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      Feasibility and Safety of the Distal Transradial Artery for Coronary Diagnostic or Interventional Catheterization

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          Abstract

          Background

          This prospective study compared the success rate and safety of a distal transradial artery (dTRA) approach to that of the conventional transradial artery (TRA) for coronary angiography or percutaneous coronary intervention.

          Methods

          From January 2019 to April 2020, nine hundred consecutive patients (height < 190 cm) scheduled for coronary angiography or percutaneous coronary interventions were randomly and equally assigned to receive either dTRA or conventional TRA catheterization.

          Results

          Successful access was achieved in 96.00% and 96.67% of the dTRA and conventional TRA groups, respectively ( P=0.814). Compared with the TRA group, patients in the dTRA experienced significantly less hemostatic band removal time (150.5 ± 50.5 cf. 210.6 ± 60.5 min, P=0.032); minor bleeding of the access site (2.44% cf. 6.44%, P=0.038); hemostatic band cost (USD; 0.1 cf. 59.4, P=0); and postprocedural radial artery occlusion (1.56% cf. 3.78%, P=0.035). A lower body mass index was a higher risk factor for dTRA access failure (odds ratio = 0.79, P=0.024), with a cutoff of 22.04 kg/m 2.

          Conclusion

          Compared to conventional TRA, dTRA had a comparable high success rate, with fewer associated complications. Clinicians should use the dTRA with caution in patients with low body mass index.

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          Most cited references17

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          Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial.

          Sanjit S Jolly, Salim Yusuf, John Cairns … (2011)
          Small trials have suggested that radial access for percutaneous coronary intervention (PCI) reduces vascular complications and bleeding compared with femoral access. We aimed to assess whether radial access was superior to femoral access in patients with acute coronary syndromes (ACS) who were undergoing coronary angiography with possible intervention. The RadIal Vs femorAL access for coronary intervention (RIVAL) trial was a randomised, parallel group, multicentre trial. Patients with ACS were randomly assigned (1:1) by a 24 h computerised central automated voice response system to radial or femoral artery access. The primary outcome was a composite of death, myocardial infarction, stroke, or non-coronary artery bypass graft (non-CABG)-related major bleeding at 30 days. Key secondary outcomes were death, myocardial infarction, or stroke; and non-CABG-related major bleeding at 30 days. A masked central committee adjudicated the primary outcome, components of the primary outcome, and stent thrombosis. All other outcomes were as reported by the investigators. Patients and investigators were not masked to treatment allocation. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, NCT01014273. Between June 6, 2006, and Nov 3, 2010, 7021 patients were enrolled from 158 hospitals in 32 countries. 3507 patients were randomly assigned to radial access and 3514 to femoral access. The primary outcome occurred in 128 (3·7%) of 3507 patients in the radial access group compared with 139 (4·0%) of 3514 in the femoral access group (hazard ratio [HR] 0·92, 95% CI 0·72-1·17; p=0·50). Of the six prespecified subgroups, there was a significant interaction for the primary outcome with benefit for radial access in highest tertile volume radial centres (HR 0·49, 95% CI 0·28-0·87; p=0·015) and in patients with ST-segment elevation myocardial infarction (0·60, 0·38-0·94; p=0·026). The rate of death, myocardial infarction, or stroke at 30 days was 112 (3·2%) of 3507 patients in the radial group compared with 114 (3·2%) of 3514 in the femoral group (HR 0·98, 95% CI 0·76-1·28; p=0·90). The rate of non-CABG-related major bleeding at 30 days was 24 (0·7%) of 3507 patients in the radial group compared with 33 (0·9%) of 3514 patients in the femoral group (HR 0·73, 95% CI 0·43-1·23; p=0·23). At 30 days, 42 of 3507 patients in the radial group had large haematoma compared with 106 of 3514 in the femoral group (HR 0·40, 95% CI 0·28-0·57; p<0·0001). Pseudoaneurysm needing closure occurred in seven of 3507 patients in the radial group compared with 23 of 3514 in the femoral group (HR 0·30, 95% CI 0·13-0·71; p=0·006). Radial and femoral approaches are both safe and effective for PCI. However, the lower rate of local vascular complications may be a reason to use the radial approach. Sanofi-Aventis, Population Health Research Institute, and Canadian Network for Trials Internationally (CANNeCTIN), an initiative of the Canadian Institutes of Health Research. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; Systematic overview and meta-analysis of randomized trials.

            Giovanni de Castro, Martial Hamon, M Luisa de Benedictis … (2004)
            We sought to compare, through a meta-analytic process, the transradial and transfemoral approaches for coronary procedures in terms of clinical and procedural outcomes. The radial approach has been increasingly used as an alternative to femoral access. Several trials have compared these two approaches, with inconclusive results. The MEDLINE, CENTRAL, and conference proceedings from major cardiologic associations were searched. Random-effect odds ratios (ORs) for failure of the procedure (crossover to different entry site or impossibility to perform the planned procedure), entry site complications (major hematoma, vascular surgery, or arteriovenous fistula), and major adverse cardiovascular events (MACE), defined as death, myocardial infarction, emergency revascularization, or stroke, were computed. Twelve randomized trials (n = 3,224) were included in the analysis. The risk of MACE was similar for the radial versus femoral approach (OR 0.92, 95% confidence interval [CI] 0.57 to 1.48; p = 0.7). Instead, radial access was associated with a significantly lower rate of entry site complications (OR 0.20, 95% CI 0.09 to 0.42; p < 0.0001), even if at the price of a higher rate of procedural failure (OR 3.30, 95% CI 1.63 to 6.71; p < 0.001). The radial approach for coronary procedures appears as a safe alternative to femoral access. Moreover, radial access virtually eliminates local vascular complications, thanks to a time-sparing hemostasis technique. However, gaining radial access requires higher technical skills, thus yielding an overall lower success rate. Nonetheless, a clear ongoing trend toward equalization of the two procedures, in terms of procedural success, is evident through the years, probably due to technologic progress of materials and increased operator experience.
            Article 0 comments Cited 150 times – based on 0 reviews     Review now
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              Left distal transradial access in the anatomical snuffbox for coronary angiography (ldTRA) and interventions (ldTRI).

              Ferdinand Kiemeneij (2017)
              To demonstrate the feasibility of distal left transradial approach for patients in whom left radial access is preferred over right radial access for coronary angiography and interventions. This procedure is more convenient for the operator. For the right- handed patient, left radial access is more convenient because of the free use of the right hand after the procedure. In addition, this technique reduces the chance for radial artery occlusion at the site of the distal forearm.
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                Author and article information

                Contributors
                Shaohong Dong:
                ORCID: https://orcid.org/0000-0002-7615-7931
                Journal
                Journal ID (nlm-ta): J Interv Cardiol
                Journal ID (iso-abbrev): J Interv Cardiol
                Journal ID (publisher-id): JITC
                Title: Journal of Interventional Cardiology
                Publisher: Hindawi
                ISSN (Print): 0896-4327
                ISSN (Electronic): 1540-8183
                Publication date Collection: 2020
                Publication date (Electronic): 9 December 2020
                Volume: 2020
                Electronic Location Identifier: 4794838
                Affiliations
                1Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Guangzhou, China
                2The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen 518020, Guangdong, China
                Author notes

                Academic Editor: Piotr Musialek

                Author information
                https://orcid.org/0000-0002-4075-4259
                https://orcid.org/0000-0002-7615-7931
                Article
                DOI: 10.1155/2020/4794838
                PMC ID: 7744178
                PubMed ID: 33380922
                SO-VID: 2a9499dd-e254-4307-86c1-afb9f2b4e9c0
                Copyright © Copyright © 2020 Yaowang Lin et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 8 May 2020
                Date revision received : 12 July 2020
                Date accepted : 23 November 2020
                Funding
                Funded by: Shenzhen Municipal Health Commission
                Award ID: SZFZ2017029
                Award ID: SZLY2017025
                Funded by: Shenzhen Foundation
                Award ID: JCYJ20170307100512856
                Categories
                Subject: Research Article

                Data availability:

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