<p><strong>Aim</strong>. The analyses of radial artery patency during hospitalisation in patients with acute coronary syndrome after percutaneous coronary interventions were performed using three options of radial approaches, i.e. traditional, classical and dorsopalmar distal radial approaches.</p><p><strong>Methods</strong>. Patients (n = 178) with acute coronary syndrome on whom endovascular procedure by the traditional and two options of distal radial approach were performed met the entry criteria. The classical distal radial approach was performed within an anatomic snuffbox in 65 patients (36.5%), and the dorsopalmar type was performed in 29 patients (16.3%); the traditional radial approach was performed in 84 patients (47.2%). On completion of the percutaneous coronary interventions and final radial artery angiography, hemostasis was performed with bandage application for 6 h. From <!-- x-tinymce/html-mce_16411137711604383874135 -->the 5<sup>th</sup> to the 7<sup>th</sup> day after intervention, examination, palpation and ultrasound duplex scan were performed in every patient.</p><p><strong>Results</strong>. Examination, palpation and ultrasound duplex scan performed from the 5th to 7th day after intervention revealed 3 cases (1.7%) of forearm radial artery occlusion (high type). All the 3 cases were in the traditional radial approach group. Access side radial artery occlusion (at the anatomical snuffbox and the dorsum of the plant [local type]) with saved blood supplement on the forearm was registered in the classical distal radial approach group in 4 cases (2.3%). There were no cases of access side radial artery occlusion in the dorsopalmar group.</p><p><strong>Conclusion</strong>. The use of the distal radial approach for primary percutaneous coronary intervention in patients with acute coronary syndrome definitely reduces the risk of radial artery occlusion of the forearm, whereas the dorsopalmar distal radial approach can be considered as a basic approach.</p><p>Received 11 May 2020. Revised 31 May 2020. Accepted 3 June 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and design: S.P. Semitko, R.V. Akhramovich<br />Data collection and analysis: R.V. Akhramovich, I.S. Melnichenko<br />Drafting the article: R.V. Akhramovich<br />Critical revision of the article: S.P. Semitko<br />Final approval of the version to be published: R.V. Akhramovich, S.P. Semitko, A.V. Azarov, I.S. Melnichenko, A.I. Analeev, I.E. Chernyisheva, A.A. Tretyakov, D.G. Ioseliani</p>
Background: Primary percutaneous coronary interventions (PCI) in acute coronary syndrome (ACS) with transradial access (TRA) are associated with the risk of local complications, such as occlusion of the radial artery (ORA), hematomas, pseudoaneurysms, and arteriovenous fistulas. Aim: To perform comparative assessment of clinical efficacy and safety of the TRA and dorsopalmar (modified distal) radial access (DpRA) for primary percutaneous coronary intervention in in-patients with ACS. Materials and methods: This was a randomized, dynamic, single-center, prospective study in two parallel groups. The patients were randomized in a 1:1 ratio into two groups with different types of the radiation access: TRA (n = 100) or DpRA (n = 100). TRA was made at the distal third of the forearm and DpRA on the dorsal palm surface. After the access zone was evaluated by angiography, the pressure bandage was placed on the zone for 6 hours for hemostasis. The comfort of hemostasis was assessed by the Gaston-Johansson 10-point verbal-descriptive pain rating scale. On the 57th day after PCI, all patients were examined with palpation and ultrasound assessment of the access artery. Results: The number of attempts, average duration of the radial artery puncture, duration of the fluoroscopy procedure, and the conversion rate did not depend on the access type. The scoring of the subjective hemostasis comfort showed a significant advantage of DpRA over TRA (6.4 [4; 10] in the TRA group vs 1.7 [0; 6] in the DpRA group, p 0.001). The rate of EASY III hematomas was 15 (15%) in the TRA group vs 3 (3%) in the DpRA group (p = 0.004). There were no EASY IVV hematomas, occlusion of the radial artery of the forearm, pseudoaneurysms and arteriovenous fistulas in the DpRA group. The diameter of the forearm radial artery was significantly larger than the diameter on the dorsal palm surface in the patients of both groups, regardless of the type of access chosen (2.75 0.32 mm and 2.38 0.36 mm in the TRA group, p 0.001; 2.84 0.38 mm and 2.45 0.36 mm in the DpRA group, p 0.001). In the patients with access conversion in both groups, the diameter of the radial artery at both levels was less than the average one. Conclusion: DpRA for PCI in ACS patients is a safe alternative to conventional radiation access. Ultrasound examination of the radial artery diameter in its distal and forearm parts before PCI could reduce the conversion rate.
Objective. To prove the safety and efficacy of distal radial artery (DRA) puncture for endovascular interventions versus the traditional forearm radial artery (RA) puncture site by comparing immediate and long-term results. Methods. In 2017, a multicenter, open, randomized (1:1) study TENDERA (Comparison between Traditional Entry Point and Distal Puncture of Radial Artery) was started. During 2 years, 520 patients were included, mean age 63.4±10.0 years. The observation group (DRA puncture) included 271 patients, the comparison group (RA puncture) - 249 patients. The study included both stable patients and those with NSTEMI: the observation group - 39 (14.4%), the comparison group - 34 (13.7%), p=0.809. The primary endpoint is immediate (hospital) or late radial thrombosis. Secondary endpoints are: 1 - composite point, complications from the access artery; 2 - puncture parameters. Results. The average difference in the diameters of the RA and DRA was 0.3 mm and 0.4 mm, in some patients the DRA diameter corresponded to the RA or even exceeded it. The diameter of RA and DRA in men and women significantly differs, 2.65±0.44 mm and 2.36±0.36 mm (p=0.001), 2.31±0.39 mm and 2.13±0.38 mm (p=0.001). Technical success of DRA access requre the number of attempts. 94.1% - the percentage of successful cardiac catheterization performed through the distal radial artery approach, which is significantly less than via RA - 100% (p<0.001). In the observation group, significantly fewer rebleedings and rehemostasis were occured. In the long-term period, there were registered outstandingly more hematomas in the observation group at the time of discharge and after 1 week. Conclusion. Intermediate analysis of the results of the TENDERA study shows that there is no significant difference in the primary endpoint, but the number of complications in the observation group associated with the puncture markedly - hematoma more than 5 cm to the day of discharge and after 7 days. What this paper adds Intermediate results of the first multicenter open randomized (1:1) study devoted to the comparison of distal puncture of the radial artery versus the traditional entry point of puncture of the radial artery on the forearm during the endovascular interventions have been presented. A significant reduction of the number of local complications has been revealed in the group of distal puncture of the radial artery and the absence of differences according to the primary endpoint: early and late radial artery thrombosis.
The aim of the study is to analyze the effectiveness and safety of distal and traditional radial access for endovascular interventions. Methods. The study included 282 patients who underwent endovascular intervention with distal radial access (DRA, 139 patients) or traditional radial access (TRA, 143 patients). Results. The median diameter of the radial artery in its proximal part, i.e. at the site of TRA, was 2.5 mm [Q1; Q3: 2.27; 2.8], in the DRA group the median was 2.28 mm [Q1;Q3: 2.06; 3.56], p0.0001. At the same time, we noted statistically significant differences in the time of puncture (p=0.0215), but not the time of insertion of the introducer, catheterization of the coronary artery, the time of fluoroscopy, the total time of intervention, the dose of ionizing radiation. The study is registered on the website www.clinicaltrials.gov NCT04211584. In total, 28 complications developed (9.9% of 282): 14 in each of the groups in one year after intervention. Two (0.7% of 282) patients developed bleeding (1 (0.7% of 139) DRA, 1 (0.7% of 143) - TRA), five (1.8% of 282) radial artery dissection (2 (1.4% of 139) - DRA, 3 (2.1% of 143) - TRA), 9 (3.2% of 282) puncture failure (7 (5% of 139) DRA, 2 (1.4% of 143) - TRA), 4 (1.4% of 282) radial artery perforation (2 (1.4% of 139) DRA, 2 (1.4% of 143) - TRA), 7 (2.5% of 282) hematoma more than 5 cm (2 (1.4% of 139) DRA, 5 (3.5% of 143) - TRA), 1 one (0.4% of 282 and 0.7% of 143) radial artery thrombosis (TRA). The risk of complications did not depend on the type of access. Conclusion. Distal and traditional radial access do not differ in efficiency and safety. At the same time, we noted a certain tendency to a longer puncture of the radial artery with distal radial access compared to the traditional one, which is due to the smaller diameter of the radial artery.
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