Distal Versus Conventional Radial Access for Coronary Angiography and Intervention

Aminian, Adel; Sgueglia, Gregory A.; Wiemer, Marcus; Kefer, Joëlle; Gasparini, Gabriele L.; Ruzsa, Zoltán; Leeuwen, Maarten A.H. van; Ungureanu, Claudiu; Leibundgut, Gregor; Vandeloo, Bert; Kedev, Saško; Bernát, Ivo; Ratib, Karim; Iglesias, Juan F.; Hage, Elias Al; Posteraro, G; Pascut, Dan; Maes, Frédéric; Regazzoli, Damiano; Kákonyi, Kornél; Meijers, Thomas A.; Colletti, Giuseppe; Krivoshei, Lian; Lochy, Stijn; Zafirovska, Biljana; Hořák, David; Nolan, James; Degrauwe, Sophie; Tobita, Kazuki; Saïto, Shigeru

doi:10.1016/j.jcin.2022.04.032

Cited by 56 publications

(60 citation statements)

References 31 publications

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“…Despite the previously described strategies, the rate of RAO in our study and DISCO RADIAL was even lower in the DRA group, around 2–3 times lower than in the FRA group [ 30 ]. This is because the puncture point in the anatomical snuffbox is located beyond the bifurcation into the deep palmar arch.…”

Section: Discussioncontrasting

confidence: 80%

“…In our trial, the incidence of RAO was nonsignificant with two proximal radial artery obstruction incidences reported in the FRA group (1.9%) and none in the DRA group ( p =0.139). The recently released DISCO RADIAL trial similarly showed no significant difference in RAO rates between the two groups [ 30 ]. In this study, a strict hemostasis strategy was used to prevent RAO, as well as rigorous operator eligibility requirements, assuring extensive operational experience with both access methods.…”

Section: Discussionmentioning

confidence: 99%

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Distal Radial Artery Access in comparison to Forearm Radial Artery Access for Cardiac Catheterization: A Randomized Controlled Trial (DARFORA Trial)

Daralammouri

Nazzal

Mosleh

et al. 2022

Journal of Interventional Cardiology

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Background. In our clinical practice, conventional radial access has been employed routinely for coronary procedures. The distal radial artery (DRA) access site has recently emerged as a novel technique in cardiac procedures. Objectives. This study compares distal radial access to standard forearm radial access (FRA) in terms of feasibility, outcomes, and complications. Method. This prospective, randomized trial was conducted at a single center. The patients were chosen from An-Najah National University Hospital’s catheterization laboratory between December 2019 and November 2020. A total of 209 patients were randomized into two groups: DRA group (n = 104) and FRA group (n = 105). Results. Access was successful in 98% of patients in both the groups. The DRA group had a longer puncture duration and a higher number of attempts (duration: 56.6 ± 61.1 s DRA vs. 20.0 ± 18.4 s FRA, p < 0.001 , attempts: 1.9 ± 1.3 DRA vs. 1.2 ± 0.60 FRA, p < 0.001 ). Puncture-associated pain was greater in the DRA group (4 ± 2.2 DRA vs. 3 ± 2.1 FRA, p = 0.001 ). There were two radial artery occlusions in the FRA group and none in the DRA group ( p = 0.139 ). Percutaneous coronary intervention (PCI) was performed in 26% of the DRA group and 37.1% of the FRA group. The DRA group had significantly shorter procedure times ( p = 0.006 ), fluoroscopy times ( p = 0.002 ), and hemostasis times ( p = 0.002 ). Over time, the learning curve demonstrated improved puncture duration and a decrease in the number of puncture attempts. Conclusions. DRA is a safe and practical alternative to FRA for coronary angiography and intervention. The overtime learning curve is expected to improve puncture-related outcomes.

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Section: Discussioncontrasting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Distal Radial Artery Access in comparison to Forearm Radial Artery Access for Cardiac Catheterization: A Randomized Controlled Trial (DARFORA Trial)

Daralammouri

Nazzal

Mosleh

et al. 2022

Journal of Interventional Cardiology

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“…Several randomized-control trials and meta-analyses have showed that DRA was associated with a substantial reduction of RAO ( 13 – 16 ). As shown in the DISCO RADIAL trial ( 17 ), DRA certainly may prolong the time to secure access but may increase the simplicity and the safety of the hemostasis phase without no specific impact on the procedural phase itself. However, most studies excluded STEMI patients.…”

Section: Introductionmentioning

confidence: 99%

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

Wang

Liu

et al. 2022

Front. Cardiovasc. Med.

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BackgroundConventional transradial access (TRA) has been the preferred access for coronary intervention. Recently, distal radial access (DRA) is introduced as an alternative choice to reduce radial artery occlusion (RAO) risk. The study sought to assess the impact of DRA on early RAO using Doppler ultrasound in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI).MethodsThis is a prospective, single-center, open-label randomized clinical trial in which patients with indications for primary PCI from January 2022 to September 2022 were assigned to DRA or TRA group with 100 cases in each group. The primary endpoint was the incidence of forearm RAO, evaluated by Doppler ultrasound before discharge.ResultsThe rate of access success was comparable between the DRA and TRA groups (98.0 vs. 94.0%, P = 0.279). Compared with the TRA group, longer puncture time was observed in the DRA group [2.4 (1.7–4.2) min vs. 1.7 (1.4–2.3) min; P < 0.001] whereas the door-to-wire time was not delayed in primary PCI [71 (54–88) min vs. 64 (56–82) min, P = 0.103]. Shorter hemostasis time was required in the DRA group [3.1 (2.7–3.3) h vs. 6.2 (5.9–6.4) h; P < 0.001]. Significant reduction of the incidence of forearm RAO was observed in the DRA group (2.0 vs. 9.0%, P = 0.030). Local hematomas ≤ 5 cm was similar in both groups (4.0 vs. 6.0%, P = 0.516), while those > 5 cm were significantly more frequent in the TRA group (0 vs. 6.0%, P = 0.029).ConclusionDistal radial access is associated with a comparable lower incidence of forearm RAO, shorter hemostasis time, and lower rate of vascular complications compared to TRA in primary PCI.Systematic review registration[https://www.chictr.org.cn], identifier [ChiCTR2200061841].

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“… 7 , 11 The most recent DISCO RADIAL, the largest randomized trial in this topic, did not find any difference regarding radiation dose between the two arms. 12 , 13 A numerically but not significantly increase in DAP in dTRA group was also noticed in another randomized trial. 8 Fluoroscopy time was significantly increased in the dTRA comparing to TRA arm in a non-randomized study by Lu et al.…”

mentioning

confidence: 63%

Could radiation exposure be the Achilles’ heel of distal transradial artery access?

Apostolos

Vasilagkos²,

Tsigkas³

2022

Indian Heart Journal

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Distal Versus Conventional Radial Access for Coronary Angiography and Intervention

Cited by 56 publications

References 31 publications

Distal Radial Artery Access in comparison to Forearm Radial Artery Access for Cardiac Catheterization: A Randomized Controlled Trial (DARFORA Trial)

Distal Radial Artery Access in comparison to Forearm Radial Artery Access for Cardiac Catheterization: A Randomized Controlled Trial (DARFORA Trial)

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

Could radiation exposure be the Achilles’ heel of distal transradial artery access?

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