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

Achim, Alexandru; Kákonyi, Kornél; Jambrik, Zoltán; Nagy, Frédéric; Tóth, J; Sasi, Viktor; Hausinger, Péter; Nemes, Attila; Varga, Albert; Bertrand, Olivier; Ruzsa, Zoltán

doi:10.3390/jcm10245974

Cited by 19 publications

(38 citation statements)

References 18 publications

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“…Issues such as the appropriate choice of sheath and catheter sizes to minimize arterial wall injury, adequate procedural anticoagulation, non-occlusive techniques, and adequate hemostasis (e.g., “patent hemostasis”) are important steps to further improve this technique ( 23 ). In one of our previous reports, we found that it takes at least 150 cases to reach the learning curve and maintain a consistently high success rate of >94.0% ( 2 ). These findings are also consistent with a Korean report ( 24 ).…”

Section: Discussionmentioning

confidence: 69%

“…this imbalance could be equated with DRA. Ultimately, bringing both hands over the patient's pelvis is equivalent to the transfemoral positioning ( 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, appropriate size matching between the catheter and the radial artery diameter may theoretically introduce another challenge when pursuing DRA. In a large registry of over 1,000 patients, the mean diameter in the distal segment was of 2.3 ± 0.5 mm, while the outer diameter of the 7-French Glidesheath is 2.79 mm, and that of the 6-F is 2.46 mm ( 2 ). Another study found even smaller diameters (2.01 ± 0.53 mm, 19% smaller than the proximal segment) ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

“…The indication for CTO PCI was established by the local heart team, as well as the recanalization strategy. There were 3 main operators responsible for all the procedures, the learning curve of the DRA as well as its technique being described elsewhere ( 2 ). Patients with ultrasound evidence of arterial occlusion, severe calcification, and a lumen of <1 mm were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…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%

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

Achim

Szigethy

Olajos

et al. 2022

Front. Cardiovasc. Med.

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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.

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Section: Discussionmentioning

confidence: 69%

“…this imbalance could be equated with DRA. Ultimately, bringing both hands over the patient's pelvis is equivalent to the transfemoral positioning ( 2 ).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Achim

Szigethy

Olajos

et al. 2022

Front. Cardiovasc. Med.

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Stent graft implantation from distal radial access—A novel way to treat femoral access site complication during transcatheter aortic valve replacement: A case report

Andréka,

Sasi,

Tóth

et al. 2024

Cathet Cardio Intervent

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In this paper, a case of an 82‐year‐old man who was admitted to our department with sever symptomatic degenerative aortic valve stenosis is presented and discussed. After all screening procedures, a successful transfemoral transcatheter aortic valve replacement was performed, but the closure of the femoral access was unsuccessful due to suture‐based device failure. We decided to perform a prolonged balloon dilatation and external compression at the bleeding site, but the bleeding did not stop; therefore, an iCover stent graft was implanted from distal radial artery access using slender technique. Following that, the bleeding was stopped, and the patient had an uneventful outcome.

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Interventions for renal artery stenosis: Appraisal of novel physiological insights and procedural techniques to improve clinical outcome

Drieghe,

De Buyzere,

Bové

et al. 2024

Cathet Cardio Intervent

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Randomized clinical trials failed to show additional benefit of renal artery stenting on top of medical therapy. Instead of writing an obituary on renal artery stenting, we try to explain these disappointing results. A transstenotic pressure gradient is needed to reduce renal perfusion and to activate the renin‐angiotensin‐aldosterone system. In only a minority of patients included in trials, a transstenotic pressure gradient is measured and reported. Like the coronary circulation, integration of physiological lesion assessment will allow to avoid stenting of non‐significant lesions and select those patients that are most likely to benefit from renal artery stenting. Renal artery interventions are associated with peri‐procedural complications. Contemporary techniques, including radial artery access, no‐touch technique to engage the renal ostium and the use of embolic protection devices, will minimize procedural risk. Combining optimal patient selection and meticulous technique might lead to a netto clinical benefit when renal artery stenting is added to optimal medical therapy.

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

Cited by 19 publications

References 18 publications

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

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

Stent graft implantation from distal radial access—A novel way to treat femoral access site complication during transcatheter aortic valve replacement: A case report

Interventions for renal artery stenosis: Appraisal of novel physiological insights and procedural techniques to improve clinical outcome

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