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 ¼ 0.004). The success of arterial puncture was comparable for d-TRA and w-TRA (93% and 99%, respectively; p ¼ 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

“…e 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.…”

“…e 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). e 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).…”

“…e 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). e Egger test showed no publication bias among the studies (P � 0.398).…”

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

“…Studies included 11 randomized control trials 4,5,17,[22][23][24][25][26][27][28][29] and the remainder were nonrandomized control or observational studies. 3,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] The follow-up postcatheterization ranged from 1 day 28,35,36 to 6 months. 42 Sample sizes in the included studies ranged from 41 to 1307 patients (total: 9151 patients [DRA: 4,474; CRA: 4677]) (Table 1).…”

“…The ages of patients ranged from 50 to 72 years old, and studies included predominantly male patients [DRA: 72.4%; CRA: 70.0%]. Seven studies did not include any acute coronary syndrome (ACS) patients, 23,25,31,32,42,43,45 while one study included only ACS patients. 39 The rate of PCI varied amongst the studies (Table 2).…”