
- Vigilant monitoring and careful patient selection are necessary to mitigate risks of critical ischemic complications in unstable patients.
Background:
Distal transradial access (dTRA) has gained attention for its lower risk of vascular complications compared to conventional transradial access (TRA). However, its feasibility and safety in patients with out-of-hospital cardiac arrest (OHCA) undergoing emergency percutaneous coronary intervention (PCI) remain uncertain.
Aim:
To evaluate the procedural success, safety, and clinical outcomes of dTRA in OHCA patients undergoing emergency PCI.
Methods:
This retrospective single-center study included 48 OHCA patients who underwent emergency PCI for presumed coronary etiology between January 2022 and December 2025. dTRA was the default access strategy unless contraindicated. Among them, dTRA was attempted in 44 patients. Patients in whom dTRA was successfully achieved were included in the main analysis. Clinical, procedural, and outcome data were comprehensively reviewed, including access-site complications and neurological status.
Results:
dTRA was successfully achieved in 43 of 44 attempted cases (97.7%). The median door-to-balloon time was 67 min. Mechanical circulatory support was used in 38 patients (extracorporeal membrane oxygenation: 17; intra-aortic balloon pumping: 29). Access-site complications included one case of limb ischemia requiring amputation and three minor hematomas (EASY classification grade 3-5) with no major bleeding (BARC 3-5). The 30-day mortality was 51.2% (22/43), and among the 21 survivors, 14 (66.7%) achieved a favorable neurological outcome (CPC 1-2).
Conclusions:
In this OHCA cohort requiring emergency PCI, dTRA was feasible and safe in the majority of patients, including those receiving mechanical support. However, critical ischemic complications may still occur under unstable systemic conditions, warranting careful patient selection and vigilant post-procedural monitoring.
