Advancement in Coronary Angiography or Percutaneous Coronary Intervention Using the Distal Transradial Artery Access in Acute Coronary Syndrome and Complex Coronary Artery Disease

Cao, Gang; Cai, Huaxiu; Cao, Jun

doi:10.5152/anatoljcardiol.2021.933

Cited by 11 publications

(5 citation statements)

References 48 publications

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“…Blind intubation without measuring artery diameter may be associated with a higher risk of arterial injury [15]. Our study found that patients with artery diameter smaller than the sheath had obvious resistance during the placement of the sheath, pushing the guide wire and sending the guide catheter, and patients felt obvious discomfort during removal of the catheter [16]. The reason for this occurrence may be that the abundant alpha-adrenergic receptors in the outer vascular membrane of the artery make the radial artery prone to have higher vascular reactivity, which contributes to tem-porary and sudden vascular narrowing after local trauma [17].…”

Section: Discussionmentioning

confidence: 67%

Efficacy and Safety of Distal Radial Artery Approach for Coronary Angiography: A Retrospective Study

Chen,

Li,

Huang

et al. 2023

HSF

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Background: The distal radial artery approach has been employed as a potential alternative technique for coronary angiography. Nevertheless, its clinical implementation is significantly constrained by the narrow diameter of the radial artery. A comprehensive investigation of the efficacy and safety of the distal radial artery approach for coronary angiography is lacking. The objective of this study is to investigate the impact of the distal radial artery approach for coronary angiography and transradial artery access for interventional diagnosis and treatment. In addition, the effectiveness and safety of the distal radial artery approach for coronary artery angiography will be analyzed, for the wider adoption of this technique in clinical practice. Methods: A total of 68 patients with coronary heart disease (CHD) who underwent coronary catheterization via the left distal radial artery approach from December 2020 to December 2022 using the Distal radial artery approach (TRA) comprised the case-control study group. Seventy-three CHD patients who underwent routine left Transradial Artery Access coronary catheterization were selected as the Regular TRA group during the same period. Clinical data including age, body mass index (BMI), gender, CHD risk factors, routine drug treatment, ultrasonic-related indicators and operation-related indicators were collected from electronic medical records and the catheterization database from the two groups of patients. Results: The diameter and Endothelium-dependent vasodilation (noe FMD) of puncture vessels in the Distal TRA group were significantly lower than those in the Regular radial artery approach (TRA) group (p-value < 0.05). After a period of 48 hours following the catheterization, the puncture vessel diameter and flow-mediated dilation (FMD) of the Distal TRA group were significantly lower compared to those of the Regular TRA group (p-value < 0.05). The effectiveness of transradial artery access was then compared between the two groups. It was determined that the Distal TRA group exhibited significantly higher values in terms of the Visual Analog Scale (VAS) score, puncture time, and heparin usage, in comparison to the Regular TRA group (p-value < 0.05). The occurrence rates of local hematoma, mediastinal hematoma, retroperitoneal hematoma, pseudoaneurysm, arteriovenous fistula, vagal reflex, vasospasm, blood transfusion, and other complications among patients in the Distal TRA group were comparable to those in the Regular TRA group (p-value > 0.05). The incidence of puncture and X-ray radiation in the Distal TRA group was found to be marginally higher compared to the Regular TRA group. This study suggests that the safety profile of patients undergoing coronary artery catheterization via the distal radial artery is relatively higher than those undergoing the procedure via the transradial artery, although the difference was not statistically significant (p-value > 0.05). Conclusions: The Distal radial artery approach can be used for conducting comprehensive coronary interventional diagnosis and treatment procedures, offering benefits such as reduced postoperative compression time, better hemostasis through the distal radial artery approach, and enhanced patient comfort. This approach demonstrates favorable efficacy and safety, making it a suitable routine puncture method for clinical treatment.

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Section: Discussionmentioning

confidence: 67%

Efficacy and Safety of Distal Radial Artery Approach for Coronary Angiography: A Retrospective Study

Chen,

Li,

Huang

et al. 2023

HSF

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“…In the emergency context, the dTRA puncture time is a concern as it may delay the D-to-B time. A review about dTRA in STEMI indicated that the puncture time of the dTRA did not affect the timely opening of the culprit vessel [ 18 ]. Kim Y reported that the mean snuffbox puncture time was 2.7 ± 1.6 min in patients with STEMI, which did not delay the D-to-B time [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the feasibility and safety between distal transradial access and conventional transradial access in patients with acute chest pain: a single-center cohort study using propensity score matching

Liang

et al. 2023

BMC Geriatr

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Background Distal transradial access (dTRA) has been suggested to have great advantages over cTRA. However, there is a lack of preliminary data on dTRA in patients undergoing emergency coronary angiography (CAG) or percutaneous coronary intervention (PCI). To explore the feasibility and safety of distal transradial access in patients with acute chest pain. Methods A total of 1269 patients complaining of acute chest pain in our emergency department from January 2020 to February 2022 were retrospectively included. The patients who met the inclusion criteria were divided into the conventional transradial access (cTRA) group (n = 238) and the dTRA group (n = 158). Propensity score matching was used to minimize the baseline differences. Results The cannulation success rate in the dTRA group was significantly lower than that in the cTRA group (87.41% vs. 94.81%, p < 0.05). No significant differences in the puncture time and total procedure time were noted between the two groups (p > 0.05). Compared with the cTRA group, the hemostasis duration was significantly shorter [4(4, 4) h vs. 10(8, 10) h, p < 0.001) and the incidence of minor bleeding (BARC Type I and II) was significantly lower in the dTRA group than that in the cTRA group (0.85% vs. 5.48%, p = 0.045). Asymptomatic radial artery occlusion was observed in six patients (5.83%) in the cTRA group and one patient (1.14%) in the dTRA group (p = 0.126). The subgroup analysis of ST-elevation myocardial infarction (STEMI) showed no significant differences in the puncture time, D-to-B time or total procedure time between the two groups. Conclusions The dTRA for emergency CAG or PCI has an acceptable success rate and puncture time, a shorter hemostasis time, and a downward trend in RAO rate compared to the cTRA. The dTRA did not increase the D-to-B time in emergency coronary interventions in STEMI patients. On the contrary, a low incidence of RAO by the dTRA created an opportunity for future coronary interventions in non-culprit vessels in the same access. Trial registration Retrospectively registered in Chinese Clinical Trial Registry (registry number: ChiCTR2200061104, date of registration: June 15, 2022).

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“…However, patients in the DRA group had shorter fluoroscopy times, total radiation doses, and hospitalization days, and patients in the TF group had a higher mortality rate during hospitalization (0% in the dTRA group and 18% in the TF group, p = 0.013). 58 Cao et al’s review showed that the puncture time for coronary angiography or PCI using the DRA path for ACS is 28.63 s to 162 ± 96 s. 59 As a perspective, the option of using large bore catheters in complex high-risk coronary cases remains open and must be tested with DRA 60 ; for example, a 2.0 mm rotablation burr requires an 8-French catheter and not all arterial lumens support such a size. In this case, the role of ultrasound becomes relevant again by means of preoperative assessment of arterial diameter because the incidence of RAO is directly related to the ratio between the sheath and artery size.…”

Section: Distal Radial Access For Coronary Interventionsmentioning

confidence: 99%

The distal radial artery: Versatile vascular access for transcatheter interventions

Achim

Ruzsa

2022

J Vasc Access

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Conventional transradial access has been established as the gold standard for invasive coronary angiography and percutaneous interventions by the current European and American guidelines. The distal or snuffbox radial artery access represents an alternative transradial access site that allows radial sheath insertion with the patient’s hand pronated. Firstly described 40 years ago, it exploded in popularity only recently. Promising additional benefits, the distal radial access is increasingly being adopted in various types of percutaneous interventions, being preferred by many interventional cardiologists and radiologists for its reduced vascular complications and time to hemostasis, and improvement of patient and operator comfort. Other centers consider it a fad, waiting for solid clear evidence and benefits. The evidence is dynamic and discrepant, depending on the center, the operator, and how it was collected (randomized controlled vs observational studies). Another essential aspect raised by “skeptics” was whether distal radial access, by its smaller diameter and more angled course, can support all types of interventions. The aim of this review is to gather all the scenarios where distal radial access has been utilized and to conclude whether this vascular access is feasible across all transcatheter interventions.

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Advancement in Coronary Angiography or Percutaneous Coronary Intervention Using the Distal Transradial Artery Access in Acute Coronary Syndrome and Complex Coronary Artery Disease

Cited by 11 publications

References 48 publications

Efficacy and Safety of Distal Radial Artery Approach for Coronary Angiography: A Retrospective Study

Efficacy and Safety of Distal Radial Artery Approach for Coronary Angiography: A Retrospective Study

Comparison of the feasibility and safety between distal transradial access and conventional transradial access in patients with acute chest pain: a single-center cohort study using propensity score matching

The distal radial artery: Versatile vascular access for transcatheter interventions

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