Distal Versus Conventional Transradial Artery Access for Coronary Angiography and Intervention: A Meta-Analysis

Hamandi, Mohanad; Saad, Marwan; Hasan, Rimsha; Megaly, Michael; Abbott, J. Dawn; Dib, Chad; Potluri, Srinivasa; Lotfi, Amir; Kiemeneij, Ferdinand; Al‐Azizi, Karim

doi:10.1016/j.carrev.2020.03.020

Cited by 42 publications

(53 citation statements)

References 25 publications

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“…Many operators suggest the benefits of this access over the standard radial access including easier left-sided access for aorto-coronary grafts, future proximal radial artery preservation, shorter time hemostasis and patient and operator comfort. However, few studies had compared the two approach and the published results remain controversial and limited [6][7][8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…While, in the Turkish study [ 6 ], vasospasm was described rather with CRA (4 cases, p < 0.001), it also required crossover to a new access and it was explained by an alpha-1 adrenoreceptor contained in a medial layer of radial artery. In the recent meta-analysis of 5 studies, there was no difference between the two techniques in regard to radial artery vasospasm (1.42 versus 3.84%, RR = 0.91; 95%CI 0.32–2.62; p = 0.86) [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

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Distal radial approach versus conventional radial approach: a comparative study of feasibility and safety

Hammami

Zouari

Abdessalem

et al. 2020

Libyan Journal of Medicine

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The distal radial approach (DRA) is suggested to have benefits over the conventional radial approach (CRA) in terms of local complications and comfort of both patient and operator. Therefore, we aimed to compare the feasibility and safety of DRA and CRA in a real life population. We conducted a prospective, observational multicentric trial, including all patients undergoing coronary procedures in September 2019. Patients with impalpable proximal or distal radial pulse were excluded. Thus, the choice of the approach is left to the operator discretion. The primary endpoints were cannulation failure and procedure failure. The secondary endpoints were time of puncture, local complications and radial occlusion assessed by Doppler performed one day after the procedure. We enrolled 177 patients divided into two groups: CRA (n = 95) and DRA (n = 82). Percutaneous intervention was achieved in 37% in CRA group and 34% in DRA group (p = 0.7). Cannulation time was not significantly different between the two sets (p = 0.16). Cannulation failure was significantly higher in DRA group (4.8% vs 2%, p < 0.0008). Successful catheterization was achieved in 98% for the CRA group and in 88% for the DRA group (p = 0.008). Radial artery occlusion, detected by ultrasonography, was found in 3 patients in the CRA group (3.1%) and nobody in the DRA group (p = 0.25). The median diameter of the radial artery diameter was higher in the DRA than the CRA group (2.2 mm vs 2.1 mm; p = 0.007). The distal radial approach is feasible and safe for coronary angiography and interventions, but needs a learning curve.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Distal radial approach versus conventional radial approach: a comparative study of feasibility and safety

Hammami

Zouari

Abdessalem

et al. 2020

Libyan Journal of Medicine

View full text Add to dashboard Cite

show abstract

“…Nevertheless, interventional cardiology literature proved that dRA access has a similar safety and efficacy profile than the conventional transradial approach. 16 The current literature even suggests dRA access to have some additional advantages over transradial access including decreased risk of hand ischemia, decreased time to hemostasis, greater patient and operator comfort. 10–13,15 dRA also offers the option for repeat dRA access and/or future radial artery access.…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis of 4 observational studies and 1 randomized controlled trial showed a statistically significant lower rate of radial artery occlusions with dRA versus transradial access (2.3% versus 4.86%, P = 0.004). 16 In his 2017 paper on left dRA access for coronary angiography and interventions Kiemeneij 17 mentions a 2014 EuroPCR talk by A. Kaledin who treated 656 patients via dRA and reported 1.5% of dRA occlusions. Other likely access related complications in this cohort included arm edema in 0.2%, arteriovenous and pseudoaneurysm formation in 0.2% each, radial artery dissection in 0.3%, transitory finger numbness in 0.6% and wrist and/or forearm hematoma in 0.8%.…”

Section: Discussionmentioning

confidence: 99%

Distal radial artery (snuffbox) access for carotid artery stenting – Technical pearls and procedural set-up

et al. 2020

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Purpose To report use of distal radial artery (dRA) access for carotid artery stenting (CAS) and to discuss procedural setup and technical considerations for a successful intervention. Methods A retrospective review of our prospective neurointerventional database of CAS was conducted between May 2019 and March 2020. All CAS cases via dRA in the anatomical snuffbox were identified. Patient demographics, clinical information, procedural and radiographic data was collected. Results 22 CAS procedures in 20 patients via dRA were identified. Patients’ mean age was 69.4 years (range 53–87 years). 3 patients were female. Mean radial artery diameter was 2.1 mm (range 1.6–2.8 mm). dRA access was achieved in all cases. Conversion to femoral access was required in 2 cases (9.1%) due to persistent radial artery vasospasm resulting in patient discomfort despite multiple additional doses of intraarterial vasodilators and added intravenous sedation as well as tortuous vessel anatomy and limited support of the catheters in a type 3 aortic arch for left CAS. Conclusion Our preliminary experience with dRA access for CAS suggests this approach to be feasible and safe for patients. Technical considerations are important and preprocedural planning is necessary for a successful intervention. Catheter systems and devices specifically designed for radial access are needed to enable more interventionalists to safely perform neurointerventional procedures via wrist access.

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“…This increases the potential for expansion of this new access route, although the complications of the procedure and the clinical outcomes of DRA have not been systematically assessed, therefore the safety of this approach remains unknown. 11 In the present study, the objective was to investigate the impact of DRA on RAO, and post-procedure hemorrhagic events in three centers with an increasing experience in the technique.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of radial artery occlusion in patients undergoing diagnostic and therapeutic coronary procedures via distal radial access. A retrospective observational study (RDISTAL DOR)

Tebet¹,

Ogama²,

Kreimer³

et al. 2021

J Transcat Intervent

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Background: The use of the distal radial access for invasive coronary procedures has been rapidly adopted by the medical community, but with no evaluation of efficacy and safety outcomes of this approach. The objective was to evaluate the rate of radial artery occlusion involved in this technique, using Doppler ultrasound. Methods: This was an observational, retrospective study involving patients undergoing invasive diagnostic or therapeutic coronary procedures via distal radial access, with assessment of the radial artery patency by Doppler ultrasound. The primary outcome analyzed was the rate of radial artery occlusion. Results: Between July and December 2020, 51 patients underwent procedures via distal radial access, with assessment of the radial artery patency, out of a total of 603 patients seen during this period. Patients were aged 58±10.8 years, 68.6% were male, 26.9% had diabetes mellitus, and 68.6% were diagnosed with acute coronary syndrome. Diagnostic procedures were performed in 68.2% of sample, and 23.5% of patients had undergone a previous use of the ipsilateral proximal radial access. Doppler ultrasound was performed over a mean period of 24 hours, and no occlusion of the radial artery was observed, with mean time for sheath insertion of 1.9 minutes. There was no major vascular complication. In two patients, pain was observed at the access point; another two had a small subcutaneous hematoma, and, one patient, presented with moderate spasm. Conclusion: The use of distal radial access was associated with a low rate of hemorrhagic complications in the access route, and absence of occlusion of the radial artery by Doppler ultrasound assessment.

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Distal Versus Conventional Transradial Artery Access for Coronary Angiography and Intervention: A Meta-Analysis

Cited by 42 publications

References 25 publications

Distal radial approach versus conventional radial approach: a comparative study of feasibility and safety

Distal radial approach versus conventional radial approach: a comparative study of feasibility and safety

Distal radial artery (snuffbox) access for carotid artery stenting – Technical pearls and procedural set-up

Evaluation of radial artery occlusion in patients undergoing diagnostic and therapeutic coronary procedures via distal radial access. A retrospective observational study (RDISTAL DOR)

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