Randomized Trial Comparing Radial and Ulnar Access in Single-Catheter Primary Coronary Intervention

To compare the procedural success, complication rates, and clinical outcomes of transradial and transulnar arterial interventions in patients undergoing primary percutaneous coronary interventions (PCIs) due to acute ST elevation myocardial infarction (STEMI). The effectiveness of access routes was evaluated in procedures performed using a single catheter.

A total of 258 patients diagnosed with STEMI and who underwent primary PCI were included in the study. Eighteen patients were excluded for not meeting the study criteria, and the remaining 240 patients were randomized 1:1 into radial and ulnar groups. After excluding cross-overs, the remaining 231 patients underwent the procedure, including 113 via the radial route (Group R) and 118 via the ulnar route (Group U), and their data were analyzed. Procedural success, the number of arterial punctures, procedure duration, complication rates and clinical outcomes were prospectively compared.

No significant difference in procedural success was observed between the two groups. However, the number of arterial punctures was higher in the transulnar group (≥ 2 punctures: Group R: 24 [21.2%], Group U: 48 [40.7%]; p = 0.001), and the puncture duration was longer (Group R: 15 sec [10-20], Group U: 15 sec [10-30], p = 0.001). There were no significant differences in post-procedural hematoma formation or arterial occlusion rates between the two groups.

Our results demonstrated that single-catheter transulnar access offers a similar procedural success rate and safety profile to transradial access. However, transulnar access was associated with a longer puncture duration and increased puncture attempts. Transulnar access may be considered a reliable alternative when transradial access is not feasible.