Efficacy and safety of distal radial approach for cardiac catheterization: A systematic review and meta-analysis

Abstract

BACKGROUND The traditional radial approach (RA) is recommended as the standard method for coronary angiography (CAG), while a distal RA (DRA) has been recently used for CAG. AIM To assess the efficacy and safety of the DRA vs RA during CAG. METHODS The following databases were searched through December 2020: MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, the World Health Organization International Clinical Trials Platform Search Portal, and ClinicalTrials.gov. Individual randomized-controlled trials for adult patients undergoing cardiac catheterization were included. The primary outcomes were the successful cannulation rate and the incidence of radial artery spasm (RAS) and radial artery occlusion (RAO). Study selection, data abstraction and quality assessment were independently performed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS Three randomized control trials and 13 registered trials were identified. The two approaches showed similar successful cannulation rates [risk ratio (RR) 0.90, 95% confidence interval (CI): 0.72-1.13]. The DRA did not decrease RAS (RR 0.43, 95%CI: 0.08-2.49) and RAO (RR 0.48, 95%CI: 0.18-1.29). Patients with the DRA had a shorter hemostasis time in comparison to those with the RA (mean difference -6.64, 95%CI: -10.37 to -2.90). The evidence of certainty was low. CONCLUSION For CAG, the DRA would be safer than the RA with comparable cannulation rates. Given the limited data, additional research, including studies with standard protocols, is necessary.

Efficacy and Safety of Distal Radial Access for Transcatheter Arterial Chemoembolization (TACE) of the Liver

“…The mean number of attempts made to gain vascular access was slightly better than that reported by Aoi and Izumida [35,36], of 1.8 and 2.4, respectively. The constant use of ultrasound guidance could explain this finding.…”

“…Successful cannulation and sheath introduction were not possible only in one out of 42 patients (2.4%) due to vessel tortuosity despite fluoroscopic guidance. In their recent meta-analysis, Izumida and Liang [36,40] reported a dRA cannulation failure of 20.2% and 4.3%, respectively. The heterogeneity could be explained by patients discarded a priori from various investigations for anatomical factors, leading to potential selection bias.…”

Retrograde Recanalization of Occluded Radial Artery: A Single-Centre Experience and Literature Review

“…8,9,27 Meta-analysis results elucidated that after overcoming the learning curve, the safety and effectiveness of coronary intervention via the DRA was verified in several studies. 28 In 2007, Pancoly 10 first reported on his experience with retrograde recanalization of the occluded radial artery via the DRA, although not in the anatomic snuffbox region. In 12 of 14 patients, RAO was successfully recanalized without any complications.…”

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

“…Prior systematic reviews have compared the DRA and CRA access but have been limited to randomized control trials, searched a restricted number of databases, evaluated only certain outcomes, or included noncoronary procedures 8–16 . Following the recent publication of two of the largest randomized control trials to date, the ANGIE trial 5 and the DISCO RADIAL trial, 17 we aimed to systematically search, critically appraise, and evaluate the differences between DRA versus CRA access for coronary angiography or interventions using an updated systematic review with meta‐analysis.…”

“…Prior systematic reviews have compared the DRA and CRA access but have been limited to randomized control trials, searched a restricted number of databases, evaluated only certain outcomes, or included noncoronary procedures. [8][9][10][11][12][13][14][15][16] Following the recent publication of two of the largest randomized control trials to date, the ANGIE trial 5 and the DISCO RADIAL trial, 17 we aimed to systematically search, critically appraise, and evaluate the differences between DRA versus CRA access for coronary angiography or interventions using an updated systematic review with metaanalysis. The systematic review included an extensive database search and included randomized and nonrandomized control or observational studies, which permitted the review to cover multiple procedural and clinical outcomes of interest not exclusively included in only randomized control trials.…”