Distal or Traditional Transradial Access Site for Coronary Procedures

Tsigkas, Grigorios; Papageorgiou, Angeliki; Moulias, Athanasios; Kalogeropoulos, Andreas P.; Papageorgopoulou, Chrysanthi P.; Toutouzas, Konstantinos; Papanikolaou, Amalia; Vasilagkos, Georgios; Davlouros, Periklis

doi:10.1016/j.jcin.2021.09.037

Cited by 74 publications

(110 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…First, the present study confirms that distal radial access is more difficult and less predictable than proximal radial access: it required a longer time (111 vs. 50 seconds) and was associated with higher crossover to another access point (18% vs. 0%). These findings are very similar to the findings of the largest randomized controlled trial performed to date (n = 1042) comparing distal and proximal radial access [11] that reported 78.7% vs. 94.8% successful sheath insertion (P <0.001) and 120 vs. 75 seconds to insert the sheath (P <0.001) [11]. To what extent the higher failure and longer time required to obtain access via the distal radial artery is related to operator experience and access technique remains to be seen.…”

Section: Related Articlesupporting

confidence: 86%

“…This was required to prevent confounding of the endothelial damage markers. In the study by Tsigkas et al [11], time to hemostasis was shorter with distal radial access (60 vs. 120 minutes; P <0.001). Shorter hemostasis time could increase patient comfort and potentially "counterbalance" some of the discomfort experienced while obtaining access.…”

Section: Related Articlementioning

confidence: 88%

“…Fourth, the risk of complications was similar with distal and proximal radial access, but the study was underpowered for clinical endpoints. Three randomized controlled trials have demonstrated lower rates of radial artery occlusion with distal radial access [11,13,14]. The distal radial artery may decrease the risk of compartment syndrome that could be a catastrophic complication.…”

Section: Related Articlementioning

confidence: 99%

See 2 more Smart Citations

Distal radial access: A better way to the heart?

2022

View full text Add to dashboard Cite

Section: Related Articlesupporting

confidence: 86%

Section: Related Articlementioning

confidence: 88%

Section: Related Articlementioning

confidence: 99%

See 1 more Smart Citation

Distal radial access: A better way to the heart?

2022

View full text Add to dashboard Cite

“…Eleven years after its initial description [1], the use of DRA was not yet widespread as expected [2,4,10,12]. Despite the feasibility of the technique by the right access, to date, specific comparisons between the rDRA and the lDRA were not available for operators who prefer the right approach to perform coronary procedures, and this fact could limit the expansion of the technique.…”

Section: Equivalence Of the Right And The Left Distal Radial Accessmentioning

confidence: 99%

Comparison between the Right and Left Distal Radial Access for Patients Undergoing Coronary Procedures: A Propensity Score Matching Analysis

Rivera

Fernández-Rodríguez

Casanova-Sandoval

et al. 2022

Journal of Interventional Cardiology

View full text Add to dashboard Cite

Introduction. Distal radial access for coronary procedures decreases hemostasis time, prevents radial occlusion, and improves patient comfort compared to conventional transradial access. Initially described for left distal radial access (lDRA), the right distal radial access (rDRA) is feasible. However, there are no comparative studies to date. This study aimed to evaluate the impact of the access site on vascular access and procedural performance. Methods. From August 2020 to October 2021, coronary procedures performed through distal radial access were prospectively recorded. After propensity score matching, the rDRA and lDRA were compared. The primary endpoint was the proportion of approach success. The secondary endpoints included access time, coronary procedural success, radial spasm, exposition to ionizing radiation, patient comfort, and vascular access-related complications. Results. From a total of 385 procedures in 382 patients, after a propensity score matching, 182 procedures were compared between the rDRA and lDRA. There were no differences in the baseline characteristics between the groups. Compared to the lDRA, the rDRA presented similar approach success (96.7% vs. 96.7%, p = 1.0 ), less access time (39 (25–60) sec vs. 50 (29–90) sec, p = 0.018 ), comparable coronary procedural success after sheath placement (100% vs. 100%, p = 1.000 ), and not statistically significant radial spasm (2.19% vs. 6.59%, p = 0.148 ). No differences in dose-area product (32 (20–56.2) Gy.m2 vs. 32.3 (19.4–46.3) Gy.m2; p = 0.472 ) and fluoroscopy time (4.4 (2.5–9.1) min vs. 4.3 (2.4–7.5) min, p = 0.251 ) were detected between the groups. No vascular access-related complications were observed in any group. Conclusions. The rDRA, compared to the lDRA, had the same proportion of approach success and procedural performance, with a slight reduction in access time for patients undergoing coronary procedures.

show abstract

“…Distal radial access (DRA), a technique that can no longer be called “novel” in terms of its widespread adoption, has already been declared feasible and safe in various types of coronary, structural and peripheral procedures ( 1 – 7 ). The most notable advantages are the low rate of radial artery occlusion, few local complications, short hemostasis time and better ergonomics, both for the patient and for the operator ( 1 , 2 ), especially in the case of left radial artery access.…”

Section: Introductionmentioning

confidence: 99%

Switching From Proximal to Distal Radial Artery Access for Coronary Chronic Total Occlusion Recanalization

Achim

Szigethy

Olajos

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundDistal radial access (DRA) was recently introduced in the hopes of improving patient comfort by allowing the hand to rest in a more ergonomic position throughout percutaneous coronary interventions (PCI), and potentially to further reduce the rate of complications (mainly radial artery occlusion, [RAO]). Its safety and feasibility in chronic total occlusion (CTO) PCI have not been thoroughly explored, although the role of DRA could be even more valuable in these procedures.MethodsFrom 2016 to 2021, all patients who underwent CTO PCI in 3 Hungarian centers were included, divided into 2 groups: one receiving proximal radial access (PRA) and another DRA. The primary endpoints were the procedural and clinical success and vascular access-related complications. The secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE) and procedural characteristics (volume of contrast, fluoroscopy time, radiation dose, procedure time, hospitalization time).ResultsA total of 337 consecutive patients (mean age 64.6 ± 9.92 years, 72.4% male) were enrolled (PRA = 257, DRA = 80). When compared with DRA, the PRA group had a higher prevalence of smoking (53.8% vs. 25.7%, SMD = 0.643), family history of cardiovascular disease (35.0% vs. 15.2%, SMD = 0.553), and dyslipidemia (95.0% vs. 72.8%, SMD = 0.500). The complexity of the CTOs was slightly higher in the DRA group, with higher degrees of calcification and tortuosity (both SMD >0.250), more bifurcation lesions (45.0% vs. 13.2%, SMD = 0.938), more blunt entries (67.5% vs. 47.1%, SMD = 0.409). Contrast volumes (median 120 ml vs. 146 ml, p = 0.045) and dose area product (median 928 mGy×cm2 vs. 1,300 mGy×cm2, p < 0.001) were lower in the DRA group. Numerically, local vascular complications were more common in the PRA group, although these did not meet statistical significance (RAO: 2.72% vs. 1.25%, p = 0.450; large hematoma: 0.72% vs. 0%, p = 1.000). Hospitalization duration was similar (2.5 vs. 3.0 days, p = 0.4). The procedural and clinical success rates were comparable through DRA vs. PRA (p = 0.6), moreover, the 12-months rate of MACCE was similar across the 2 groups (9.09% vs. 18.2%, p = 0.35).ConclusionUsing DRA for complex CTO interventions is safe, feasible, lowers radiation dose and makes dual radial access more achievable. At the same time, there was no signal of increased risk of periprocedural or long-term adverse outcomes.

show abstract

Distal or Traditional Transradial Access Site for Coronary Procedures

Cited by 74 publications

References 23 publications

Distal radial access: A better way to the heart?

Distal radial access: A better way to the heart?

Comparison between the Right and Left Distal Radial Access for Patients Undergoing Coronary Procedures: A Propensity Score Matching Analysis

Switching From Proximal to Distal Radial Artery Access for Coronary Chronic Total Occlusion Recanalization

Contact Info

Product

Resources

About