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Hand Dysfunction After Intervention via Distal Versus Conventional Transradial Access: A Meta-Analysis of Randomized
Xinyu Fan1, Tong Zhou2, Feng Li2
1Changzhou Wujin People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China.
Insights
Distal transradial access (dTRA) may reduce hand clumsiness and pain after percutaneous coronary intervention (PCI) compared to conventional transradial access (TRA). However, dTRA might increase the risk of temporary hand numbness.
Area of Science:
- Cardiovascular Interventions
- Vascular Access Techniques
- Patient Outcomes Research
Background:
- Percutaneous coronary intervention (PCI) is a key treatment for coronary artery disease (CAD).
- Distal transradial access (dTRA) is emerging as an alternative to traditional transradial access (TRA).
- Both TRA and dTRA can potentially lead to post-procedural hand dysfunction.
Purpose of the Study:
- To compare the incidence of hand dysfunction and vascular complications between dTRA and TRA.
- To evaluate the safety and efficacy of dTRA versus TRA in cardiovascular interventions.
Main Methods:
- A systematic review and meta-analysis of 11 randomized controlled trials (RCTs) from PubMed and Web of Science.
- Evaluation of hand motor and sensory dysfunction, nerve injury, and radial artery occlusion (RAO).
Main Results:
- dTRA may be associated with lower risks of hand motor dysfunction and persistent pain compared to TRA.
- A potentially higher incidence of temporary hand numbness was observed with dTRA within 24 hours post-procedure.
- dTRA demonstrated a significantly lower risk of radial artery occlusion (RAO) than TRA.
Conclusions:
- dTRA offers potential advantages over TRA, including reduced hand clumsiness, persistent pain, RAO, and arteriovenous fistula (AVF) formation.
- Clinicians should be aware of the potentially higher, though likely transient, risk of hand numbness with dTRA.
Background:
Percutaneous coronary intervention (PCI) is an important treatment for coronary artery disease (CAD). Distal transradial access (dTRA) has gained popularity as an alternative to conventional transradial access (TRA) in cardiovascular interventional procedures. However, some patients may experience hand dysfunction after undergoing TRA or dTRA procedures.
Methods:
In this study, the literature from the PubMed and Web of Science (WOS) databases was reviewed and 11 randomized controlled trials (RCTs) were selected. Meta-analysis and narrative synthesis were used to evaluate the hand dysfunction and vascular complications.
Result:
A total of 6903 participants were included in the study. The average age was 62.8 years, and 66.9% were male. In terms of hand motor dysfunction, pooled data from two trials showed that the risk of dTRA may be lower than that of TRA. In terms of hand sensory dysfunction, a pooled analysis of two studies showed that the incidence of numbness within 24 h postoperatively may be higher with dTRA than with TRA, but the incidence of persistent pain may be lower with dTRA than with TRA. Only one included study reported the incidence of nerve injury. Additionally, a pooled analysis of ten trials demonstrated that dTRA had a lower risk of radial artery occlusion (RAO) than TRA.
Conclusion:
Compared with TRA, dTRA may be associated with a lower risk of hand clumsiness, persistent pain, RAO, and AVF, but a potentially higher incidence of hand numbness.
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