Importance of measurement of the diameter of the distal radial artery in a distal radial approach from the anatomical snuffbox before coronary catheterization

Norimatsu, Kenji; Kusumoto, Takaaki; Yoshimoto, Keisuke; Tsukamoto, Mitoshi; Kuwano, Takashi; Nishikawa, Hiroaki; Matsumura, Toshiyuki; Miura, Shin‐ichiro

doi:10.1007/s00380-019-01404-2

Cited by 52 publications

(57 citation statements)

References 12 publications

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“…Other studies show that the diameter of DRA positively correlated with both body weight and basal metabolic index. Ulnar arteries were slightly larger than radial arteries and may be used as an alternative to DRA [8][9][10].…”

Section: Diametermentioning

confidence: 99%

“…A further benefit of US guidance is that the operator can measure the vessel size before puncturing. The outer diameters of 5 French, 6 French, and 7 French introducer sheaths are usually 2.3, 2.6, and 2.8 mm respectively, and it can help to determine whether the radial artery can accommodate the required procedural sheath and hardware, and to choose a smaller diameter sheath in order to reduce the risk of vascular injury, unnecessary patient pain, and RAO [10,14].…”

Section: Ultrasound Guidancementioning

confidence: 99%

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Distal Radial Artery Access: The Future of Cardiovascular Intervention

Nairoukh¹,

Jahangir²,

Adjepong³

et al. 2020

Cureus

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Access sites for coronary intervention have been changing over the last several decades, from the femoral artery to the radial artery and then to the distal radial artery. Distal radial access, which was first used in 2017 and is still not recommended by the guidelines, shows a higher success rate and less complications than other sites; therefore, it might be the future for cardiovascular intervention. In this study, we reviewed almost all of the articles that are related to the distal radial access, from 2017 to present, and summarized the technique, success rate, advantages, disadvantages, and noncardiac use of this access site.

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Section: Diametermentioning

confidence: 99%

Section: Ultrasound Guidancementioning

confidence: 99%

Distal Radial Artery Access: The Future of Cardiovascular Intervention

Nairoukh¹,

Jahangir²,

Adjepong³

et al. 2020

Cureus

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“…Several studies have demonstrated that major bleeding did not occur in patients who underwent CAG and PCI via the DRA [7][8][9][11][12][13][14]19]. In the present study, new P2Y 12 receptor inhibitors, including ticagrelor and prasugrel, were loaded before primary PCI in about 90% of patients and unfractionated heparin was used during primary PCI in all 128 patients.…”

Section: Discussionmentioning

confidence: 73%

“…In our previous retrospective and prospective studies, the success rate was 88.0% (132/150) and 95.5% (191/200), respectively [8,9]. Several other studies have also reported an 89.8% to 100% success rate of the DRA [11][12][13][14]. However, these studies enrolled a small number of patients with STEMI.…”

Section: Discussionmentioning

confidence: 96%

“…Data on the DRA for primary PCI remains limited, and only a few cases have been reported [15,16]. Furthermore, several studies have demonstrated that the diameter of the distal radial artery is relatively smaller than that of the conventional radial artery, thus raising the concern about whether the DRA can be as feasible as the conventional radial approach [8,9,13,14,17]. In our study, successful primary PCI was performed without a change in access-site in all 128 patients in whom successful snuffbox puncture was achieved.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of primary percutaneous coronary intervention via the distal radial approach in patients with ST-elevation myocardial infarction

Kim

Lee

et al. 2021

Korean J Intern Med

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Background/Aims: Recently, distal radial approach (DRA), called as snuff box approach, has gained the interest of interventional cardiologists, but there is a lack of data about the feasibility of DRA as an alternative route for primary percutaneous coronary intervention (PCI). Methods: A total of 138 patients presenting with ST-elevation myocardial infarction (STEMI) in whom primary PCI via the DRA was attempted at three hospitals from October 2017 to September 2019 were analyzed. Results: The success rate of snuff box puncture in the setting of STEMI was 92.8% (128/138). Successful primary PCI via the DRA was achieved in all 128 patients. The snuff box puncture time, defined as the time interval from local anesthesia induction to successful sheath cannulation, was 2.7 ± 1.6 minutes, and snuff box puncture was performed within 5 minutes in 95.3% of patients. Moreover, the percentage of the puncture time in the door-to-balloon time was 3.3%. The left DRA was selected in 103 patients (80.5%), and primary PCI via the DRA was performed using a 6-Fr guiding catheter in 125 patients (97.7%). There was no major bleeding; however, there were four cases (3.1%) of access-site complications, including three cases of local hematoma (≤ 5 cm diameter) and one case of local numbness, which improved 3 months later. Conclusions: In the setting of STEMI, the DRA could be a feasible alternative access route for primary PCI.

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

Feghaly

Chen

Blanco

et al. 2023

Cathet Cardio Intervent

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Background The distal radial artery (DRA) access is an alternative to the conventional radial artery (CRA) access for coronary angiography and interventions and appears to be associated with reduced incidence of certain outcomes. Methods A systematic review was performed to evaluate differences between DRA versus CRA access for coronary angiography and/or interventions. Following preferred reporting items for systematic review and meta‐analysis‐protocols guidelines, two reviewers independently selected studies published in the electronic databases (MEDLINE, EMBASE, SCOPUS, CENTRAL) from inception to October 10, 2022, followed by data extraction, meta‐analysis, and quality assessment. Results The final review included 28 studies with (total: 9151 patients [DRA: 4474; CRA: 4677]). Compared with CRA, DRA access was found to be associated with a shorter time to achieve hemostasis (mean difference, MD: −32.49 [95% confidence interval, CI: −65.53, −2.46], p < 0.00001), and reduced incidence of radial artery occlusion (RAO) (risk ratio, RR: 0.38 [95% CI: 0.25, 0.57], p < 0.00001), any bleeding (RR: 0.44 [95% CI: 0.22, 0.86], p = 0.02), and pseudoaneurysm (RR: 0.41 [95% CI: 0.18, 0.99], p = 0.05). However, DRA access has increased access time (MD: 0.31 [95% CI: −0.09, 0.71], p < 0.00001) and crossover rates (RR: 2.75 [95% CI: 1.70, 4.44], p < 0.00001). There were no statistically significant differences in other technical aspects and complications. Conclusion DRA access is a safe and feasible approach for coronary angiography and interventions. Compared to CRA, DRA provides a shorter hemostasis time, lower incidence of RAO, any bleeding, and pseudoaneurysm, and is associated with increased access time and crossover rates.

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Importance of measurement of the diameter of the distal radial artery in a distal radial approach from the anatomical snuffbox before coronary catheterization

Cited by 52 publications

References 12 publications

Distal Radial Artery Access: The Future of Cardiovascular Intervention

Distal Radial Artery Access: The Future of Cardiovascular Intervention

Feasibility of primary percutaneous coronary intervention via the distal radial approach in patients with ST-elevation myocardial infarction

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

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