Distal Versus Traditional Radial Approach for Coronary Angiography

Koutouzis, Michael; Kontopodis, Eleftherios; Tassopoulos, Andreas; Tsiafoutis, Ioannis; Katsanou, Konstantina; Rigatou, Aggeliki; Didagelos, Matthaios; Andreou, Konstantinos; Lazaris, Efstathios; Oikonomidis, Nikolaos; Maniotis, Christos; Ziakas, Antonios

doi:10.1016/j.carrev.2018.09.018

Cited by 120 publications

(138 citation statements)

References 8 publications

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“…However, we found that aiming the needle 45–50 degrees medially toward the course of the distal radial artery (which can be traced with ultrasound) corrected that problem. Koutouzis et al reported similar observations and reported a significantly longer time of cannulation in the dTRA group than in the TRA group (269±251 s vs 140±161 s, p<0.001) although this did not affect overall procedure time 32. However, it is important to note the number of failed attempts at dTRA decreased steeply with experience (figure 1).…”

Section: Discussionsupporting

confidence: 55%

“…Furthermore, RAO in the distal radial artery does not limit future interventions via a traditional TRA or surgical grafting. One randomized study of 200 patients demonstrated no significant difference in rates of RAO after dTRA versus TRA for coronary intervention (5% dTRA vs 9% TRA, p=0.407) 32. However, in a study of 1320 patients who underwent right dTRA for coronary intervention, late RAO was observed in only 0.61% of cases 18.…”

Section: Discussionmentioning

confidence: 98%

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Distal transradial access in the anatomical snuffbox for diagnostic cerebral angiography

Brunet

Chen

Sur

et al. 2019

J NeuroIntervent Surg

103

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BackgroundThe transradial approach for endovascular angiography and interventional procedures is superior to the traditional transfemoral approach in several metrics, including lower access-site complication rates, higher patient satisfaction, and lower hospital costs. Interventional cardiologists have begun to adopt the distal transradial approach (dTRA) for coronary interventions as it has an improved safety profile and improved procedural ergonomics. Adaptation of dTRA for neuroendovascular procedures promises similar benefit, but requires a learning curve.ObjectiveTo report the first use of dTRA for diagnostic cerebral angiography and demonstrate the feasibility and safety of a dTRA.MethodsA retrospective review of our prospective institutional database of consecutive cases of cerebral DSA performed via dTRA between August 2018 and December 2018 was performed. Patient demographics, procedural and radiographic metrics, and clinical data were recorded.Results85 patients were identified with an average age of 53.8 years (range 18–82); 67 (78.8%) patients were female. 78 patients underwent successful dTRA diagnostic cerebral angiography, with a mean of five vessels catheterized and average fluoroscopy time of 12.0 min, or 2.6 min for each vessel. Seven patients required conversion to transfemoral access, with the most common reason being inability to advance the wire and radial artery spasm. There were no complications.ConclusiondTRA is associated with decreased rates of radial artery occlusion, ischemic hand events, as well as improved patient comfort, faster periprocedural management, and cost benefits. Our preliminary experience with dTRA for diagnostic cerebral angiography demonstrates excellent feasibility and safety in combination with relative efficiency.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 98%

Distal transradial access in the anatomical snuffbox for diagnostic cerebral angiography

Brunet

Chen

Sur

et al. 2019

J NeuroIntervent Surg

103

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“…Second, there is low rate of DRA obstruction Since antegrade flow through the superficial palmar arch is still maintained, the radial artery does not thrombose in case of occlusion of the radial artery in the snuffbox. Other advantages include early hemostasis, low risk for hematoma formation, low level of pain perceived by patients, reduced risk of compartment syndrome, saving the radial artery for possible future coronary artery bypass graft, and the ability of the operator to work at a safe distance from the radiation source [5,13,22,31]. Finally, it might be a potential site for retrograde recanalization of RAO [32].…”

Section: Advantagementioning

confidence: 99%

Distal Radial Artery Access: The Future of Cardiovascular Intervention

Nairoukh¹,

Jahangir²,

Adjepong³

et al. 2020

Cureus

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Access sites for coronary intervention have been changing over the last several decades, from the femoral artery to the radial artery and then to the distal radial artery. Distal radial access, which was first used in 2017 and is still not recommended by the guidelines, shows a higher success rate and less complications than other sites; therefore, it might be the future for cardiovascular intervention. In this study, we reviewed almost all of the articles that are related to the distal radial access, from 2017 to present, and summarized the technique, success rate, advantages, disadvantages, and noncardiac use of this access site.

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“…A recent randomized Greek study of 200 patients who underwent radial versus DDRA coronary angiography ( n = 100, each group) by experienced operators showed lower rates of successful access and manual hemostasis time in the DDRA cohort ( p < .001). DDRA was also associated with an increased number of attempts and skin punctures . Hence, DDRA is a new alternative radial access site that requires further data and clinical research.…”

Section: Discussionmentioning

confidence: 99%

“…21 DDRA was also associated with an increased number of attempts and skin punctures. 25 Hence, DDRA is a new alternative radial access site that requires further data and clinical research. It may become an attractive site in the future for patients who prefer left hand access or avoidance of the forearm compartment.…”

Section: Ddra Versus Ulnar Access Considerationsmentioning

confidence: 99%

Systematic review of alternative access for cardiac catheterization and percutaneous coronary intervention: Dorsal distal radial and ulnar artery catheterization

Kar

2019

Cathet Cardio Intervent

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The femoral and radial arteries are the standard access routes for cardiac catheterization. In cases where the right radial artery has been previously utilized or is not suitable for repeat procedures, the left dorsal distal radial artery (anatomical snuff box) or the ulnar artery may be an alternative access site. In this systematic review, alternative access sites are described along with the techniques of cannulation, technical considerations, ultrasound imaging, clinical studies, and their complications. As we routinely perform more radial procedures, increased complications will arise, so it becomes important to gain expertise in alternative access for future coronary interventions. Such a systematic review has not been previously published so it will enhance the reader's knowledge of alternative access.

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Distal Versus Traditional Radial Approach for Coronary Angiography

Cited by 120 publications

References 8 publications

Distal transradial access in the anatomical snuffbox for diagnostic cerebral angiography

Distal transradial access in the anatomical snuffbox for diagnostic cerebral angiography

Distal Radial Artery Access: The Future of Cardiovascular Intervention

Systematic review of alternative access for cardiac catheterization and percutaneous coronary intervention: Dorsal distal radial and ulnar artery catheterization

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