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

Abstract

Introduction: Distal radial access (dRA) has recently gained global popularity as an alternative access route for vascular procedures. Among the benefits of dRA are the low risk of entry site bleeding complications, the low rate of radial artery occlusion, and improved patient and operator comfort. The aim of this large multicenter registry was to demonstrate the feasibility and safety of dRA in a wide variety of routine procedures in the catheterization laboratory, ranging from coronary angiography and percutaneous coronary intervention to peripheral procedures. Methods: The study comprised 1240 patients who underwent coronary angiography, PCI or noncoronary procedures through dRA in two Hungarian centers from January 2019 to April 2021. Baseline patient characteristics, number and duration of arterial punctures, procedural success rate, crossover rate, postoperative compression time, complications, hospitalization duration, and different learning curves were analyzed. Results: The average patient age was 66.4 years, with 66.8% of patients being male. The majority of patients (74.04%) underwent a coronary procedure, whereas 25.96% were involved in noncoronary interventions. dRA was successfully punctured in 97% of all patients, in all cases with ultrasound guidance. Access site crossover was performed in 2.58% of the patients, mainly via the contralateral dRA. After experiencing 150 cases, the dRA success rate plateaued at >96%. Our dedicated dRA step-by step protocol resulted in high open radial artery (RA) rates: distal and proximal RA pulses were palpable in 99.68% of all patients at hospital discharge. The rate of minor vascular complications was low (1.5%). A threshold of 50 cases was sufficient for already skilled radial operators to establish a reliable procedural method of dRA access. Conclusion: The implementation of distal radial artery access in the everyday routine of a catheterization laboratory for coronary and noncoronary interventions is feasible and safe with an acceptable learning curve.

Switching From Proximal to Distal Radial Artery Access for Coronary Chronic Total Occlusion Recanalization

“…Issues such as the appropriate choice of sheath and catheter sizes to minimize arterial wall injury, adequate procedural anticoagulation, non-occlusive techniques, and adequate hemostasis (e.g., “patent hemostasis”) are important steps to further improve this technique ( 23 ). In one of our previous reports, we found that it takes at least 150 cases to reach the learning curve and maintain a consistently high success rate of >94.0% ( 2 ). These findings are also consistent with a Korean report ( 24 ).…”

“…this imbalance could be equated with DRA. Ultimately, bringing both hands over the patient's pelvis is equivalent to the transfemoral positioning ( 2 ).…”

“…Nonetheless, appropriate size matching between the catheter and the radial artery diameter may theoretically introduce another challenge when pursuing DRA. In a large registry of over 1,000 patients, the mean diameter in the distal segment was of 2.3 ± 0.5 mm, while the outer diameter of the 7-French Glidesheath is 2.79 mm, and that of the 6-F is 2.46 mm ( 2 ). Another study found even smaller diameters (2.01 ± 0.53 mm, 19% smaller than the proximal segment) ( 25 ).…”

“…The indication for CTO PCI was established by the local heart team, as well as the recanalization strategy. There were 3 main operators responsible for all the procedures, the learning curve of the DRA as well as its technique being described elsewhere ( 2 ). Patients with ultrasound evidence of arterial occlusion, severe calcification, and a lumen of <1 mm were excluded.…”

“…Distal radial access (DRA), a technique that can no longer be called “novel” in terms of its widespread adoption, has already been declared feasible and safe in various types of coronary, structural and peripheral procedures ( 1 – 7 ). The most notable advantages are the low rate of radial artery occlusion, few local complications, short hemostasis time and better ergonomics, both for the patient and for the operator ( 1 , 2 ), especially in the case of left radial artery access.…”