Safety and efficacy of coronary angiography and percutaneous coronary intervention via distal transradial artery access in the anatomical snuffbox: a single-centre prospective cohort study using a propensity score method

Abstract

Background This study investigated the safety and efficacy of coronary angiography (CAG) and percutaneous coronary intervention (PCI) via distal transradial artery access (d-TRA). Methods For this single-centre prospective cohort study, a total of 1066 patients who underwent CAG or PCI procedures from September 2019 to November 2020 were included. Patients were divided into two groups: the d-TRA group (346) and the conventional transradial artery access (c-TRA) group (720) based on access site. A total of 342 pairs of patients were successfully matched using propensity score matching (PSM) for subsequent analysis. Results No significant differences in puncture success rate, procedural method, procedural time, sheath size, contrast dosage or fluoroscopy time were noted between the two groups. The puncture time in the d-TRA group was longer than that in the c-TRA group (P < 0.01), and the procedure success rate was lower than that in the c-TRA group (90.94% vs. 96.49%, P = 0.01). The haemostasis time in the d-TRA group was shorter than that in the c-TRA group (P < 0.01), and the visual analogue scale (VAS) was lower than that in the c-TRA group (P < 0.01). In addition, the prevalence of bleeding and haematoma in the d-TRA group was lower than that in the c-TRA group (1.75% vs. 7.31%, P < 0.01; 0.58% vs. 3.22%, P = 0.01, respectively). No significant difference in the incidence of numbness was noted between the two groups. No other complications were found in two groups. Conclusion d-TRA is as safe and effective as c-TRA for CAG and PCI. It has the advantages of improved comfort and fewer complications. Trail registration Chinese Clinical Trial Registry, ChiCTR1900026519.

Distal versus conventional radial artery access for coronary catheterization: A systematic review and meta‐analysis

“…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. 42 Sample sizes in the included studies ranged from 41 to 1307 patients (total: 9151 patients [DRA: 4,474; CRA: 4677]) (Table 1).…”

“…The ages of patients ranged from 50 to 72 years old, and studies included predominantly male patients [DRA: 72.4%; CRA: 70.0%]. Seven studies did not include any acute coronary syndrome (ACS) patients, 23,25,31,32,42,43,45 while one study included only ACS patients. 39 The rate of PCI varied amongst the studies (Table 2).…”

“…[3][4][5]17,23,24,27,28,30,35,36,38,44 Eighteen studies assessed hematomas. [3][4][5][22][23][24][25][26][28][29][30]35,[38][39][40][41]44,45 Six studies assessed any bleeding. 5,17,22,38,39,45 Four studies assessed pseudoaneurysm.…”

“…[3][4][5][22][23][24][25][26][28][29][30]35,[38][39][40][41]44,45 Six studies assessed any bleeding. 5,17,22,38,39,45 Four studies assessed pseudoaneurysm. 5,22,38,39 Five studies assessed arteriovenous fistula.…”

Efficacy and Safety of Coronary Intervention via Distal Transradial Access (dTRA) in Patients with Low Body Mass Index

“…The surgical methods and procedures of puncture and catheterization were introduced in our previous study [ 12 ]. Briefly, the access site in the dTRA group was in the anatomic snuffbox.…”