Comparison of distal radial access versus standard transradial access in patients with smaller diameter radial Arteries(The distal radial versus transradial access in small transradial ArteriesStudy: D.A.T.A - S.T.A.R study)

Abstract

Aims :To evaluate safety and efficacy of distal right radial access (DRRA) compared to right radial access (RRA), for coronary procedures, in patients with smaller diameter radial arteries (SDRA) (radial artery diameter (RAD) < 2.1 mm). Methods and results This is a retrospective analysis of safety and efficacy of DRRA Vs. RRA in patients undergoing coronary procedures at our cardiac catheterization laboratories over a 10- month period between September 2017 and June, 2018 (first 5 calendar months with RRA-first; next 5 calendar months with DRRA-first). All patients underwent pre-procedure ultrasound of arm arteries. All patients had RAD<2.1 mm (mean RAD 1.63 ± 0.27 mm; RAD≤1.6 mm in 73.5%). Baseline characteristics were similar between groups. Primary end-point of puncture success was significantly lower in DRRA vs RRA group [79.5% vs 98.5%, p < 0.0001]. Puncture success was also lower in the subgroup of patients with RAD <1.6 mm Vs. ≥ 1.6 mm in the DRRA group ( p < 0.0001). The secondary end-point of puncture time was significantly higher (2.1 ± 1.4 min vs. 1.0 ± 0.45 min, p < 0.00001) in the DRRA Vs. RRA group. The occurrence of vascular access site complications (including access site hematomas), radial artery occlusion (RAO) and distal RAO at day 1 and day 30 were similar between RRA and DRRA groups.Non-vascular access-site complication was seen only in the DRRA group. Conclusion DRRA is a safe and effective access for coronary procedures; though technically challenging in patients with SDRA (RAD<2.1 mm; mean RAD 1.63 ± 0.27 mm), with lower puncture success and higher puncture time compared to RRA.

The technical features of the diagnosis or treatment of coronary artery disease through the distal radial artery approach at the anatomical snuffbox compared with the conventional radial artery approach

“…The procedure success rate of 97.4% in the dTRI group was consistent with other studies [ 17 , 18 ]. Therefore, the distal radial artery approach can complete coronary angiography and most PCI processes with a high procedure success rate and good immediate angiography results.…”

“…During the intervention process, the guiding catheter does not need to be passed through the dorsal wrist to the proximal radial artery, which facilitates the delivery of a larger stent and balloon. The procedure success rate of 97.4% in the dTRI group was consistent with other studies [17,18]. Therefore, the distal radial artery approach can complete coronary angiography and most PCI processes with a high procedure success rate and good immediate angiography results.…”

Distal Radial Artery Access for Coronary and Peripheral Procedures: A Multicenter Experience

“…While head-to-head comparisons between pRA and dRA have been started [18][19][20][21], we believe randomized, controlled trials directly comparing dRA to pRA are not sine qua non with regard to juxtaposition between the two sites as one does not substitute the other. dRA represents an evolution and a complement of the developing nature of TRA and nuances such as preservation of the common radial artery, easier hemostasis, and ergonomics play a role when choosing a specific entry site.…”

Comparison between the Right and Left Distal Radial Access for Patients Undergoing Coronary Procedures: A Propensity Score Matching Analysis

“…Access Technique. US-guided puncture offers advantages, such as the assessment of anatomical landmarks and accurate location of the puncture site [13], and improves patient selection [16,17]. In our protocol, with the mandatory evaluation of the arteries by US prior to the procedure, only patients with the highest probability of success for DRA were selected, excluding patients with small-caliber arteries that are associated with more access failure.…”