A comparison of the clinical effects and safety between the distal radial artery and the classic radial artery approaches in percutaneous coronary intervention

Wang, Hui; Peng, Wenjin; Liu, Yanhong; Ma, Guan-Qun; Wang, Dan; Su, Bin; Liu, Yingwu

doi:10.21037/apm-19-479

Cited by 23 publications

(33 citation statements)

References 10 publications

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“…According to our findings, Wang et al [ 21 ], the mean puncture time for d-TRA was 5.4 ± 1.6 min and 5.6 ± 1.4 min for TRA, and the mean operational time for d-TRA and TRA was 50.0 ± 8.3 min and 51.0 ± 7.9 min, respectively. They also discovered that there were no significant differences in puncture success rate, puncture time, or operation duration between the two groups ( P > 0.05).…”

Section: Discussionsupporting

confidence: 78%

“…Wang et al [ 21 ] also found that among the 160 males and 152 females in the distal radial artery puncture group, the average age was 50.17.2 years. There were 157 males and 151 females in the radial artery puncture group, with an average age of 51.27.3 years.…”

Section: Discussionmentioning

confidence: 99%

“…Wang et al [ 21 ] found no significant differences in puncture success rate, average puncture time, surgical time, implanted stent, or artery diameter of patients in these two groups ( P > 0.05).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…In a study by Wang et al of 620 patients who underwent PCI with either conventional TRA or dRA approach, there was no significant difference in puncture time, puncture success rate, procedure time, puncture site hemorrhage, hematoma and aneurysm but RAO was significantly lower in dRA access (p < 0.05). 16 Similar findings were observed in a metanalysis of five studies (four observational and one randomized trial), with a total of 4676 patients. 17 The rate of RAO was lower with dRA approach (2.30 versus 4.86%, RR = 0.51; 95%CI 0.32–0.81; p = 0.004) as compared to conventional TRA.…”

Section: Clinical Considerationssupporting

confidence: 75%

Anatomical snuff box approach for percutaneous coronary interventions – Current status

Deora

Agrawal

Choudhary

et al. 2021

Indian Heart Journal

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Anatomical snuff box or distal radial artery approach for various percutaneous coronary angiograms and interventions has gained increased interest in recent years. The main advantage is the ergonomic comfort to the patient as it allows the patient's arm to be in more natural position. The safety and feasibility of this novel approach has been studied in past few years but still the data is limited and the distal radial artery approach has not been included in the guidelines. The present review focuses on the latest evidence, technique, advantages and disadvantages of this distal radial artery access.

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“…The meta-analysis showed compared with cTRA, the access time was longer in dTRA, with the statistical difference between studies (SMD = 0.32, 95CI [0.08, 0.56], P =0.008; I 2 = 86.7%, P < 0.001) (see Figure 6 ). We conducted a sensitivity analysis by removing the outlier study, heterogeneity was significantly reduced after excluding the study by Wang [ 22 ], and there was still a statistical difference (SMD = 0.41, 95CI [0.29, 0.54], P < 0.001; I 2 = 32.5%, P =0.205). The Egger test showed no publication bias among the studies ( P =0.463).…”

Section: Resultsmentioning

confidence: 99%

Distal Transradial Access in Anatomical Snuffbox for Coronary Angiography and Intervention: An Updated Meta-Analysis

Liang

Han

Jia

et al. 2021

Journal of Interventional Cardiology

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Objective. The previous meta-analysis has assessed that distal transradial access (dTRA) in anatomical snuffbox is safe and effective for coronary angiography and intervention and can reduce radial artery occlusion. However, since the publication of the previous meta-analysis, several observational studies have been added, so we performed an updated meta-analysis to include more eligible studies to compare distal transradial access in anatomical snuffbox with conventional transradial access (cTRA). Method. Pubmed, Embase, and Cochrane Library databases were searched for relevant studies from the literature published until 5 January 2021 to evaluate catheterization/puncture failure, hematoma, radial artery spasm, radial artery occlusion (RAO), access time, fluoroscopy time, radiation dose area product, total procedure time, and hemostatic device removal time. The pooled odds ratio (OR), weighted mean difference (WMD), and standardized mean difference (SMD) with 95% confidence interval (95% CI) were calculated for dichotomous and continuous variables, respectively. Results. A total of 9,054 patients from 14 studies were included in the meta-analysis, and we found no significant difference in catheterization/puncture failure (OR = 1.94, 95CI [0.97, 3.86], P = 0.06 ), hematoma (OR = 0.97, 95CI [0.55, 1.73], P = 0.926 ), radial artery spasm (OR = 0.76, 95CI [0.43, 1.36], P = 0.354 ), total procedure time (SMD = 0.23, 95CI [−0.21, 0.68], P = 0.308 ), or radiation dose area product (WMD = 216.88 Gy/cm2, 95CI [−126.24, 560.00], P = 0.215 ), but dTRA had a lower incidence of RAO (OR = 0.39, 95CI [0.23, 0.66], P < 0.001 ), shorter hemostatic device removal time (WMD = −66.62 min, 95CI [−76.68, −56.56], P < 0.001 ), longer access time (SMD = 0.32, 95CI [0.08, 0.56], P = 0.008 ), and longer fluoroscopy time (SMD = 0.16, 95CI [−0.00, 0.33], P = 0.05 ) than cTRA. Conclusion. Compared with the cTRA, the dTRA has a lower incidence of radial artery occlusion and shorter hemostatic device removal time, which is worthy of further evaluation in clinical practice.

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A comparison of the clinical effects and safety between the distal radial artery and the classic radial artery approaches in percutaneous coronary intervention

Cited by 23 publications

References 10 publications

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

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

Anatomical snuff box approach for percutaneous coronary interventions – Current status

Distal Transradial Access in Anatomical Snuffbox for Coronary Angiography and Intervention: An Updated Meta-Analysis

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