Traditional versus distal radial access for coronary angiography: a meta-analysis of randomized controlled trials

Abstract

Radial artery occlusion (RAO) is a well known complication that occurs after traditional radial artery (TRA) intervention and limits the radial artery as a future access site, as well as an arterial conduit. Distal radial artery (DRA) access has emerged recently as an alternative approach with a potential lower incidence of RAO. Database search of Pubmed/MEDLINE, Cochrane Library, and EMBASE was conducted by two authors from inception through 1 October 2022. Randomized trials that compared TRA with the DRA approach to perform coronary angiography were included. Two authors extracted pertinent data into predefined data collection tables. The risk ratios and 95% confidence intervals (CIs) were reported. Eleven trials were included (5700 patients) in the study. The mean age was 62.0 ± 10.9 years. Compared with DRA, vascular access through the TRA was associated with a higher incidence of RAO (risk ratio 3.05, 95% CI, 1.74–5.35, P < 0.01); however, arterial access by using the TRA was associated with a lower incidence of access failure leading to a crossover compared with the DRA approach (risk ratio 0.35; 95% CI, 0.21–0.57, P < 0.01). The incidence of radial artery spasm and access site-associated hematoma was not significant in the group treated with TRA compared with the DRA approach (P > 0.05). The DRA approach was associated with a lower incidence of RAO compared with the TRA approach but this was at the expense of a higher crossover rate.

Impact of sex differences on the feasibility and safety of distal radial access for coronary procedures: a multicenter prospective observational study

“…We also want to emphasize that the percentage of access-related vascular complications was very low and no differences were observed between the groups, which shows that DRA procedures are feasible and safe. These results are consistent with the low rate of complications of DRA in previous investigations [4–13].…”

“…In addition to access success, our study compared other performance parameters in DRA procedures. The overall incidence of radial spasm in this investigation was similar to that reported in previous randomized studies and meta-analysis, which compared DRA with TRA [7,9–13]. The presence of a slightly higher rate of radial spasm in the female group appears to be related to the size of the proximal and distal radial arteries in women.…”

“…Several observational and randomized studies have established its feasibility and safety [5–9], with evidence of certain advantages over TRA, such as a reduction in hemostasis time, a lower incidence of complications at the puncture site, and a lower incidence of radial artery occlusion (RAO). Notwithstanding that, a recent randomized study reported a similar RAO rate between DRA and TRA [10], and several meta-analyzes confirm the advantages of DRA, despite a consistently significant high crossover rate [11–13].…”

Comparison of long-term radial artery occlusion via distal vs. conventional transradial access (CONDITION): a randomized controlled trial

“…In recent years, the distal transradial aceess (dTRA) has emerged as an attractive and alternative access to the conventional transradial access (TRA) for cardiovascular interventional diagnosis and/or treatment [1][2][3]. Compared with other approaches, cardiovascular catheterization via the dTRA not only increases patient comfort but also significantly shortens the time of compression haemostasis and reduces the incidence of vascular access-related complications [4][5][6]. Thus, a significant reduction in the incidence of radial artery occlusion (RAO) is an important reason for interventional doctors to choose the dTRA in cardiovascular interventions.…”