An observational comparison of distal radial and traditional radial approaches for coronary angiography

Abstract

Background Several studies have recently reported regarding feasibility and safety of distal transradial access (d-TRA) in the anatomical snuff-box (ASB); however, literature comparing it with the conventional TRA at the wrist (w-TRA) is sparse. This study compares the technical efficiency and safety of ASB and wrist approaches for TRA for coronary angiography (CAG) and evaluates the radial artery (RA) anatomy at these sites. Methods Two hundred consecutive patients undergoing CAG via w-TRA or d-TRA (100 in each group) were investigated. The primary endpoint was comparison of procedural efficiency of the two methods, defined as CAG completion from the intended access site. The secondary endpoints assessed d-TRA approach in terms of achievement of successful cannulation, arterial puncture, access time (AT), and total procedure time (TPT) in comparison with the conventional method. Safety endpoints included radiation parameters and complications. Furthermore, in 112 normal adults, RA anatomy was assessed at wrist and at ASB. Results In d-TRA group, 77% patients achieved primary endpoint compared with 93% in w-TRA group ( p = 0.004). The success of arterial puncture was comparable for d-TRA and w-TRA (93% and 99%, respectively; p = 0.065), but the cannulation rate was lower for d-TRA. Safety endpoints were similar in both the groups. AT and TPT were longer for d-TRA. Conclusions The ASB approach for CAG lowers the success rate and prolongs AT and TPT. The RA at ASB is smaller, has a curved course, and more anatomical variations than the RA at the wrist.

Distal Transradial Access in Anatomical Snuffbox for Coronary Angiography and Intervention: An Updated Meta-Analysis

“…The meta-analysis showed similar catheterization/puncture failure between dTRA and cTRA, with no statistical significance (OR = 1.94, 95CI [0.97, 3.86], P =0.06; I 2 = 78.5%, P < 0.001). We conducted a sensitivity analysis by removing outlier studies, heterogeneity was significantly reduced after excluding the studies by Bhambhani [ 11 ] and Koutouzis [ 17 ], and there was still no statistical difference (OR = 1.06, 95CI [0.69, 1.64], P =0.788; I 2 = 38.2%, P =0.114). The Egger test suggested the existence of publication bias among the studies ( P =0.015), so we used the trim and fill method to recalculate the effect size: the number of studies did not change, and there was still no statistical difference between them (OR = 1.927, 95CI [0.981, 3.785]), suggesting that the result was robust (see Figure 2 ).…”

“…The meta-analysis showed the total procedure time was similar between dTRA and cTRA, with no statistical significance (SMD = 0.23, 95CI [−0.21, 0.68], P =0.308; I 2 = 91.8%, P < 0.001) (see Figure 9 ). We conducted a sensitivity analysis by removing the outlier study, heterogeneity was significantly reduced after excluding the study by Bhambhani [ 11 ], and there was still no statistical difference (SMD = −0.03, 95CI [−0.17, 0.11], P =0.642; I 2 = 13%, P =0.328). The Egger test showed no publication bias among the studies ( P =0.398).…”

“…The overall catheterization/puncture failure of dTRA included in this meta-analysis was higher than that of cTRA, but there was no statistically significant difference (4.3% VS 3.8%, P > 0.05), and the access time was prolonged in dTRA, but did not affect total procedure time. Bhambhani [ 11 ] performed distal radial artery cannulation in 100 patients and found access time in dTRA was progressively reduced, from 5.89 minutes in the first 25 cases to 2.47 minutes in the last 25 cases. Also, Lee [ 26 ] found that puncture time stabilized after approximately 150 distal radial artery punctures had been performed.…”

Distal versus conventional radial artery access for coronary catheterization: A systematic review and meta‐analysis

“…Baseline studies characteristics included multinational single and multicenter studies published between 2017 and 2022 with enrollment periods spanning from 2016 to 2021. Studies included 11 randomized control trials 4,5,17,22–29 and the remainder were nonrandomized control or observational studies 3,30–45 . The follow‐up postcatheterization ranged from 1 day 28,35,36 to 6 months 42…”

Anatomical snuff box approach for percutaneous coronary interventions – Current status

“…An observational study by Bhambhani et al in 200 patients undergoing CAG showed increased procedural time with dRA approach (13.4 ± 4.2 vs 9.2 ± 3.1 min; p < 0.01) but insignificant difference in fluoroscopic time between the two groups. 20 With increase in experience and after certain learning curve (at least 50 successful puncture), the procedural time could be decreased further specially the time to access the artery in ASB.…”