Comparison of Distal Radial, Proximal Radial, and Femoral Access in Patients with ST-Elevation Myocardial Infarction

Abstract

Recent studies have indicated that distal radial access (DRA) is feasible in patients undergoing percutaneous coronary intervention (PCI). The present study aimed to compare DRA, proximal radial access (PRA), and femoral access (FA) in patients with ST-elevation myocardial infarction (STEMI) undergoing PCI. Data were analyzed for 109 patients with STEMI treated via primary PCI from March 2020 to May 2021. The success rate of DRA was 83.3% (35/42), including seven cases of failed puncture (puncture failure = 5, severe radial artery spasm = 2). Primary PCI via the DRA was successful in all 35 patients. After classifying the patients requiring crossover into a separate group, the percentage of the puncture time in the door-to-wiring time was 2.7% [2.2–4.3], 3.3% [2.3–4.0], 2.6% [1.2–4.9], and 27.0% [13.5–29.3] in the DRA (n = 35), PRA (n = 24), FA (n = 26), and crossover (n = 9) groups, respectively (p < 0.01). Only two local hematomas (≤5 cm) occurred in the DRA group, while one patient in the FA group required surgical treatment and a transfusion for an access-site vascular injury. When performed by an experienced operator, DRA may represent a feasible alternative to other access routes in select patients with STEMI undergoing PCI, such as those with a high risk of bleeding.

Early prevention of radial artery occlusion via distal transradial access for primary percutaneous coronary intervention

“…Besides, in a retrospective observational studies of STEMI patients, the puncture time via DRA was 2.7 ± 1.6 min ( 28 ). Lee OH et al ( 19 ) presented the puncture time for primary PCI via DRA and TRA was 116.1 ± 56.1 s vs. 100.8 ± 46.0 s ( P = 0.27), respectively. In our study, the puncture time was higher in the DRA group than in the TRA group [2.4 (1.7–4.2) min vs. 1.7 (1.4–2.3) min; P < 0.001].…”

“…In another retrospective cohort study ( 29 ), all 30 patients were successfully punctured via the left DRA. Lee et al ( 19 ) compared DRA, TRA, and femoral access in patients with STEMI undergoing primary PCI, and the success rate of DRA was 83.3% (35/42). In this study, the rate of access success in the DRA group was 98.0%.…”

“…The puncture time was defined as the time interval between local anesthesia induction and successful sheath insertion ( 11 ). Door-to-wiring time was expressed as the duration from hospital arrival to guidewire passage through the culprit lesion ( 19 ). Haemostasias time was defined as the period from the application of the compression band to its removal.…”

The Role of Ultrasound in Accessing the Distal Radial Artery at the Anatomical Snuffbox for Cardiovascular Interventions

“…It remains to be seen whether the utility of US in DRA will outweigh its practical role and bring benefits on clinical hard endpoints, as it did for femoral access [ 32 ]. For this, it must prove its versatility in acute cases (i.e., ST-elevation myocardial infarction, cardiogenic shock) or in high-risk, complex percutaneous coronary interventions [ 33 , 34 , 35 ]. Even so, clinical imaging is a safe, cost-effective, easy to learn, and ubiquitously available tool which should be acquired by any operator performing percutaneous interventions—whether they are an angiologist, radiologist, or interventional cardiologist, all need to be “a little” imager as well.…”

Distal Radial Artery Access for Coronary and Peripheral Procedures: A Multicenter Experience

“…While head-to-head comparisons between pRA and dRA have been started [18][19][20][21], we believe randomized, controlled trials directly comparing dRA to pRA are not sine qua non with regard to juxtaposition between the two sites as one does not substitute the other. dRA represents an evolution and a complement of the developing nature of TRA and nuances such as preservation of the common radial artery, easier hemostasis, and ergonomics play a role when choosing a specific entry site.…”