Distal Radial Artery Access in comparison to Forearm Radial Artery Access for Cardiac Catheterization: A Randomized Controlled Trial (DARFORA Trial)

Abstract

Background. In our clinical practice, conventional radial access has been employed routinely for coronary procedures. The distal radial artery (DRA) access site has recently emerged as a novel technique in cardiac procedures. Objectives. This study compares distal radial access to standard forearm radial access (FRA) in terms of feasibility, outcomes, and complications. Method. This prospective, randomized trial was conducted at a single center. The patients were chosen from An-Najah National University Hospital’s catheterization laboratory between December 2019 and November 2020. A total of 209 patients were randomized into two groups: DRA group (n = 104) and FRA group (n = 105). Results. Access was successful in 98% of patients in both the groups. The DRA group had a longer puncture duration and a higher number of attempts (duration: 56.6 ± 61.1 s DRA vs. 20.0 ± 18.4 s FRA, p < 0.001 , attempts: 1.9 ± 1.3 DRA vs. 1.2 ± 0.60 FRA, p < 0.001 ). Puncture-associated pain was greater in the DRA group (4 ± 2.2 DRA vs. 3 ± 2.1 FRA, p = 0.001 ). There were two radial artery occlusions in the FRA group and none in the DRA group ( p = 0.139 ). Percutaneous coronary intervention (PCI) was performed in 26% of the DRA group and 37.1% of the FRA group. The DRA group had significantly shorter procedure times ( p = 0.006 ), fluoroscopy times ( p = 0.002 ), and hemostasis times ( p = 0.002 ). Over time, the learning curve demonstrated improved puncture duration and a decrease in the number of puncture attempts. Conclusions. DRA is a safe and practical alternative to FRA for coronary angiography and intervention. The overtime learning curve is expected to improve puncture-related outcomes.

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

“…Baseline studies characteristics included multinational single and multicenter studies published between 2017 and 2022 with enrollment periods spanning from 2016 to 2021. 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.…”

“…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).…”

“…3,4,22,24,26,27,29,31,32,34,40,42,44 Six studies assessed rates of successful access on the first attempt. 4,24,28,37,41 Thirteen studies assessed crossover to alternative arterial access rate. [3][4][5]17,24,[26][27][28][29][30]36,37,39 Eight studies assessed total procedure time (minutes).…”

“…4,24,28,37,41 Thirteen studies assessed crossover to alternative arterial access rate. [3][4][5]17,24,[26][27][28][29][30]36,37,39 Eight studies assessed total procedure time (minutes). 24,26,28,29,31,33,34,42 Seven studies assessed fluoroscopy time (minutes).…”

“…[3][4][5]17,24,[26][27][28][29][30]36,37,39 Eight studies assessed total procedure time (minutes). 24,26,28,29,31,33,34,42 Seven studies assessed fluoroscopy time (minutes). 4,24,27,28,31,33,42 Four studies assessed radiation dose area product (cGy/cm 2 ).…”