Distal radial approach between theory and clinical practice.. Time to go distal!

Abstract

Background Transradial access (TRA), which has a minimal risk of problems such as radial artery occlusion (RAO), hemorrhage, spasm, and so on, is now considered the standard procedure for cardiac catheterization. The aim of the study is to present the distal transradial access (d-TRA) as a possible promising novel technique in the field of cardiac coronary interventions comparing it to the standard conventional TRA using primary and secondary endpoints, exploring its benefits and drawbacks as a new experience in Alexandria University. One hundred cases with variable indications for coronary interventions were randomized to two arms using systematic random sampling method, coronary interventions in the first one were done via d-TRA (50 patients) and in the second arm via conventional TRA group (50 patients). Results Technically, there were highly statistically significant differences between the two arms in favor of TRA regarding procedural success, number of punctures taken, Access time, Total procedural time, vasodilator used, and crossover to another access site; meanwhile safety profile parameters have showed statistically significant differences in favor of d-TRA regarding post-operative hematoma, AV fistula, post-operative pain and compression time, and there were no statistically significant differences regarding RAO although it occurred more in TRA group. Conclusions In the realm of cardiac intervention, the distal radial approach is a promising technique. When compared to TRA, we found it to be a viable and safe method for coronary angiography and interventions and it could be a real option for the interventionists in the near future, with a lower risk of radial artery blockage and no significant differences in wrist hematoma and radial artery spasm. The success rate of d-TRA is proportional to the steepness of the operator's learning curve and the quality of the examples chosen.

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][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.…”

“…Thirteen studies assessed access time (minutes). 3,4,22,24,26,27,29,31,32,34,40,42,44 Six studies assessed rates of successful access on the first attempt. 4,24,28,37,41 Thirteen studies assessed crossover to alternative arterial access rate.…”

“…4,24,28,37,41 Thirteen studies assessed crossover to alternative arterial access rate. [3][4][5]17,24,[26][27][28][29][30]36,37,39 Eight studies assessed total procedure time (minutes). 24,26,28,29,31,33,34,42 Seven studies assessed fluoroscopy time (minutes).…”

“…[3][4][5]17,24,[26][27][28][29][30]36,37,39 Eight studies assessed total procedure time (minutes). 24,26,28,29,31,33,34,42 Seven studies assessed fluoroscopy time (minutes). 4,24,27,28,31,33,42 Four studies assessed radiation dose area product (cGy/cm 2 ).…”

“…24,26,31,33 Seven studies assessed contrast dose (milliliters). 17,24,[26][27][28][29]33,42 Six studies assessed hemostasis time (minutes). 22,[26][27][28]33 There were no statistically significant differences between DRA and CRA in successful access on the first attempt, total procedure time, fluoroscopy time, radiation dose, or contrast dose (Figure 2).…”