Distal Transradial Access for Coronary Angiography and Interventions in Everyday Practice: Data From the TRIANGLE Registry (TwitteR Initiated registry for coronary ANgiography in Germany via distaL radial accEss)

Abstract

Introduction: Transradial access (TRA) has become the primary route for coronary angiography (CAG) and percutaneous coronary interventions (PCI). Recently a new puncture site more distally in the area of the anatomical snuffbox has been described. With this multicenter registry, we wish to demonstrate the feasibility and safety of the distal radial access (dRA).Methods: Between December 2018 and May 2019 all patients with a planned CAG or PCI via dRA in three cardiology centers in Germany were entered into this registry. Procedural data, puncture success, crossover rate and complications were registered. Proximal and distal radial artery patency were examined by ultrasound within 48 h. Results: A total of 327 patients were enrolled (mean age: 69 ± 12 years, 69% male gender, 49% PCI), in 5 cases bilateral distal puncture was performed. Puncture success, defined as completed sheath placement was high (N = 316/332, 95%) and the crossover rate was low (27/332, 8%). The rate of proximal radial artery occlusion after 1-48 h was low (2/332 1%), the rate of occlusion at the distal puncture site was also very low (3/332, 1%). Major complications were not encountered. Conclusion: Coronary angiography and interventions via the distal transradial access in the area of the anatomical snuffbox can be performed with a high rate of success and safety. This data suggests a reduced rate of radial artery occlusion compared to previously reported data after cannulation via the standard forearm radial artery puncture site. Randomized studies are needed to further investigate these results. Trial Registration: This study was registered in the German registry for clinical trials: DRKS00017110, retrospectively on 07.May 2019

Emerging Perspectives of Anatomical snuff box in Invasive Cardiology

“…Gajurel, et al [14] (n = 82) Pan, et al [9] (n = 52) Lin, et al [15] (n = 450) Bhambhani, et al [12] (n = 100) intervention by right or left snuff-box access remains a source of contention. [13]…”

Arterial Accesses in Coronary Angiography and Intervention—Review with a Focus on Prognostic Relevance

“…Having published this technique as video on YouTube© and Twitter© facilitated a uniquely rapid spreading of the dTRA in interventional cardiology and radiology worldwide ( ). Thus, the first based on social media initiated medical trial was started by three investigators who met via Twitter© [ 16 ]. Besides promising results for dTRA-feasibility the TRIANGLE and other registries showed low RAO rates for dTRA which were confirmed by randomized trials comparing dTRA with conventional pTRA as statistically significant [ 17 , 18 , 37 , 38 , 39 ].…”

“…However, when using the traditional radial puncture site—the proximal radial artery (pTRA)—radial artery occlusion (RAO) occurs in 5–8% (in meta analyses and up to 10% in certain centers) limiting future use of this safe route and, thus, feeding controversy among interventional cardiologists [ 12 , 13 , 14 , 15 ]. Using a more distal radial segment—behind the offgoing superficial palmar arch—within the so called “snuffbox” (SB) or even further distal in the dorsal box (DB) has recently been proven to be less prone to occlude after puncture [ 16 , 17 , 18 , 19 ] (Fig. 1 ).…”

Effect of Transradial Artery Catheterization on Shock Patients

“…The radial artery is usually the first choice for arterial catheterization, because the radial and ulnar arteries have a rich lateral circulation that avoids ischemic necrosis of the anterior limb. However, obesity, ectopia, hypoperfusion (hypotension, low cardiac output), extreme-weak arterial beats, and arterial spasm can all lead to failed arterial catheterization [ 4 , 5 ]. In recent years, ultrasound guidance has been widely used in jugular catheterization, peripherally inserted central venous catheterization, and femoral venous catheterization, but there have been few applications reported in artery catheterization.…”