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Al-Azizi K, Moubarak G, Dib C, Sayfo S, Szerlip M, Thomas S, Hale S, Zyl JV, Settele RM, Gonzalez OR, Ventura SJ, DiMaio JM, Mack MJ, Potluri S. Distal Versus Proximal Radial Artery Access for Cardiac Catheterization: 1-Year Outcomes. Am J Cardiol 2024; 220:102-110. [PMID: 38432334 DOI: 10.1016/j.amjcard.2024.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/02/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
Proximal radial artery (PRA) access for cardiac catheterization is safe but can jeopardize subsequent use of the artery because of occlusion. Distal radial artery (DRA) access in the anatomical snuffbox preserves the RA but safety and potential detrimental effects on hand function are unknown. We aimed to assess hand function and complications after DRA and PRA. In this single-center trial, 300 patients were randomly allocated 1:1 to cardiac catheterization through DRA or PRA. The primary end point of change in hand function from baseline to 1 year was a composite of the Quick Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, hand grip test, and thumb-forefinger pinch test. The secondary end points included access feasibility and complications. Of 216 patients with 1-year completed follow-up, 112 were randomly allocated to DRA and 104 to PRA, with balanced demographics and procedural characteristics. Both groups had similar access site bleeding rates (DRA 0% vs PRA 1.4%, p = 0.25). Radial artery occlusion occurred in 1 PRA patient versus 2 in DRA. There was no significant difference in change of hand function, median (interquartile range) hand grip (DRA 0.7 [-3 to 4.5] vs PRA 1.3 [-2 to 4.3] kg, p = 0.57), pinch grip (DRA -0.1 [-1.1 to 1] vs PRA -0.3 [-1 to 0.7] kg, p = 0.66), and Quick DASH (DRA 0 [-6.6 to 2.3] vs PRA 0 [-4.6 to 2.9] points, p = 0.58). The composite of hand function was comparable between PRA and DRA. In conclusion, DRA is a safe strategy for cardiac catheterization, with a low complication rate. Compared with PRA, there is no increased risk of hand dysfunction or radial artery occlusion at 1 year.
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Affiliation(s)
- Karim Al-Azizi
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas.
| | | | - Chadi Dib
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Sameh Sayfo
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Molly Szerlip
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas; Baylor Scott and White Research Institute, Plano, Texas
| | - Sibi Thomas
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Sarah Hale
- Baylor Scott and White Research Institute, Plano, Texas
| | | | | | | | | | - J Michael DiMaio
- Baylor Scott and White Research Institute, Plano, Texas; Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Michael J Mack
- Baylor Scott and White Research Institute, Plano, Texas; Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Srinivasa Potluri
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas
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Mufarrih SH, Haider S, Qureshi NQ, Khan MS, Kazimuddin M, Akbar MS, Saleem S, Mufarrih SA, Tripathi A, Singh A, Waheed MA. Distal Versus Proximal Radial Arterial Access for Percutaneous Coronary Angiography and Intervention: Updated Meta-Analysis of Randomized Controlled Trials. Am J Cardiol 2024; 218:34-42. [PMID: 38432336 DOI: 10.1016/j.amjcard.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/23/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
Radial artery occlusion (RAO) is a major impediment to reintervention in patients who underwent proximal transradial access (p-TRA) for coronary catheterization. Distal transradial access (d-TRA) at the level of snuffbox distal to the radial artery bifurcation is a novel alternative to p-TRA. We conducted an updated meta-analysis of all available randomized controlled trials (RCTs) to compare the incidence of RAO between p-TRA and d-TRA, along with access site-related complications. PubMed, Web of Science, and Google Scholar were searched for RCTs published since 2017 to October 2023 comparing d-TRA and p-TRA for coronary angiography and/or intervention. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals were calculated using the random-effects model for procedural and clinical outcomes for the 2 approaches. A total of 18 RCTs with 8,205 patients (d-TRA n = 4,096, p-TRA n = 4,109) were included. The risk of RAO (RR 0.31, 0.21 to 0.46, p ≤0.001) and time to hemostasis (minutes) (MD -51.18, -70.62 to -31.73, p <0.001) was significantly lower in the d-TRA group. Crossover rates (RR 2.39, 1.71 to 3.32, p <0.001), access time (minutes) (MD 0.93, 0.50 to 1.37, p <0.001), procedural pain (MD 0.46, 0.13 to 0.79, p = 0.006), and multiple puncture attempts (RR 2.13, 1.10 to 4.11, p = 0.03) were significantly higher in the d-TRA group. The use of d-TRA for coronary angiography and/or intervention is associated with a lower risk of RAO at the forearm and may preserve p-TRA site for reintervention in selective patients by reducing the incidence of RAO.
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Affiliation(s)
| | - Sajjad Haider
- Department of Medicine, University of Kentucky, Bowling Green, Kentucky; Department of Cardiology, Western Kentucky Heart and Lung, Bowling Green, Kentucky
| | | | - Mohammad Saud Khan
- Department of Medicine, University of Kentucky, Bowling Green, Kentucky; Department of Cardiology, Western Kentucky Heart and Lung, Bowling Green, Kentucky
| | - Mohammed Kazimuddin
- Department of Medicine, University of Kentucky, Bowling Green, Kentucky; Department of Cardiology, Western Kentucky Heart and Lung, Bowling Green, Kentucky
| | - Muhammad Shoaib Akbar
- Department of Medicine, University of Kentucky, Bowling Green, Kentucky; Department of Cardiology, Western Kentucky Heart and Lung, Bowling Green, Kentucky
| | - Sameer Saleem
- Department of Medicine, University of Kentucky, Bowling Green, Kentucky; Department of Cardiology, Western Kentucky Heart and Lung, Bowling Green, Kentucky
| | | | - Avnish Tripathi
- Department of Cardiology, CHI St. Vincent, Heart Clinic Arkansas, Little Rock, Arizona
| | - Aniruddha Singh
- Department of Medicine, University of Kentucky, Bowling Green, Kentucky; Department of Cardiology, Reading Hospital, West Reading, Pennsylvania
| | - Mohammad Abdul Waheed
- Department of Medicine, University of Kentucky, Bowling Green, Kentucky; Department of Cardiology, Western Kentucky Heart and Lung, Bowling Green, Kentucky
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Acar E, Izci S, Donmez I, Yilmaz MF, Ozgul N, Kayabası O, Gokce M, Güneş Y, Izgi IA, Kirma C. The Left D istal transradial access site co uld give a safe alter nate sit e for tra nsradial coronary in tervention (The Litaunent Study). Angiology 2024; 75:425-433. [PMID: 37345456 DOI: 10.1177/00033197231183226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Transradial Access (TRA) is the suggested method when performing coronary procedures. TRA has several advantages over the transfemoral approach, but also some restrictions. The present study compared the efficacy and safety of the traditional proximal transradial approach (pTRA) with a newer technique known as the distal transradial approach (dTRA) for performing a coronary angiography (CAG) and percutaneous coronary intervention (PCI). Patients (n = 700) were placed into one of two categories (dTRA or pTRA) based on a random technique. The primary endpoint was RAO at follow-up. The secondary endpoints included the time required for sheath insertion, the rate of successful sheath insertion, rate of successful completion of CAG and PCI, total procedure time, total fluoroscopy time, total radiation dose, total contrast volume used, pain perception (visual analog scale 0-10), and hemostasis duration. dTRA patients had more skin punctures, failed punctures, failed wiring, overlap of access sites, sheath insertion time, and pain evaluation scale, while the pTRA group had more hemostasis time and first-time cannulation. RAO and pseudoaneurysm (PseA) were lower in the dTRA group. In this randomized study, dTRA had lower RAO and PseA than pTRA. However, multicenter, larger-patient trials are needed to provide definitive evidence.
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Affiliation(s)
- Emrah Acar
- Department of Cardiology, Abant Izzet Baysal University, Bolu, Turkey
| | - Servet Izci
- Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Ibrahim Donmez
- Department of Cardiology, Abant Izzet Baysal University, Bolu, Turkey
| | - Mehmet Fatih Yilmaz
- Department of Cardiology, Siyami Ersek Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Neryan Ozgul
- Department of Cardiology, Kastamonu Training and Research Hospital, Kastamonu, Turkey
| | - Oguz Kayabası
- Department of Cardiology, Cankiri State Hospital, Cankiri, Turkey
| | - Mustafa Gokce
- Department of Cardiology, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
| | - Yilmaz Güneş
- Department of Cardiology, Abant Izzet Baysal University, Bolu, Turkey
| | - Ibrahim Akin Izgi
- Department of Cardiology, Abant Izzet Baysal University, Bolu, Turkey
| | - Cevat Kirma
- Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
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Umekawa M, Koizumi S, Ohara K, Ishigami D, Miyawaki S, Saito N. Distal radial artery approach is safe and effective for cerebral angiography and neuroendovascular treatment: A single-center experience with ultrasonographic measurement. Interv Neuroradiol 2024; 30:280-287. [PMID: 36285518 PMCID: PMC11095355 DOI: 10.1177/15910199221135308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/10/2022] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The transradial artery approach to cerebral angiography can reduce both patient stress following examination and the risk of major complications due to hematoma. Recently, the distal radial artery approach (DRA) has garnered attention in cardiology as a minimally invasive method. DRA is also considered applicable to neurosurgery, although concerns about procedural difficulty and complications persist. Therefore, this study aimed to evaluate the efficacy of the DRA in cerebral angiography and neuroendovascular treatment. METHODS We retrospectively selected 30 consecutive patients for whom the DRA was attempted for cerebral angiography at our hospital. The patients' age, sex, height, weight, and medical history information was collected and correlated with successful puncture and complications. The diameter of the distal radial artery (RA) was measured using ultrasonography. RESULTS The median patient age was 67 years (range, 32-87 years) and 21 (70%) were men. The median diameter of the distal RA was 2.3 mm (range, 1.7-3.2 mm). Distal RA puncture was successful in 23 patients (77%) and no complications were noted; however there was no significant correlation between successful puncture and any of the patient factors. Carotid artery stenting and preoperative tumor embolization were performed via DRA in six and three cases, respectively. Although puncture site hematoma occurred in only one case, all treatments were successful, and no major complications were observed. CONCLUSION DRA can be safely used for cerebral angiography and neuroendovascular treatment.
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Affiliation(s)
- Motoyuki Umekawa
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Satoshi Koizumi
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Kenta Ohara
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Daiichiro Ishigami
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo 113-8655, Japan
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Sato D, Umekawa M, Koizumi S, Ishigami D, Kiyofuji S, Saito N. Trans-Distal Radial Artery Carotid Revascularization with Forearm Flow Reversal: An Alternative Option of CAS in the TCAR Era. World Neurosurg 2024; 183:e920-e927. [PMID: 38237802 DOI: 10.1016/j.wneu.2024.01.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Transcarotid artery revascularization (TCAR) has emerged as an alternative to carotid artery stenting (CAS). TCAR demonstrated its superiority by avoiding femoral artery puncture and establishing proximal protection without crossing the stenotic lesion. In the TCAR era, we focused on the possibility of a trans-distal radial approach (DRA). A balloon-guide catheter was navigated via DRA to establish proximal protection before lesion crossing. The forearm subcutaneous vein was used as the flow-reversal circuit. METHODS Six internal carotid artery stenosis patients underwent CAS using "the forearm flow reversal technique." Every procedure was performed under continuous flow reversal from the common carotid artery to the forearm cephalic vein. RESULTS Successful revascularization was achieved without ischemic or access-site complications. The distal radial artery was patent at discharge in all cases. CONCLUSIONS Trans-distal radial CAS with forearm flow reversal is a feasible and less invasive technical option.
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Affiliation(s)
- Daisuke Sato
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Motoyuki Umekawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Satoshi Koizumi
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
| | - Daiichiro Ishigami
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Satoshi Kiyofuji
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
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Korotkikh AV, Babunashvili AM, Kazantsev AN, Annaev ZS. Distal Radial Access: Is There a Clinical Benefit? Cardiol Rev 2024; 32:110-113. [PMID: 36538417 DOI: 10.1097/crd.0000000000000472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
For decades, the femoral artery has been the most common vascular access for diagnostic and therapeutic endovascular procedures. However, over the past 20 years, radial access has been gaining popularity, as it is a safer and allows practical access with more benefits. Recently, the new distal radial access has proven to be an equal or perhaps even safer vascular access for diagnostic and therapeutic coronary and noncoronary interventions. Today, this access should be in the arsenal of every interventional surgeon.
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Affiliation(s)
- A V Korotkikh
- From the Cardiac Surgery Clinic, Amur State Medic al Academy, Blagoveshchensk, Russian Federation
| | - A M Babunashvili
- Interventional Cardiology Department, Sechenov University, Moscow, Russian Federation
| | - A N Kazantsev
- Surgery Department, City Alexandrovskaya Hospital, St. Petersburg, Russian Federation
| | - Z S Annaev
- Neurosurgery Department, Novyy Urengoy Central Hospital, Novyy Urengoy, Russia
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7
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Achim A, Ruzsa Z. The distal radial artery: Versatile vascular access for transcatheter interventions. J Vasc Access 2024; 25:415-422. [PMID: 38477132 DOI: 10.1177/11297298221118235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Conventional transradial access has been established as the gold standard for invasive coronary angiography and percutaneous interventions by the current European and American guidelines. The distal or snuffbox radial artery access represents an alternative transradial access site that allows radial sheath insertion with the patient's hand pronated. Firstly described 40 years ago, it exploded in popularity only recently. Promising additional benefits, the distal radial access is increasingly being adopted in various types of percutaneous interventions, being preferred by many interventional cardiologists and radiologists for its reduced vascular complications and time to hemostasis, and improvement of patient and operator comfort. Other centers consider it a fad, waiting for solid clear evidence and benefits. The evidence is dynamic and discrepant, depending on the center, the operator, and how it was collected (randomized controlled vs observational studies). Another essential aspect raised by "skeptics" was whether distal radial access, by its smaller diameter and more angled course, can support all types of interventions. The aim of this review is to gather all the scenarios where distal radial access has been utilized and to conclude whether this vascular access is feasible across all transcatheter interventions.
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Affiliation(s)
- Alexandru Achim
- Department of Interventional Cardiology, Medicala 1 Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Klinik für Kardiologie, Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal, Switzerland
- Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Zoltan Ruzsa
- Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
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8
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Lee JW, Kim Y, Lee BK, Yoo SY, Lee SY, Kim CJ, Jin HY, Park JS, Heo JH, Kim DH, Lee JB, Kim DK, Bae JH, Lee SY, Lee SH. Distal Radial Access for Coronary Procedures in a Large Prospective Multicenter Registry: The KODRA Trial. JACC Cardiovasc Interv 2024; 17:329-340. [PMID: 38355261 DOI: 10.1016/j.jcin.2023.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/18/2023] [Accepted: 11/14/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Distal radial access (DRA) as an alternative access route lacks evidence, despite its recent reputation. OBJECTIVES The aim of this study was to evaluate the safety and feasibility of DRA on the basis of daily practice. METHODS The KODRA (Korean Prospective Registry for Evaluating the Safety and Efficacy of Distal Radial Approach) trial was a prospective multicenter registry conducted at 14 hospitals between September 2019 and September 2021. The primary endpoints were the success rates of coronary angiography (CAG) and percutaneous coronary intervention (PCI). The secondary endpoints included successful distal radial artery puncture, access-site crossover, access site-related complications, bleeding events, and predictors of puncture failure. RESULTS A total of 4,977 among 5,712 screened patients were recruited after the exclusion of 735 patients. The primary endpoints, the success rates of CAG and PCI via DRA, were 100% and 98.8%, respectively, among successful punctures of the distal radial artery (94.4%). Access-site crossover occurred in 333 patients (6.7%). The rates of distal radial artery occlusion and radial artery occlusion by palpation were 0.8% (36 of 4,340) and 0.8% (33 of 4,340) at 1-month follow-up. DRA-related bleeding events were observed in 3.3% of patients, without serious hematoma. Multilevel logistic regression analysis identified weak pulse (OR: 9.994; 95% CI: 7.252-13.774) and DRA experience <100 cases (OR: 2.187; 95% CI: 1.383-3.456) as predictors of puncture failure. CONCLUSIONS In this large-scale prospective multicenter registry, DRA demonstrated high success rates of CAG and PCI, with a high rate of puncture success but low rates of distal radial artery occlusion, radial artery occlusion, bleeding events, and procedure-related complications. Weak pulse and DRA experience <100 cases were predictors of puncture failure. (Korean Prospective Registry for Evaluating the Safety and Efficacy of Distal Radial Approach [KODRA]; NCT04080700).
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Affiliation(s)
- Jun-Won Lee
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Yongcheol Kim
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital and Cardiovascular Center, Yonsei University College of Medicine, Yongin, South Korea
| | - Bong-Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Sang-Yong Yoo
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, South Korea; Division of Cardiology, Department of Internal Medicine, Good Morning Hospital, Pyeongtaek, South Korea
| | - Sang Yeub Lee
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea; Division of Cardiology, Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea
| | - Chan Joon Kim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, South Korea
| | - Han-Young Jin
- Division of Cardiology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jin Sup Park
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
| | - Jung Ho Heo
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
| | - Do Hoi Kim
- Division of Cardiology, Department of Internal Medicine, Hyundai Uvis Hospital, Incheon, South Korea; Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital Gumi, Gumi, South Korea
| | - Jin Bae Lee
- Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Dong-Kie Kim
- Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jun Ho Bae
- Division of Cardiology, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, South Korea
| | - Sung-Yun Lee
- Division of Cardiology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea; Division of Cardiology, Department of Internal Medicine, Seoul Medical Center, Seoul, South Korea
| | - Seung-Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea; Division of Cardiology, Department of Internal Medicine, Konkuk University Chungju Hospital, Chungju, South Korea.
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Chen T, Li L, Li F, Lu W, Shi G, Li W, Yang A, Huang H, Xiao J, Zhang Q, Gu J, Xue S, Zhang L, Li L, Xu L, Ji R, Wang H, Cai G. Comparison of long-term radial artery occlusion via distal vs. conventional transradial access (CONDITION): a randomized controlled trial. BMC Med 2024; 22:62. [PMID: 38331793 PMCID: PMC10854098 DOI: 10.1186/s12916-024-03281-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/01/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The distal transradial access (dTRA) has become an attractive and alternative access to the conventional transradial access (TRA) for cardiovascular interventional diagnosis and/or treatment. There was a lack of randomized clinical trials to evaluate the effect of the dTRA on the long-term radial artery occlusion (RAO). METHODS This was a prospective, randomized controlled study. The primary endpoint was the incidence of long-term RAO at 3 months after discharge. The secondary endpoints included the successful puncture rate, puncture time, and other access-related complications. RESULTS The incidence of long-term RAO was 0.8% (3/361) for dTRA and 3.3% (12/365) for TRA (risk ratio = 0.25, 95% confidence interval = 0.07-0.88, P = 0.02). The incidence of RAO at 24 h was significantly lower in the dTRA group than in the TRA group (2.5% vs. 6.7%, P < 0.01). The puncture success rate (96.0% vs. 98.5%, P = 0.03) and single puncture attempt (70.9% vs. 83.9%, P < 0.01) were significantly lower in the dTRA group than in the TRA group. However, the number of puncture attempts and puncture time were higher in the dTRA group. The dTRA group had a lower incidence of bleeding than the TRA group (1.5% vs. 6.0%, P < 0.01). There was no difference in the success rate of the procedure, total fluoroscopy time, or incidence of other access-related complications between the two groups. In the per-protocol analysis, the incidence of mEASY type ≥ II haematoma was significantly lower in the dTRA group, which was consistent with that in the as-treated analysis. CONCLUSIONS The dTRA significantly reduced the incidence of long-term RAO, bleeding or haematoma. TRIAL REGISTRATION ClinicalTrials.gov identifer: NCT05253820.
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Affiliation(s)
- Tao Chen
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Lamei Li
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Feng Li
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Wei Lu
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Ganwei Shi
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Wenhua Li
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Anni Yang
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Hui Huang
- Department of Cardiology, Jiangyin Hospital of Traditional Chinese Medicine, Wuxi, 214400, Jiangsu Province, China
| | - Jianqiang Xiao
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Qiuwei Zhang
- Department of Catheter Room, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Jun Gu
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Sheliang Xue
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Liuyan Zhang
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Li Li
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Lingxia Xu
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Rongrong Ji
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Haibo Wang
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, 100191, China.
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, 38 Xueyuan St, Haidian District, Beijing, 100191, China.
| | - Gaojun Cai
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China.
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10
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Barbosa RR, De Barros L, Sylvestre RC, Belloti VL, de Oliveira GF, Ferraz RD, de Aragão BP, Calil OA, Serpa R, Barbosa LFM. Distal Transradial Access in the Anatomical Snuffbox for Interventional Coronary Procedures: Analysis of Access Site Pain and Complications. Cureus 2024; 16:e54878. [PMID: 38533145 PMCID: PMC10965110 DOI: 10.7759/cureus.54878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION A novel arterial access distally on the radial artery through the anatomical snuffbox has been recently described for coronary interventional procedures. However, there is insufficient data comparing the advantages and limitations of distal transradial access (dTRA), conventional transradial access (TRA), and transfemoral access (TFA). The aim of this study was to compare the three access sites regarding local pain and complications during or after coronary interventional procedures. METHODS This prospective observational single-center study included 211 patients undergoing cardiac catheterization or percutaneous coronary intervention, divided into three groups: dTRA (n=69), TRA (n=71), and TFA (n=71). The access site was chosen at the discretion of three operators. We administered a questionnaire to all patients, addressing local pain or discomfort during or after the procedure and the occurrence of possible complications such as distal pallor, local bleeding, and purple color on the access site. RESULTS Pain on the access site during the procedure was reported more frequently in the TRA group (dTRA 15.9% vs. TRA 32.4% vs. TFA 15.5%). There were no differences in the occurrence of local pain after the procedure in all three groups (29.6% in the dTRA group, 28.2% in the TRA group, and 26.8% in the TFA group). Pain intensity, when it occurred, was higher in the dTRA group (dTRA 5.8 vs. TRA 4.8 vs. TFA 4.6 on a 1-10 scale), as was its duration (dTRA 13.7 vs. TRA 7.6 vs. TFA 8.2 days). Only two local bleeding events were reported, both in the TFA group. No major complications were recorded. CONCLUSION The occurrence of local pain on the puncture site after coronary interventional procedures did not differ among the three groups. The dTRA group presented a lower incidence of pain during the procedure when compared to TRA and a lower incidence of purple color when compared to TFA. However, pain intensity and duration were higher in the dTRA group when pain was reported. Using dTRA for coronary procedures is a feasible and safe strategy in selected cases.
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Affiliation(s)
- Roberto R Barbosa
- Cardiology, Hospital Santa Casa de Misericórdia de Vitória, Vitória, BRA
| | - Lucas De Barros
- Cardiology, Hospital Santa Casa de Misericórdia de Vitória, Vitória, BRA
| | | | - Vítor L Belloti
- Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, BRA
| | | | - Rodrigo D Ferraz
- Internal Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, BRA
| | - Bruno P de Aragão
- Internal Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, BRA
| | - Osmar A Calil
- Cardiology, Hospital Santa Casa de Misericórdia de Vitória, Vitória, BRA
| | - Renato Serpa
- Cardiology, Hospital Santa Casa de Misericórdia de Vitória, Vitória, BRA
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11
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Koziński Ł, Orzałkiewicz Z, Dąbrowska-Kugacka A. Feasibility and Safety of the Routine Distal Transradial Approach in the Anatomical Snuffbox for Coronary Procedures: The ANTARES Randomized Trial. J Clin Med 2023; 12:7608. [PMID: 38137677 PMCID: PMC10743677 DOI: 10.3390/jcm12247608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
The distal transradial approach (dTRA) through the anatomical snuffbox is hypothesized to offer greater benefits than the conventional transradial access (cTRA) for patients undergoing coronary procedures. Our goal was to assess the safety and efficacy of dTRA. Out of 465 consecutive Caucasian patients, 400 were randomized (1:1) to dTRA or cTRA in a prospective single-center trial. Clinical and ultrasound follow-ups were obtained at 24 h and 60 days post-procedure. The primary combined endpoint consisted of access crossover, access-related complications, and major adverse cardiovascular events (MACE). Secondary endpoints included clinical success endpoints (puncture success, crossover, and access time), access-site complications endpoints, and MACE at 60 days. The primary endpoint was significantly higher in the dTRA [odds ratio (OR): 2.31, 95% confidence interval (CI): 1.38-3.86, p = 0.001]. Clinical success endpoints, namely crossover (10% vs. 3.5%, p < 0.05) and access-time [median: 140s (85-322) vs. 80s (58-127), p < 0.001], did not favor the dTRA, despite a similar success rate in radial artery puncture between the dTRA and cTRA (99.5% vs. 99%). Radial artery spasm (19% vs. 4.5%, p < 0.0001), physical discomfort during access, and transient thumb numbness after the procedure occurred more frequently with the dTRA. However, early (2.5% vs. 4.5%, p = 0.41) and mid-term (2.5% vs. 3%, p = 0.98) forearm radial artery occlusion rates were comparable between the dTRA and cTRA. Randomization to the dTRA, lower forearm radial pulse volume, higher body mass index, and lower body surface area independently predicted the primary endpoint in multivariate analysis. In the interaction effect analysis, only diabetes increased the incidence of the primary endpoint with the dTRA (OR: 18.67, 95% CI: 3.96-88.07). The dTRA was a less favorable strategy than cTRA during routine coronary procedures due to a higher incidence of arterial spasm and the necessity for access crossover. The majority of local complications following the dTRA were clinically minor complications. Individuals with diabetes were particularly susceptible to complications associated with the dTRA.
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Affiliation(s)
- Łukasz Koziński
- Department of Cardiology, Chojnice Specialist Hospital, Lesna 10, 89-600 Chojnice, Poland
| | - Zbigniew Orzałkiewicz
- Department of Cardiology, Chojnice Specialist Hospital, Lesna 10, 89-600 Chojnice, Poland
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland
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12
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Tal MG, Covey A, Qaqish S, Livne R, Klass D. Prospective evaluation of efficacy and safety of distal radial and radial artery access using a novel articulating-tip guidewire. J Vasc Access 2023:11297298231212227. [PMID: 37997046 DOI: 10.1177/11297298231212227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Guidewire-facilitated access to peripheral vessels is commonplace in vascular access, but guidewire insertion into small vessels, such as the radial and distal radial arteries, can still be challenging. Failure to gain access on the first attempt may contribute to increased risks of procedural complications, such as vessel dissection, spasm, and occlusion. This research assessed the safety and efficacy of radial and distal radial artery access using a novel, FDA-cleared, small-core-diameter guidewire with an articulating tip, under ultrasound guidance. METHODS This was a prospective, single-arm, single-center trial. Patients in need of vascular access were screened for participation and enrolled in the study. Guidewire insertion was attempted by four physicians (three interventional radiologists and an interventional nephrologist) at 162 arterial sites-65 radial and 97 distal radial, having a mean diameter of 2.0 mm. RESULTS First-attempt successful placement of the guidewire in the artery occurred at 87.6% of access sites (142/162) and differences in the success rate between the radial and distal radial arteries or between vessels with diameter smaller or larger than 2 mm were not observed (62/68 and 67/77, respectively; p = 0.6). Four of the five reported adverse events were unrelated to the study device or procedure. Two of the three distal radial artery spasms occurred before the guidewire was used. The other two events were a radial artery spasm, and a distal radial artery site hematoma. All adverse events resolved spontaneously. CONCLUSIONS First-attempt placement of a novel articulating tip guidewire in the radial and distal radial arteries occurred at a high rate in our study and was not associated with safety concerns.
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Affiliation(s)
- Michael G Tal
- Division of Interventional Radiology, Hadassah Medical Center, Jerusalem, Israel
| | - Anne Covey
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Ron Livne
- Embrace Medical Ltd., Tel Aviv, Israel
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13
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Al‐Azizi K, Moubarak G, Dib C, Sayfo S, Szerlip M, Thomas S, McCracken J, Smith A, Kelavkar U, Hale S, Van Zyl J, McCoy SL, Lanfear AT, Banwait JK, Ravindranathan P, Chionh K, DiMaio JM, Mack MJ, Potluri S. Distal Versus Proximal Radial Artery Access for Cardiac Catheterization: 30-Day Outcomes of the DIPRA Study. J Am Heart Assoc 2023; 12:e030774. [PMID: 37889176 PMCID: PMC10727396 DOI: 10.1161/jaha.123.030774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/31/2023] [Indexed: 10/28/2023]
Abstract
Background Proximal radial artery (pRA) access for cardiac catheterization is safe but can jeopardize subsequent use of the artery because of occlusion. Distal radial artery (dRA) access in the anatomical snuffbox preserves the radial artery, but safety and potential detrimental effects on hand function are unknown. Methods and Results In the DIPRA (Distal Versus Proximal Radial Artery Access for Cardiac Catheterization and Intervention) study, a single-center trial, 300 patients were randomized 1:1 to cardiac catheterization through dRA or pRA. The primary end point of change in hand function from baseline to 30 days was a composite of the QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand) questionnaire, hand-grip test, and thumb forefinger pinch test. Secondary end points included access feasibility and complications; 254 of 300 patients completed follow-up at 30 days; of these, 128 were randomized to dRA and 126 to pRA with balanced demographic and procedural characteristics. Both groups had similar rates of access site bleeding (dRA 0% versus pRA 1.4%; P=0.25). Six patients with dRA failed access compared with 2 patients with pRA. Radial artery occlusion occurred in 2 pRA versus none in dRA. There were no significant differences in change in hand function, median hand-grip (dRA 0 [-3.2, 3.3] versus pRA 0.7 [-2.3, 3.3] kg; P=0.21), pinch-grip (dRA -0.3 [-1.2, 0.5] versus pRA 0 [-0.9, 0.9] kg; P=0.09), and QuickDASH (dRA 0 [-4.6, 2.3] versus pRA 0 [-4.6, 2.3] points, P=0.96). There was no significant difference in the composite of hand function between pRA and dRA. Conclusions dRA is a safe strategy for cardiac catheterization with a low complication rate. Compared with pRA, there is no increased risk of hand dysfunction at 30 days. Registration URL: https://www.ClinicalTrials.gov. Unique identifier: NCT04318990.
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Affiliation(s)
- Karim Al‐Azizi
- Department of CardiologyBaylor Scott and White The Heart HospitalPlanoTX
| | | | - Chadi Dib
- Department of CardiologyBaylor Scott and White The Heart HospitalPlanoTX
| | - Sameh Sayfo
- Department of CardiologyBaylor Scott and White The Heart HospitalPlanoTX
| | - Molly Szerlip
- Department of CardiologyBaylor Scott and White The Heart HospitalPlanoTX
| | - Sibi Thomas
- Department of CardiologyBaylor Scott and White The Heart HospitalPlanoTX
| | | | - Adam Smith
- Baylor Scott and White Research InstitutePlanoTX
| | - Uma Kelavkar
- Baylor Scott and White Research InstitutePlanoTX
| | - Sarah Hale
- Baylor Scott and White Research InstitutePlanoTX
| | | | | | | | | | | | | | - J. Michael DiMaio
- Baylor Scott and White Research InstitutePlanoTX
- Department of Cardiothoracic SurgeryBaylor Scott and White The Heart HospitalPlanoTX
| | - Michael J. Mack
- Baylor Scott and White Research InstitutePlanoTX
- Department of Cardiothoracic SurgeryBaylor Scott and White The Heart HospitalPlanoTX
| | - Srinivasa Potluri
- Department of CardiologyBaylor Scott and White The Heart HospitalPlanoTX
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14
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Maitra S, Baidya DK, Ray BR, Chowhan G, Bhattacharjee S. Comparison of ultrasound guided dorsal radial artery cannulation and conventional radial artery cannulation at the volar aspect of wrist: A pilot randomized controlled trial. J Vasc Access 2023; 24:1463-1468. [PMID: 35470717 DOI: 10.1177/11297298221093953] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Distal radial artery cannulation at the "anatomical snuffbox" carries several theoretical advantages over conventional radial arterial cannulation at the wrist. However, these two techniques have not been evaluated in perioperative settings. METHODS In this randomized controlled trial, n = 200 patients requiring arterial cannulation for perioperative monitoring were recruited. Patients were randomized to either ultrasound guided distal radial artery cannulation group (group D) or ultrasound guided conventional radial artery cannulation group (group W). Primary outcome of this study was first attempt cannulation success rate. RESULTS First attempt cannulation success rate was significantly lower in distal radial artery cannulation (57% in group D and 77% in group W; p = 0.003). Use of alternative cannulation site was significantly higher in group D when compared to group W (p = 0.015) and number of attempts for successful cannulation was significantly higher in group D when compared to group W (p = 0.015). None of the patients in any group developed thrombosis and related complications and intraoperative catheter dislodgement. Time to puncture the artery (p < 0.0001), total cannulation time (p < 0.0001), and actual catheter insertion time (p < 0.0001) were significantly higher in group D in comparison to group W. CONCLUSION Distal radial artery cannulation was associated with lower first attempt cannulation success rate and requires longer time to perform. As distal radial artery is a new technique, further studies are required in different clinical settings.
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Affiliation(s)
- Souvik Maitra
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Dalim K Baidya
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Bikash R Ray
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Ganesh Chowhan
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sulagna Bhattacharjee
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
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15
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Murai K, Fujino M, Iwai T, Sawada K, Matama H, Miura H, Honda S, Yoneda S, Takagi K, Otsuka F, Kataoka Y, Asaumi Y, Tahara Y, Noguchi T. Distal Radial Approach in Coronary Angiography Using a Transdermal Nitroglycerin Patch: Double-Blinded Randomized Trial. Am J Cardiol 2023; 203:325-331. [PMID: 37517127 DOI: 10.1016/j.amjcard.2023.07.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/09/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023]
Abstract
Nitroglycerin dilates the radial artery and prevents spasm, which increases the success rate of sheath cannulation through the conventional transradial approach. However, the effects of nitroglycerin on distal radial approach (DRA) procedures are not known. The aim of this study is to elucidate whether a transdermal nitroglycerin patch improves the rate of successful DRA cannulation. A total of 92 patients scheduled for coronary angiography by means of DRA randomly received (1:1) a transdermal nitroglycerin patch preintegrated with the covering material or only the covering material on their upper arm on the side of the puncture. The diameter of the distal radial artery was evaluated with ultrasound at baseline and after application. DRA procedures were performed in a double-blind fashion. The primary outcome was the rate of successful palpation-guided distal radial artery cannulation with the first puncture. The nitroglycerin group had larger distal radial artery diameter after patch application than that of the no-treatment group (mean, 3.21 mm vs 2.71 mm, p <0.001), but not at baseline (mean, 2.64 mm vs 2.64 mm, p = 0.965).The nitroglycerin group had a significantly higher success rate of DRA cannulation with the first puncture than that of the no-treatment group (59% vs 24%, p = 0.001; odds ratio 4.5, 95% confidence interval 1.9 to 11.0). The nitroglycerin group required fewer punctures than did the no-treatment group (median, 1 vs 3, p = 0.019). There were no significant differences in the occurrence of hypotension between the 2 groups. No patients experienced radial artery occlusion. In conclusion, transdermal nitroglycerin patch application safely facilitates DRA cannulation. Trial Registration: Japan Registry of Clinical Trials, https://jrct.niph.go.jp/ (identifier: jRCTs051210128).
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Affiliation(s)
- Kota Murai
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Masashi Fujino
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan.
| | - Takamasa Iwai
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Kenichiro Sawada
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Hideo Matama
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Hiroyuki Miura
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Shuichi Yoneda
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
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16
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Gupta M, Kumar V, Rahman MW, Srivastava S, Pandey U, Sinha SK. Comparison Between Distal Trans-radial Access and Conventional Trans-radial Access for Coronary Angiography. Cureus 2023; 15:e45081. [PMID: 37842393 PMCID: PMC10568520 DOI: 10.7759/cureus.45081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Background Compared with a conventional wrist puncture for radial artery catheterization, a distal radial artery puncture has the advantage of reducing the incidence of radial artery occlusion (RAO). Aim The present study was designed to evaluate the feasibility of distal trans-radial access compared with conventional trans-radial access for coronary angiography. Methods A prospective, randomized, single-blinded, comparative study was conducted at a tertiary care center in India between December 2018 and November 2020. A total of 420 patients (aged >18 years) with signs and symptoms suggestive of coronary artery disease (CAD) and with a palpable radial artery in anatomical snuffbox were randomized into two groups. Group A comprised patients accessed at the distal trans-radial site, and Group B consisted of patients accessed at the conventional trans-radial site for coronary angiography. Baseline demographics, clinical history, and risk factors for CAD were documented. Procedural-related parameters and complications were compared between the two groups. Results The procedural success rate was non-significant between Group A and Group B (96% vs. 98%; p=0.38). Puncture in a single attempt was higher in Group B compared to Group A (92% vs. 78%; p<0.001). There was no significant difference between Group A and Group B for operation time (p=0.207), fluoroscopy time (p=0.183), and contrast volume (p=0.345). The rate of RAO was higher in Group B compared to Group A (13% vs. 2%; p<0.001). Radial artery hematoma/swelling at the puncture site between Group A (10%) and Group B (8%) was not significant (p=0.61). Post-procedural hemostasis time in Group A was 28 ± 7.86 minutes, and in Group B was 24 ± 6.23 minutes. Both post-procedural persistence of pain (p<0.001) and hand clumsiness (p<0.001) were significantly higher in Group B compared to Group A. Conclusion For coronary angiography, the distal trans-radial access site is a reliable and secure alternate access site.
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Affiliation(s)
- Manish Gupta
- Department of Cardiology, Laxmipat Singhania (LPS) Institute of Cardiology, Kanpur, IND
| | - Vinit Kumar
- Department of Cardiology, Laxmipat Singhania (LPS) Institute of Cardiology, Kanpur, IND
| | - Md Waziur Rahman
- Department of Cardiology, Laxmipat Singhania (LPS) Institute of Cardiology, Kanpur, IND
| | - Swati Srivastava
- Department of Cardiac Anesthesia, Laxmipat Singhania (LPS) Institute of Cardiology, Kanpur, IND
| | - Umeshwar Pandey
- Department of Cardiology, Laxmipat Singhania (LPS) Institute of Cardiology, Kanpur, IND
| | - Santosh K Sinha
- Department of Cardiology, Laxmipat Singhania (LPS) Institute of Cardiology, Kanpur, IND
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Kılıç R, Güzel T, Aktan A, Arslan B, Aslan M, Günlü S, Karahan MZ. Comparison of pain levels of traditional radial, distal radial, and transfemoral coronary catheterization. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230198. [PMID: 37466602 DOI: 10.1590/1806-9282.20230198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE The aim of our study was to compare the traditional radial artery, distal radial artery, and transfemoral artery, which are vascular access sites for coronary angiography, in terms of pain level using the visual analog scale. METHODS Between April 2021 and May 2022, consecutive patients from three centers were included in our study. A total of 540 patients, 180 from each of the traditional radial artery, distal radial artery , and transfemoral artery groups, were included. The visual analog scale was applied to the patients as soon as they were taken to bed. RESULTS When the visual analog scale was compared between the groups, it was found to be significantly different (transfemoral artery: 2.7±1.6, traditional radial artery: 3.9±1.9, and distal radial artery: 4.9±2.1, respectively, p<0.001). When the patients were classified as mild, moderate, and severe based on the visual analog scale score, a significant difference was found between the groups in terms of body mass index, process time, access time, and number of punctures (p<0.001). Based on the receiver operating characteristic analysis, body mass index>29.8 kg/m2 predicted severe pain with 72.5% sensitivity and 73.2% specificity [(area under the curve: 0.770, 95%CI: 0.724-0.815, p<0.0001)]. CONCLUSION In our study, we found that the femoral approach caused less access site pain and a high body mass index predicts severe pain.
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Affiliation(s)
- Raif Kılıç
- Memorial Diyarbakır Hospital, Department of Cardiology - Diyarbakır, Turkey
| | - Tuncay Güzel
- Health Science University, Gazi Yaşargil Training and Research Hospital, Department of Cardiology - Diyarbakır, Turkey
| | - Adem Aktan
- Mardin Training and Research Hospital, Department of Cardiology - Mardin, Turkey
| | - Bayram Arslan
- Ergani State Hospital, Department of Cardiology - Diyarbakır, Turkey
| | - Muzaffer Aslan
- Siirt Training and Research Hospital, Department of Cardiology - Siirt, Turkey
| | - Serhat Günlü
- Mardin Artuklu University, Faculty of Medicine, Department of Cardiology - Mardin, Turkey
| | - Mehmet Zülküf Karahan
- Mardin Artuklu University, Faculty of Medicine, Department of Cardiology - Mardin, Turkey
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18
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Tsigkas G, Papanikolaou A, Apostolos A, Kramvis A, Timpilis F, Latta A, Papafaklis MI, Aminian A, Davlouros P. Preventing and Managing Radial Artery Occlusion following Transradial Procedures: Strategies and Considerations. J Cardiovasc Dev Dis 2023; 10:283. [PMID: 37504539 PMCID: PMC10380353 DOI: 10.3390/jcdd10070283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/05/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
Τransradial artery access has recently gained widespread acceptance as the preferred approach for coronary angiography and interventions, due to its lower incidence of bleeding and vascular complications compared to transfemoral access. However, thrombotic occlusion of the radial artery has emerged as the most common complication of this method, impeding its use in future interventions, and in the creation of arteriovenous fistulae for hemodialysis patients, or as a graft for coronary artery bypasses grafting. In this comprehensive review, we delve into the anatomy of the radial artery, the pathophysiology and diagnosis of radial artery occlusion, the identification of potential risk factors and, finally, prevention and treatment strategies. We acknowledge that distal transradial access provides an effective alternative for coronary angiography and catheterizations, with a reduced incidence of radial artery occlusion.
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Affiliation(s)
- Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Amalia Papanikolaou
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Anastasios Apostolos
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
- First Department of Cardiology, Hippocration General Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Angelos Kramvis
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Filippos Timpilis
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Anastasia Latta
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | | | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, 6042 Charleroi, Belgium
| | - Periklis Davlouros
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
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Xu D, Liu Y, Xu C, Liu X, Chen Y, Feng C, Lyu N. Factors Affecting Radial Artery Occlusion After Right Transradial Artery Catheterization for Coronary Intervention and Procedures. Ther Clin Risk Manag 2023; 19:525-533. [PMID: 37388675 PMCID: PMC10305768 DOI: 10.2147/tcrm.s403410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/18/2023] [Indexed: 07/01/2023] Open
Abstract
Objective To determine the factors influencing proximal radial artery occlusion (PRAO) right radial artery after coronary intervention. Methods This is a single-center prospective observational study. A total of 460 patients were selected to undergo coronary angiography (CAG) or percutaneous coronary intervention (PCI) via the proximal transradial approach (PTRA) or distal transradial approach (DTRA). The 6F sheath tube were received by all patients. Radial artery ultrasound was performed 1 day before procedure and 1-4 days after procedure. Patients were divided into the PRAO group (42 cases) and the non-PRAO group (418 cases). General clinical data and preoperative radial artery ultrasound indexes of the two groups were compared to analyze related factors leading to PRAO. Results The total incidence of PRAO was 9.1%, including 3.8% for DTAR and 12.7% for PTRA. The PRAO rate of DTRA was significantly lower than that of PTRA (p < 0.05). Female, low body weight, low body mass index (BMI) and CAG patients were more likely to develop PRAO after procedure (p < 0.05). The internal diameter and cross-sectional area of the distal radial artery and proximal radial artery were smaller in the PRAO group than in the non-PRAO group, and the differences were statistically significant (p < 0.05). Multifactorial model analysis showed that the puncture approach, radial artery diameter and procedure type were predictive factors of PRAO, and the receiver operating characteristic curve showed a good predictive value. Conclusion A larger radial artery diameter and DTRA may reduce the incidence of PRAO. Preoperative radial artery ultrasound can guide the clinical selection of appropriate arterial sheath and puncture approach.
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Affiliation(s)
- Dujuan Xu
- Department of Ultrasound, Xuzhou Central Hospital, Xuzhou, People’s Republic of China
| | - Ying Liu
- Department of Ultrasound, Xuzhou Central Hospital, Xuzhou, People’s Republic of China
| | - Chao Xu
- Department of Radiology, Xuzhou Children’s Hospital, Xuzhou, People’s Republic of China
| | - Xuekui Liu
- Department of Central Laboratory, Xuzhou Central Hospital, Xuzhou, People’s Republic of China
| | - Ye Chen
- Department of Ultrasound, Xuzhou Central Hospital, Xuzhou, People’s Republic of China
| | - Chunguang Feng
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, People’s Republic of China
| | - Nan Lyu
- Department of Ultrasound, Xuzhou Central Hospital, Xuzhou, People’s Republic of China
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20
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Li W, Wang J, Liang X, Wang Q, Chen T, Song Y, Shi G, Li F, Li Y, Xiao J, Cai G. Comparison of the feasibility and safety between distal transradial access and conventional transradial access in patients with acute chest pain: a single-center cohort study using propensity score matching. BMC Geriatr 2023; 23:348. [PMID: 37270473 DOI: 10.1186/s12877-023-04058-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 05/22/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Distal transradial access (dTRA) has been suggested to have great advantages over cTRA. However, there is a lack of preliminary data on dTRA in patients undergoing emergency coronary angiography (CAG) or percutaneous coronary intervention (PCI). To explore the feasibility and safety of distal transradial access in patients with acute chest pain. METHODS A total of 1269 patients complaining of acute chest pain in our emergency department from January 2020 to February 2022 were retrospectively included. The patients who met the inclusion criteria were divided into the conventional transradial access (cTRA) group (n = 238) and the dTRA group (n = 158). Propensity score matching was used to minimize the baseline differences. RESULTS The cannulation success rate in the dTRA group was significantly lower than that in the cTRA group (87.41% vs. 94.81%, p < 0.05). No significant differences in the puncture time and total procedure time were noted between the two groups (p > 0.05). Compared with the cTRA group, the hemostasis duration was significantly shorter [4(4, 4) h vs. 10(8, 10) h, p < 0.001) and the incidence of minor bleeding (BARC Type I and II) was significantly lower in the dTRA group than that in the cTRA group (0.85% vs. 5.48%, p = 0.045). Asymptomatic radial artery occlusion was observed in six patients (5.83%) in the cTRA group and one patient (1.14%) in the dTRA group (p = 0.126). The subgroup analysis of ST-elevation myocardial infarction (STEMI) showed no significant differences in the puncture time, D-to-B time or total procedure time between the two groups. CONCLUSIONS The dTRA for emergency CAG or PCI has an acceptable success rate and puncture time, a shorter hemostasis time, and a downward trend in RAO rate compared to the cTRA. The dTRA did not increase the D-to-B time in emergency coronary interventions in STEMI patients. On the contrary, a low incidence of RAO by the dTRA created an opportunity for future coronary interventions in non-culprit vessels in the same access. TRIAL REGISTRATION Retrospectively registered in Chinese Clinical Trial Registry (registry number: ChiCTR2200061104, date of registration: June 15, 2022).
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Affiliation(s)
- Wenhua Li
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning North Road, Tianning District, Changzhou City, Jiangsu Province, 213002, China.
| | - Juan Wang
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning North Road, Tianning District, Changzhou City, Jiangsu Province, 213002, China
| | - Xiaofang Liang
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning North Road, Tianning District, Changzhou City, Jiangsu Province, 213002, China
| | - Qiang Wang
- Department of Cardiothoracic Surgery, Wujin Hospital Affiliated With Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, Jiangsu Province, Changzhou City, China
| | - Tao Chen
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning North Road, Tianning District, Changzhou City, Jiangsu Province, 213002, China
| | - Yanbin Song
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning North Road, Tianning District, Changzhou City, Jiangsu Province, 213002, China
| | - Ganwei Shi
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning North Road, Tianning District, Changzhou City, Jiangsu Province, 213002, China
| | - Feng Li
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning North Road, Tianning District, Changzhou City, Jiangsu Province, 213002, China
| | - Yong Li
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning North Road, Tianning District, Changzhou City, Jiangsu Province, 213002, China
| | - Jianqiang Xiao
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning North Road, Tianning District, Changzhou City, Jiangsu Province, 213002, China
| | - Gaojun Cai
- Department of Cardiology, Wujin Hospital Affiliated With Jiangsu University, the Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning North Road, Tianning District, Changzhou City, Jiangsu Province, 213002, China.
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21
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Feghaly J, Chen K, Blanco A, Pineda AM. Distal versus conventional radial artery access for coronary catheterization: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2023; 101:722-736. [PMID: 36808696 DOI: 10.1002/ccd.30602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 02/21/2023]
Abstract
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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Affiliation(s)
- Julien Feghaly
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Kai Chen
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Anamarys Blanco
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Andres M Pineda
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
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22
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Chivot C, Bouzerar R, Yzet T. A novel technique to perform cerebral angiography via the left radial approach: An 80 patients series. J Neuroradiol 2023; 50:93-98. [PMID: 33450347 DOI: 10.1016/j.neurad.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE To demonstrate that left radial access for diagnostic cerebral angiography with Extra backup and 4F vertebral catheters is feasible and safe. MATERIALS AND METHODS This study is a retrospective review of our prospective database on left radial access for cerebral angiography procedures, using an extra backup catheter associated with a 4Fr vertebral catheter, performed between March and September 2019. Patient demographics, procedural and radiographic metrics as well as clinical data were recorded. RESULTS Seventy five patients with mean age of 51...years (range 21...73) underwent 80 cerebral angiographies. An average of four vessels were catheterized and mean fluoroscopy times per subject and vessel were was of 13.9 and 3.3...min, respectively. One patient required crossover to transfemoral access because of radial artery spasm. There were one asymptomatic distal radial artery occlusion and one patient presenting with asymptomatic skin blanching area on the forearm, just proximal to the tip of the sheath, that spontaneously resolved within an hour. CONCLUSION Diagnostic cerebral angiography via left radial access is feasible and safe and allows to preserve the right radial access for future neurointerventions while providing more comfort to the right handed patient.
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Affiliation(s)
- Cyril Chivot
- Department of Radiology, Amiens University Hospital, Avenue Ren.. Laennec, F-80054 Amiens Cedex 01, France.
| | - Roger Bouzerar
- Image Processing Department, Amiens University Hospital, Avenue Ren.. Laennec, F-80054 Amiens Cedex 01, France
| | - Thierry Yzet
- Department of Radiology, Amiens University Hospital, Avenue Ren.. Laennec, F-80054 Amiens Cedex 01, France
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23
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Escutia-Cuevas HH, Alcantara Melendez M, Jiménez-Valverde AS, Zaragoza-Rodriguez G, Vargas-Cruz A, Garcia-Garcia JF, Ordonez-Salazar BA, Flores-Morgado A, Orozco Guerra G, Renteria-Valencia DA. Feasibility of distal transradial access for coronary angiography and percutaneous coronary intervention: an observational and prospective study in a Latin-American Centre. Acta Cardiol 2023; 78:55-63. [PMID: 34979883 DOI: 10.1080/00015385.2021.2015546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Distal transradial access (dTRA) as a refinement of the conventional transradial access (TRA) has advantages in terms of risk of radial artery occlusion (RAO). In order to evaluate the real-world feasibility and safety of dTRA as the default access site for routine coronary angiography (CAG) and percutaneous coronary intervention (PCI) in a Latin-American centre, this prospective observational registry was conducted. METHODS Consecutive patients with a prior assessment for CAG and/or PCI were enrolled in this single-centre prospective registry from October 2018 to March 2019. The primary endpoints were the success rate of CAG and PCI. Secondary endpoints included the success rate of puncture of the distal radial artery, complications at the puncture site and puncture time. RESULTS The success rates of CAG and PCI were 100% (155/155) and 97% (69/71), respectively. Puncture time and fluoroscopic time were 52 ± 19 seconds and 16.3 ± 35.4 minutes, respectively. Haemostasis time was 142 ± 45 min. A total of 19 (12.5%) puncture site complications occurred, including 18 (11.6%) minor haematomas and one (0.6%) arterial perforation, in which the artery was patent at the one-month follow-up. Five patients complained of left thumb numbness at a one-month follow-up. No distal radial artery occlusion, pseudoaneurysm, or arteriovenous fistula occurred. CONCLUSIONS The success and complication rates of ldTRA support the feasibility and safety of this procedure using the appropriate materials in previously selected patients.
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Affiliation(s)
| | | | | | | | - Antonio Vargas-Cruz
- Department of Interventional Cardiology, National Medical Center, Mexico City, Mexico
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24
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Aksoy MN, Sahinkus S, Agac MT, Tatli E. A randomized trial comparing left distal radial versus femoral approach for coronary artery bypass graft angiography: a pilot study. Minerva Cardiol Angiol 2023; 71:27-34. [PMID: 34137239 DOI: 10.23736/s2724-5683.21.05626-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Left distal transradial angiography (ldTRA) is a new technique for radial coronary angiography and may be an alternative to conventional transfemoral angiography (TFA) in patients who had previously undergone coronary artery bypass graft (CABG) surgery. In this study we compared ldTRA with TFA in patients who had undergone CABG surgery in terms of procedural details. METHODS Fifty-seven consecutive patients with history of previous CABG among 459 patients who were admitted to coronary angiography unit (elective and acute coronary syndromes) in our center between October 2019 and February 2020 were included in the study. Consecutive patients were randomized to ldTRA (34 patients) and TFA (23 patients) group. The difference in total procedure times was defined as primary endpoint. The difference in sheat times, fluoroscopy times, contrast volume used and radiation exposure were designated as secondary endpoints. Post angiographic complications were compared between two groups. RESULTS Out of 34 patients, successful distal radial access was obtained in 25 patients (74%). Baseline demographics, contrast use and radiation exposure were similar between groups. Sheath times in ldTRA was significantly longer (P<0.001), but total procedure times were not different (18.4±7.8 vs. 14.6±6.1, P=0.07). Non-standard angiographic equipment usage was significantly higher in ldTRA procedures (80% vs. 13%, P<0.001). There was no major bleeding in neither of groups, and three minor bleedings in FA group (0% vs.13%, P=0.10). CONCLUSIONS ldTRA in patients with a palpable pulse and successful access might be used successfully for angiography in patient with previous CABG even early in an operator's experience.
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Affiliation(s)
- Muhammed N Aksoy
- Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey -
| | - Salih Sahinkus
- Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Mustafa T Agac
- Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Ersan Tatli
- Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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25
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Hamed M, Elgendy IY, Shiu P, Mahmoud M, Mahana I, Banerjee S, Mamas M, Elbadawi A. Distal transradial approach for coronary angiography and interventions: A meta-analysis of randomized controlled trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 50:63-65. [PMID: 36642557 DOI: 10.1016/j.carrev.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/06/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Mohamed Hamed
- Department of Internal Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Paul Shiu
- Department of Internal Medicine, University of California, Berkeley, CA, USA
| | - Mohamed Mahmoud
- Department of Internal Medicine, University of Texas San Antonio, San Antonio, TX, USA
| | - Ingy Mahana
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Subhash Banerjee
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA; VA North Texas Healthcare System, Dallas, TX, USA
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Ayman Elbadawi
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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26
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Isath A, Elson D, Kayani W, Wang Z, Sharma S, Naidu SS, Jneid H, Krittanawong C. A Meta-Analysis of Traditional Radial Access and Distal Radial Access in Transradial Access for Percutaneous Coronary Procedures. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 46:21-26. [PMID: 36182561 DOI: 10.1016/j.carrev.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Radial approaches are classified into traditional radial access (TRA) and more contemporary distal radial access (DRA), with recently published comparative studies reporting inconsistent outcomes. As there have been several recent randomized control trials (RCT), we assessed the totality of evidence in an updated meta-analysis to compare outcomes of DRA and TRA. METHODS We searched PubMed, CENTRAL, Web of Science, EMBASE, and Cochrane Database of Systematic Reviews from inception to August 2022 for studies comparing DRA and TRA for coronary angiography. Primary outcomes were the rate of radial artery occlusion (RAO) and access failure. Secondary outcomes included hematomas and puncture site bleeding. The pooled risk ratio (RR) with 95 % confidence interval (95 % CI) was calculated for each outcome. RESULTS A total of 14,071 patients undergoing coronary angiography from 23 studies, including 5488 patients from 10 RCTs. The mean age of the study population was 59.8 ± 5.9 years with 66.2 % men. Outcomes for a total of 6796 (48.3 %) patients undergoing DRA and 7166 (50.9 %) patients undergoing TRA were compared. DRA was associated with a lower rate of RAO (RR = 0.36, 95CI [0.27, 0.48], I2 = 0 %) but an increased risk of vascular access failure (RR = 2.38, 95CI [1.46, 3.87], I2 = 82.7 %). There was no significant difference in the rate of bleeding or hematoma formation. CONCLUSION In an updated metanalysis, DRA is associated with lower rates of RAO but with higher rates of access failure.
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Affiliation(s)
- Ameesh Isath
- Department of Cardiology, Westchester Medical Centre, New York Medical College, Valhalla, NY, USA
| | - David Elson
- Department of Cardiology, Westchester Medical Centre, New York Medical College, Valhalla, NY, USA
| | - Waleed Kayani
- Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Samin Sharma
- Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, New York, NY, USA
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Centre, New York Medical College, Valhalla, NY, USA
| | - Hani Jneid
- Chief of the Division of Cardiology at UTMB, Houston, TX, USA
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27
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Distal Trans-radial Access Compared to Conventional Trans-radial Access in Coronary Interventions: A Meta-analysis. Crit Pathw Cardiol 2022; 21:176-178. [PMID: 36413395 DOI: 10.1097/hpc.0000000000000304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Distal trans-radial access (dTRA) is a novel technique of arterial cannulation in coronary interventions. The comparative efficacy of dTRA and conventional trans-radial access (TRA) in attenuating peri-procedural complications is unknown. METHODS Embase and PubMed/MEDLINE were searched from their inception until June 25, 2022, for randomized clinical trials. Outcomes included were radial artery occlusion (RAO), radial artery spasm, hemostasis time, access time, unsuccessful cannulation, crossover rate, and early discharge after trans-radial stenting of coronary arteries (EASY) type I-III hematomas. Statistical analysis was conducted using the random effects model to derive risk ratios (RRs) and mean differences (MDs) with their corresponding 95% confidence intervals (CIs). RESULTS A total of 6 randomized clinical trials comprising 3240 patients were included. Subjects were predominantly male (73%) and had a mean age of 66 years. The dTRA group had a lower risk of RAO [RR 0.43 (95% CI, 0.26-0.69); P = 0.0005; I 2 = 0%] and had a shorter hemostasis time [MD -22.85 min (95% CI, -39.06 to -6.65); P = 0.006; I 2 = 99%]. The dTRA group had a higher crossover rate [RR 3.04 (95% CI, 1.88-4.91); P = 0.00001; I 2 = 56%] and a longer access time [MD 0.68 min (95% CI, 0.17-1.18); P = 0.009; I 2 = 99%]. The TRA group had a lower rate of unsuccessful cannulation [RR 0.81 (95% CI, 0.70-0.95); P = 0.01; I 2 = 92%]. There was no significant difference between the groups for radial artery spasm and EASY type I-III hematomas. CONCLUSION dTRA is a safe alternative to conventional TRA for coronary interventions with a lower risk of RAO. Future trials are required to further compare both approaches.
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28
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Wang Y, Liu Z, Wu Y, Li Z, Wang Y, Wang S, Xu R, Zhang L, Wang Y, Guo J. Early prevention of radial artery occlusion via distal transradial access for primary percutaneous coronary intervention. Front Cardiovasc Med 2022; 9:1071575. [PMID: 36531698 PMCID: PMC9747753 DOI: 10.3389/fcvm.2022.1071575] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/10/2022] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Conventional transradial access (TRA) has been the preferred access for coronary intervention. Recently, distal radial access (DRA) is introduced as an alternative choice to reduce radial artery occlusion (RAO) risk. The study sought to assess the impact of DRA on early RAO using Doppler ultrasound in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). METHODS This is a prospective, single-center, open-label randomized clinical trial in which patients with indications for primary PCI from January 2022 to September 2022 were assigned to DRA or TRA group with 100 cases in each group. The primary endpoint was the incidence of forearm RAO, evaluated by Doppler ultrasound before discharge. RESULTS The rate of access success was comparable between the DRA and TRA groups (98.0 vs. 94.0%, P = 0.279). Compared with the TRA group, longer puncture time was observed in the DRA group [2.4 (1.7-4.2) min vs. 1.7 (1.4-2.3) min; P < 0.001] whereas the door-to-wire time was not delayed in primary PCI [71 (54-88) min vs. 64 (56-82) min, P = 0.103]. Shorter hemostasis time was required in the DRA group [3.1 (2.7-3.3) h vs. 6.2 (5.9-6.4) h; P < 0.001]. Significant reduction of the incidence of forearm RAO was observed in the DRA group (2.0 vs. 9.0%, P = 0.030). Local hematomas ≤ 5 cm was similar in both groups (4.0 vs. 6.0%, P = 0.516), while those > 5 cm were significantly more frequent in the TRA group (0 vs. 6.0%, P = 0.029). CONCLUSION Distal radial access is associated with a comparable lower incidence of forearm RAO, shorter hemostasis time, and lower rate of vascular complications compared to TRA in primary PCI. SYSTEMATIC REVIEW REGISTRATION [https://www.chictr.org.cn], identifier [ChiCTR2200061841].
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jincheng Guo
- Division of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
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29
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Ferrante G, Condello F, Rao SV, Maurina M, Jolly S, Stefanini GG, Reimers B, Condorelli G, Lefèvre T, Pancholy SB, Bertrand O, Valgimigli M. Distal vs Conventional Radial Access for Coronary Angiography and/or Intervention: A Meta-Analysis of Randomized Trials. JACC Cardiovasc Interv 2022; 15:2297-2311. [PMID: 36423974 DOI: 10.1016/j.jcin.2022.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/30/2022] [Accepted: 09/03/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Emerging evidence from randomized clinical trials (RCTs) comparing distal radial access (DRA) with conventional radial access (RA) is available. OBJECTIVES The aim of this study was to provide a quantitative appraisal of the effects of DRA) vs conventional RA for coronary angiography with or without intervention. METHODS The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for RCT comparing DRA vs conventional RA for coronary angiography and/or intervention. Data were pooled by meta-analysis using a random-effects model. The primary endpoint was radial artery occlusion (RAO) at the longest available follow-up. RESULTS Fourteen studies enrolling 6,208 participants were included. Compared with conventional RA, DRA was associated with a significant lower risk of RAO, either detected at latest follow-up (risk ratio [RR]: 0.36; 95% CI: 0.23-0.56; P < 0.001; number needed to treat [NNT] = 30) or in-hospital (RR: 0.32; 95% CI: 0.19-0.53; P < 0.001; NNT = 28), as well as EASY (Early Discharge After Transradial Stenting of Coronary Arteries) ≥II hematoma (RR: 0.51; 95% CI: 0.27-0.96; P = 0.04; NNT = 107). By contrast, DRA was associated with a higher risk of access site crossover (RR: 3.08; 95% CI: 1.88-5.06; P < 0.001; NNT = 12), a longer time for radial puncture (standardized mean difference [SMD]: 3.56; 95% CI: 0.96-6.16; P < 0.001), a longer time for sheath insertion (SMD: 0.37; 95% CI: 0.16-0.58; P < 0.001), and a higher number of puncture attempts (SMD: 0.59, 95% CI: 0.48-0.69; P < 0.001). CONCLUSIONS Compared with conventional RA, DRA is associated with lower risks of RAO and EASY ≥II hematoma but requires longer time for radial artery cannulation and sheath insertion, more puncture attempts, and a higher access site crossover.
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Affiliation(s)
- Giuseppe Ferrante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Cardiovascular Medicine, IRCCS-Humanitas Research Hospital, Rozzano, Italy.
| | - Francesco Condello
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Sunil V Rao
- NYU Langone Health System, New York, New York, USA
| | - Matteo Maurina
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Cardiovascular Medicine, IRCCS-Humanitas Research Hospital, Rozzano, Italy
| | - Sanjit Jolly
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Cardiovascular Medicine, IRCCS-Humanitas Research Hospital, Rozzano, Italy
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Cardiovascular Medicine, IRCCS-Humanitas Research Hospital, Rozzano, Italy
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Cardiovascular Medicine, IRCCS-Humanitas Research Hospital, Rozzano, Italy
| | - Thierry Lefèvre
- Institut Cardiovasculaire Paris Sud, Hopital Jacques Cartier, Ramsay Santè, Massy, France
| | - Samir B Pancholy
- Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA; Apex Heart Institute, Ahmedabad, India
| | | | - Marco Valgimigli
- Cardiocentro Institute, Ente Ospedaliero Cantonale, Università della Svizzera Italiana, Lugano, Switzerland
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Lin Y, Bei W, Liu H, Liu Q, Yuan J, Wu M, Sun X, Dong S. Retrograde recanalization of radial artery occlusion via the distal transradial artery: A single-center experience. Front Cardiovasc Med 2022; 9:985092. [PMID: 36211561 PMCID: PMC9543139 DOI: 10.3389/fcvm.2022.985092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022] Open
Abstract
Background Radial artery occlusion (RAO) often occurs after catheterization when using a transradial artery approach. Objective This prospective study assessed the success and feasibility of accessing the distal transradial artery (dTRA) for retrograde recanalization of RAO. Methods From June 2019 to December 2021, 44 consecutive patients who had undergone cardiac catheterization resulting in RAO were given retrograde recanalization via the dTRA. According to the result of the procedure (primary endpoint), patients' cases were analyzed as successful or failed. Rates of post-operative patency and adverse events were calculated up to 12 months. Results The procedural success rate was 88.6%. Compared with the successful group, a significantly higher percentage of patients in the failed group were current smokers and/or suffered from diabetes mellitus (each, 80.0% cf. 33.3%, P = 0.046); had undergone at least 3 previous cardiac catheterizations (60.0% cf. 12.8%, P = 0.011), lower rate of anticoagulation (30.77% cf. 0%, P = 0.048) and exhibited chronic total occlusion (100.0% cf. 51.28%, P = 0.041). In each group, one patient each had minor bleeding at the access site and hematoma. The patency rates in the successful group at postoperative 3, 6, and 12 months were 48.7, 43.6, and 35.9%, respectively. Conclusion The dTRA approach for retrograde recanalization of RAO showed a high procedural success rate, but with patency rates of <50% at follow-up.
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Alkhars H, Haq W, Al-Tayeb A, Sigounas D. Feasibility and Safety of Transradial Aneurysm Embolization: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 165:e110-e127. [PMID: 35654332 DOI: 10.1016/j.wneu.2022.05.112] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Use of the transradial access (TRA) approach for neuroendovascular procedures has been increasing in recent years. Our aim is to assess the feasibility, success rate, and complications associated with TRA for intracranial aneurysm embolization. METHODS PubMed, Scopus, and Embase were systematically searched for studies using TRA for intracranial aneurysm embolization. Random-effects models were used to obtain pooled rates of procedural success and complications. RESULTS Twenty-four studies comprising 1283 (85.9%) TRA and 122 (8.2%) distal TRA aneurysm embolization procedures were included. The pooled success rate of the 18 studies in the meta-analysis was 93.5% (95% confidence interval [CI], 91.1%-95.8%). The pooled thromboembolic complication rate was 0.5% (95% CI, 0.1%-0.9%), the hemorrhagic complication rate was 0.5% (95% CI, 0.1%-0.9%), and the access site complication rate was 0.8% (95% CI, 0.3%-1.3%). One study (4.3%) used exclusively a 7-French guide catheter, and most used a 6-French guide catheter (22 of 23 studies, 95.7%), which was further incorporated as part of a triaxial configuration through a sheathless 8-French system in 4 studies (17.4%), 7-French guide catheter in 2 studies (8.7%), and 8-French sheath in 1 study (4.3%). The embolization techniques used were flow diverter placement in 451 cases (39.1%), coiling in 376 (32.6%), stent-assisted coiling in 127 (11.0%), balloon-assisted coiling in 104 (9.0%), Woven EndoBridge system in 50 (4.3%), and flow diverter placement plus coiling in 42 (3.6%). CONCLUSIONS Treating intracranial aneurysms using various embolization techniques through TRA is feasible and associated with low access site and intraoperative complications.
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Affiliation(s)
- Hussain Alkhars
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Waqas Haq
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ahmed Al-Tayeb
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Dimitri Sigounas
- Department of Neurosurgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
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Efficacy and Safety of Coronary Intervention via Distal Transradial Access (dTRA) in Patients with Low Body Mass Index. J Interv Cardiol 2022; 2022:1901139. [PMID: 36082307 PMCID: PMC9433246 DOI: 10.1155/2022/1901139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/07/2022] [Accepted: 08/01/2022] [Indexed: 11/28/2022] Open
Abstract
The study aimed to investigate the efficacy and safety of coronary intervention via distal transradial access (dTRA) in patients with low body mass index (BMI). A total of 67 patients with low BMI who underwent coronary intervention, comprising 29 patients via dTRA and 38 patients via conventional transradial access (cTRA), were retrospectively included. There was no significant difference in the puncture success rate between the two groups (dTRA 96.6%, cTRA 97.4%, P=0.846). Compared with the cTRA group, the success rate of one-needle puncture in the dTRA group was lower (51.7% vs. 81.6%, P=0.020). The compression haemostasis time in the dTRA group was shorter than that in the cTRA group (P < 0.001). However, the incidence of radial artery occlusion was lower in the dTRA group than in the cTRA group (4.0% vs. 33.3%, P=0.007). In conclusion, coronary intervention via dTRA was safe and effective in patients with low BMI.
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Distal Radial Artery Access in comparison to Forearm Radial Artery Access for Cardiac Catheterization: A Randomized Controlled Trial (DARFORA Trial). J Interv Cardiol 2022; 2022:7698583. [PMID: 35911661 PMCID: PMC9307355 DOI: 10.1155/2022/7698583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/09/2022] [Accepted: 06/21/2022] [Indexed: 11/26/2022] Open
Abstract
Background In our clinical practice, conventional radial access has been employed routinely for coronary procedures. The distal radial artery (DRA) access site has recently emerged as a novel technique in cardiac procedures. Objectives This study compares distal radial access to standard forearm radial access (FRA) in terms of feasibility, outcomes, and complications. Method This prospective, randomized trial was conducted at a single center. The patients were chosen from An-Najah National University Hospital's catheterization laboratory between December 2019 and November 2020. A total of 209 patients were randomized into two groups: DRA group (n = 104) and FRA group (n = 105). Results Access was successful in 98% of patients in both the groups. The DRA group had a longer puncture duration and a higher number of attempts (duration: 56.6 ± 61.1 s DRA vs. 20.0 ± 18.4 s FRA, p < 0.001, attempts: 1.9 ± 1.3 DRA vs. 1.2 ± 0.60 FRA, p < 0.001). Puncture-associated pain was greater in the DRA group (4 ± 2.2 DRA vs. 3 ± 2.1 FRA, p=0.001). There were two radial artery occlusions in the FRA group and none in the DRA group (p=0.139). Percutaneous coronary intervention (PCI) was performed in 26% of the DRA group and 37.1% of the FRA group. The DRA group had significantly shorter procedure times (p=0.006), fluoroscopy times (p=0.002), and hemostasis times (p=0.002). Over time, the learning curve demonstrated improved puncture duration and a decrease in the number of puncture attempts. Conclusions DRA is a safe and practical alternative to FRA for coronary angiography and intervention. The overtime learning curve is expected to improve puncture-related outcomes.
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Aminian A, Sgueglia GA, Wiemer M, Kefer J, Gasparini GL, Ruzsa Z, van Leeuwen MAH, Ungureanu C, Leibundgut G, Vandeloo B, Kedev S, Bernat I, Ratib K, Iglesias JF, Al Hage E, Posteraro GA, Pascut D, Maes F, Regazzoli D, Kakonyi K, Meijers TA, Colletti G, Krivoshei L, Lochy S, Zafirovska B, Horák D, Nolan J, Degrauwe S, Tobita K, Saito S. Distal Versus Conventional Radial Access for Coronary Angiography and Intervention: The DISCO RADIAL Trial. JACC Cardiovasc Interv 2022; 15:1191-1201. [PMID: 35595673 DOI: 10.1016/j.jcin.2022.04.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Currently, transradial access (TRA) is the recommended access for coronary procedures because of increased safety, with radial artery occlusion (RAO) being its most frequent complication, which will increasingly affect patients undergoing multiple procedures during their lifetimes. Recently, distal radial access (DRA) has emerged as a promising alternative access to minimize RAO risk. A large-scale, international, randomized trial comparing RAO with TRA and DRA is lacking. OBJECTIVES The aim of this study was to assess the superiority of DRA compared with conventional TRA with respect to forearm RAO. METHODS DISCO RADIAL (Distal vs Conventional Radial Access) was an international, multicenter, randomized controlled trial in which patients with indications for percutaneous coronary procedure using a 6-F Slender sheath were randomized to DRA or TRA with systematic implementation of best practices to reduce RAO. The primary endpoint was the incidence of forearm RAO assessed by vascular ultrasound at discharge. Secondary endpoints include crossover, hemostasis time, and access site-related complications. RESULTS Overall, 657 patients underwent TRA, and 650 patients underwent DRA. Forearm RAO did not differ between groups (0.91% vs 0.31%; P = 0.29). Patent hemostasis was achieved in 94.4% of TRA patients. Crossover rates were higher with DRA (3.5% vs 7.4%; P = 0.002), and median hemostasis time was shorter (180 vs 153 minutes; P < 0.001). Radial artery spasm occurred more with DRA (2.7% vs 5.4%; P = 0.015). Overall bleeding events and vascular complications did not differ between groups. CONCLUSIONS With the implementation of a rigorous hemostasis protocol, DRA and TRA have equally low RAO rates. DRA is associated with a higher crossover rate but a shorter hemostasis time.
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Affiliation(s)
- Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium.
| | | | - Marcus Wiemer
- Department of Cardiology and Intensive Care, Johannes Wesling University Hospital Ruhr University Bochum, Minden, Germany
| | - Joëlle Kefer
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Zoltan Ruzsa
- Invasive Cardiology Division, Internal Medicine Department, University of Szeged, Szeged, Hungary; Cardiac and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | | | | | - Bert Vandeloo
- Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sasko Kedev
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, North Macedonia
| | - Ivo Bernat
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Charles University, Prague, Czech Republic
| | - Karim Ratib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Juan F Iglesias
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | - Elias Al Hage
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | | | - Dan Pascut
- Department of Cardiology and Intensive Care, Johannes Wesling University Hospital Ruhr University Bochum, Minden, Germany
| | - Frederic Maes
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Damiano Regazzoli
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Kornél Kakonyi
- Invasive Cardiology Division, Internal Medicine Department, University of Szeged, Szeged, Hungary; Cardiac and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Thomas A Meijers
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands
| | | | | | - Stijn Lochy
- Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Biljana Zafirovska
- Interventional Cardiology Department, University Clinic of Cardiology, Skopje, North Macedonia
| | - David Horák
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Charles University, Prague, Czech Republic
| | - James Nolan
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Sophie Degrauwe
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | - Kazuki Tobita
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
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Tsigkas G, Apostolos A, Davlouros P. Less Is More, But Not Always: Distal Transradial Access for Radial Artery Occlusion Prevention. JACC Cardiovasc Interv 2022; 15:1202-1204. [PMID: 35583362 DOI: 10.1016/j.jcin.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, Patras, Greece.
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Elbadawi A, Elgendy IY, Jia X, Hamed M, Shnoda M, Eid M, Rahman F, Khalid U, Paniagua D, Jneid H. Meta-Analysis of Randomized Trials Comparing Distal Transradial Versus Conventional Transradial Approach for Coronary Procedures. Am J Cardiol 2022; 173:147-149. [PMID: 35431049 DOI: 10.1016/j.amjcard.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 02/15/2022] [Indexed: 11/01/2022]
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Could radiation exposure be the Achilles' heel of distal transradial artery access? Indian Heart J 2022; 74:338-339. [PMID: 35716726 PMCID: PMC9453017 DOI: 10.1016/j.ihj.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 11/21/2022] Open
Abstract
Distal transradial access for vascular interventions has gained ground recently. While the novel approach is associated with reduced radial artery occlusion and faster hemostasis, it could be related with prolonged procedural time, higher crossover rate and increased radiation, comparing to conventional transradial approach. Whether the radiation is increased in the procedures performed by the novel approach remains unambiguous. In the specific article, we aim to review the current literature and to propose possible explanations for this phenomenon. Could radiation be the Achilles’ heel of distal transradial artery access?
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Achim A, Szigethy T, Olajos D, Molnár L, Papp R, Bárczi G, Kákonyi K, Édes IF, Becker D, Merkely B, Van den Eynde J, Ruzsa Z. Switching From Proximal to Distal Radial Artery Access for Coronary Chronic Total Occlusion Recanalization. Front Cardiovasc Med 2022; 9:895457. [PMID: 35615565 PMCID: PMC9124806 DOI: 10.3389/fcvm.2022.895457] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Distal radial access (DRA) was recently introduced in the hopes of improving patient comfort by allowing the hand to rest in a more ergonomic position throughout percutaneous coronary interventions (PCI), and potentially to further reduce the rate of complications (mainly radial artery occlusion, [RAO]). Its safety and feasibility in chronic total occlusion (CTO) PCI have not been thoroughly explored, although the role of DRA could be even more valuable in these procedures. Methods From 2016 to 2021, all patients who underwent CTO PCI in 3 Hungarian centers were included, divided into 2 groups: one receiving proximal radial access (PRA) and another DRA. The primary endpoints were the procedural and clinical success and vascular access-related complications. The secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE) and procedural characteristics (volume of contrast, fluoroscopy time, radiation dose, procedure time, hospitalization time). Results A total of 337 consecutive patients (mean age 64.6 ± 9.92 years, 72.4% male) were enrolled (PRA = 257, DRA = 80). When compared with DRA, the PRA group had a higher prevalence of smoking (53.8% vs. 25.7%, SMD = 0.643), family history of cardiovascular disease (35.0% vs. 15.2%, SMD = 0.553), and dyslipidemia (95.0% vs. 72.8%, SMD = 0.500). The complexity of the CTOs was slightly higher in the DRA group, with higher degrees of calcification and tortuosity (both SMD >0.250), more bifurcation lesions (45.0% vs. 13.2%, SMD = 0.938), more blunt entries (67.5% vs. 47.1%, SMD = 0.409). Contrast volumes (median 120 ml vs. 146 ml, p = 0.045) and dose area product (median 928 mGy×cm2 vs. 1,300 mGy×cm2, p < 0.001) were lower in the DRA group. Numerically, local vascular complications were more common in the PRA group, although these did not meet statistical significance (RAO: 2.72% vs. 1.25%, p = 0.450; large hematoma: 0.72% vs. 0%, p = 1.000). Hospitalization duration was similar (2.5 vs. 3.0 days, p = 0.4). The procedural and clinical success rates were comparable through DRA vs. PRA (p = 0.6), moreover, the 12-months rate of MACCE was similar across the 2 groups (9.09% vs. 18.2%, p = 0.35). Conclusion Using DRA for complex CTO interventions is safe, feasible, lowers radiation dose and makes dual radial access more achievable. At the same time, there was no signal of increased risk of periprocedural or long-term adverse outcomes.
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Affiliation(s)
- Alexandru Achim
- Division of Invasive Cardiology, Internal Medicine Department, University of Szeged, Szeged, Hungary
- “Niculae Stancioiu” Heart Institute, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
| | - Tímea Szigethy
- Cardiac and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Dorottya Olajos
- Bács-Kiskun County Hospital, Teaching Hospital of the Szent-Györgyi Albert Medical University, Kecskemét, Hungary
| | - Levente Molnár
- Cardiac and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Roland Papp
- Cardiac and Vascular Center, Semmelweis University, Budapest, Hungary
| | - György Bárczi
- Cardiac and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Kornél Kákonyi
- Division of Invasive Cardiology, Internal Medicine Department, University of Szeged, Szeged, Hungary
| | - István F. Édes
- Cardiac and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Dávid Becker
- Cardiac and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Cardiac and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Zoltán Ruzsa
- Division of Invasive Cardiology, Internal Medicine Department, University of Szeged, Szeged, Hungary
- Cardiac and Vascular Center, Semmelweis University, Budapest, Hungary
- Bács-Kiskun County Hospital, Teaching Hospital of the Szent-Györgyi Albert Medical University, Kecskemét, Hungary
- *Correspondence: Zoltán Ruzsa ;
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Sattar Y, Talib U, Faisaluddin M, Song D, Lak HM, Laghari A, Khan MZ, Ullah W, Elgendy IY, Balla S, Daggubati R, Kawsara A, Jneid H, Alraies CM, Alam M. Meta-Analysis Comparing Distal Radial Versus Traditional Radial Percutaneous Coronary Intervention or Angiography. Am J Cardiol 2022; 170:31-39. [PMID: 35248389 DOI: 10.1016/j.amjcard.2022.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 11/01/2022]
Abstract
Data comparing outcomes of distal radial (DR) and traditional radial (TR) access of coronary angiography and percutaneous coronary intervention (PCI) are limited. Online databases including Medline and Cochrane Central databases were explored to identify studies that compared DR and TR access for PCI. The primary outcome was the rate of radial artery occlusion (RAO) and access failure. Secondary outcomes included access site hematoma, access site bleeding, access site pain, radial artery spasm, radial artery dissection, and crossover. Unadjusted odds ratios (ORs) with a random-effect model, 95% confidence interval (CI), and p <0.05 were used for statistical significance. Metaregression was performed for 16 studies with 9,973 (DR 4,750 and TR 5,523) patients were included. Compared with TR, DR was associated with lower risk of RAO (OR 0.51, 95% CI 0.29 to 0.90, I2 = 42.6%, p = 0.02). RAO was lower in DR undergoing coronary angiography rather than PCI. Access failure rate (OR 1.77, 95% CI 0.69 to 4.55, I2 87.36%, p = 0.24), access site hematoma (OR 1.11, 95% CI 0.68 to 1.83, I2 0%, p = 0.68), access site pain (OR 2.22, 95% CI 0.28 to 17.38, I2 0%, p = 0.45), access site bleeding (OR 1.11, 95% CI 0.16 to 7.62, I2 85.11%, p = 0.91), radial artery spasm (OR 0.79, 95% CI 0.49 to 1.29, I2 0%, p = 0.35), radial artery dissection (OR 1.63, 95% CI 0.46 to 5.84, I2 0%, p = 0.45), and crossover (OR 1.54, 95% CI 0.64 to 3.70, I2 25.48%, p = 0.33) did not show any significant difference. DR was associated with lower incidence RAO when compared with TR, whereas other procedural-related complications were similar.
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Li SS, Li JM, Liu LL, Liu W, Yang H, Feng CG. Analysis of the Risk Factors Related to the Success Rate of Distal Transradial Artery Access in Patients with Coronary Heart Disease. Healthc Policy 2022; 15:657-663. [PMID: 35444479 PMCID: PMC9013917 DOI: 10.2147/rmhp.s357780] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/12/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to explore the factors influencing the success rate of distal transradial access (dTRA) for coronary intervention. Methods A total of 246 patients who underwent either coronary angiography or percutaneous coronary intervention in the Xuzhou Central Hospital were enrolled in this study. Access via the distal radial artery was the first choice for the procedure, and the success rate of this approach was recorded. All patients underwent color Doppler ultrasonography of the distal radial artery at the right anatomical snuff box in order to measure the artery diameter. The patients were divided into two groups depending on the success of the dTRA; 44 patients with unsuccessful punctures were assigned to the observation group and 202 patients with successful punctures acted as the control group. The basic clinical data of the two groups were recorded, and the differences between the two groups with respect to various indices were evaluated. Logistic regression analysis was carried out to explore the factors influencing the success rate of dTRA. Results Of the 246 patients, dTRA was achieved in 202, giving a puncture success rate of 82.11%. Logistic regression analysis showed that the success rate of dTRA was positively correlated with the diameter of the distal radial artery (odds ratio [OR] = 3.381, P = 0.005) and hypertension (OR = 2.427, P = 0.016), and negatively correlated with female gender (OR = 0.429, P = 0.036) and diabetes mellitus (OR = 0.325, P = 0.002). Conclusion The results of this study suggest that hypertension and distal radial artery diameter have a positive effect on the success rate of dTRA, while diabetes and female gender have a negative effect.
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Affiliation(s)
- Shan-Shan Li
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, 221009, People’s Republic of China
| | - Jian-Ming Li
- Department of Cardiac Surgery, Xuzhou Central Hospital, Xuzhou, 221009, People’s Republic of China
| | - Ling-Ling Liu
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, 221009, People’s Republic of China
| | - Wei Liu
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, 221009, People’s Republic of China
| | - Hao Yang
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, 221009, People’s Republic of China
| | - Chun-Guang Feng
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, 221009, People’s Republic of China
- Correspondence: Chun-Guang Feng, Department of Cardiology, Xuzhou Central Hospital, Xuzhou, 221009, People’s Republic of China, Tel +86 18936376559, Email
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Li F, Shi GW, Yu XL, Song RX, Xiao JQ, Huang HM, Li LM, Zhang LY, Gong C, Cai GJ. Safety and efficacy of coronary angiography and percutaneous coronary intervention via distal transradial artery access in the anatomical snuffbox: a single-centre prospective cohort study using a propensity score method. BMC Cardiovasc Disord 2022; 22:74. [PMID: 35236288 PMCID: PMC8892764 DOI: 10.1186/s12872-022-02518-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study investigated the safety and efficacy of coronary angiography (CAG) and percutaneous coronary intervention (PCI) via distal transradial artery access (d-TRA). METHODS For this single-centre prospective cohort study, a total of 1066 patients who underwent CAG or PCI procedures from September 2019 to November 2020 were included. Patients were divided into two groups: the d-TRA group (346) and the conventional transradial artery access (c-TRA) group (720) based on access site. A total of 342 pairs of patients were successfully matched using propensity score matching (PSM) for subsequent analysis. RESULTS No significant differences in puncture success rate, procedural method, procedural time, sheath size, contrast dosage or fluoroscopy time were noted between the two groups. The puncture time in the d-TRA group was longer than that in the c-TRA group (P < 0.01), and the procedure success rate was lower than that in the c-TRA group (90.94% vs. 96.49%, P = 0.01). The haemostasis time in the d-TRA group was shorter than that in the c-TRA group (P < 0.01), and the visual analogue scale (VAS) was lower than that in the c-TRA group (P < 0.01). In addition, the prevalence of bleeding and haematoma in the d-TRA group was lower than that in the c-TRA group (1.75% vs. 7.31%, P < 0.01; 0.58% vs. 3.22%, P = 0.01, respectively). No significant difference in the incidence of numbness was noted between the two groups. No other complications were found in two groups. CONCLUSION d-TRA is as safe and effective as c-TRA for CAG and PCI. It has the advantages of improved comfort and fewer complications. Trail registration Chinese Clinical Trial Registry, ChiCTR1900026519.
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Affiliation(s)
- Feng Li
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2 North Yongning Road, Changzhou, 213017, Jiangsu Province, People's Republic of China
| | - Gan-Wei Shi
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2 North Yongning Road, Changzhou, 213017, Jiangsu Province, People's Republic of China
| | - Xiao-Long Yu
- Department of Ultrasonic, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Rui-Xiao Song
- Department of Ultrasonic, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu Province, China
| | - Jian-Qiang Xiao
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2 North Yongning Road, Changzhou, 213017, Jiangsu Province, People's Republic of China
| | - Hao-Min Huang
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2 North Yongning Road, Changzhou, 213017, Jiangsu Province, People's Republic of China
| | - La-Mei Li
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2 North Yongning Road, Changzhou, 213017, Jiangsu Province, People's Republic of China
| | - Liu-Yan Zhang
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2 North Yongning Road, Changzhou, 213017, Jiangsu Province, People's Republic of China
| | - Chun Gong
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2 North Yongning Road, Changzhou, 213017, Jiangsu Province, People's Republic of China
| | - Gao-Jun Cai
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, 2 North Yongning Road, Changzhou, 213017, Jiangsu Province, People's Republic of China.
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Feasibility and safety of coronary catheterization with the distal radial approach for hemodialysis patients. J Cardiol 2022; 80:162-166. [DOI: 10.1016/j.jjcc.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/20/2022] [Accepted: 02/17/2022] [Indexed: 02/03/2023]
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Sanhoury MI, Sobhy MA, Saddaka MA, Nassar MA, Elwany MN. Distal radial approach between theory and clinical practice.. Time to go distal! Egypt Heart J 2022; 74:8. [PMID: 35122566 PMCID: PMC8818067 DOI: 10.1186/s43044-022-00243-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/17/2022] [Indexed: 11/24/2022] Open
Abstract
Background Transradial access (TRA), which has a minimal risk of problems such as radial artery occlusion (RAO), hemorrhage, spasm, and so on, is now considered the standard procedure for cardiac catheterization. The aim of the study is to present the distal transradial access (d-TRA) as a possible promising novel technique in the field of cardiac coronary interventions comparing it to the standard conventional TRA using primary and secondary endpoints, exploring its benefits and drawbacks as a new experience in Alexandria University. One hundred cases with variable indications for coronary interventions were randomized to two arms using systematic random sampling method, coronary interventions in the first one were done via d-TRA (50 patients) and in the second arm via conventional TRA group (50 patients).
Results Technically, there were highly statistically significant differences between the two arms in favor of TRA regarding procedural success, number of punctures taken, Access time, Total procedural time, vasodilator used, and crossover to another access site; meanwhile safety profile parameters have showed statistically significant differences in favor of d-TRA regarding post-operative hematoma, AV fistula, post-operative pain and compression time, and there were no statistically significant differences regarding RAO although it occurred more in TRA group.
Conclusions In the realm of cardiac intervention, the distal radial approach is a promising technique. When compared to TRA, we found it to be a viable and safe method for coronary angiography and interventions and it could be a real option for the interventionists in the near future, with a lower risk of radial artery blockage and no significant differences in wrist hematoma and radial artery spasm. The success rate of d-TRA is proportional to the steepness of the operator's learning curve and the quality of the examples chosen.
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Affiliation(s)
- Mohamed I Sanhoury
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed A Sobhy
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed A Saddaka
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed A Nassar
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Mostafa N Elwany
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Prasad RM, Pandrangi P, Pandrangi G, Yoo H, Salazar AM, Ukponmwan E, Kehdi M, Abela G. Meta-Analysis Comparing Distal Radial Artery Approach Versus Traditional for Coronary Procedures. Am J Cardiol 2022; 164:52-56. [PMID: 34815063 DOI: 10.1016/j.amjcard.2021.10.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 11/01/2022]
Abstract
Distal radial artery access (DRA) is recommended as the preferred approach over the traditional proximal radial artery access (TRA) for coronary procedures; however, there are limited randomized controlled trials (RCTs) that compared the 2. We conducted an updated meta-analysis of all RCTs from inception to July 26, 2021, that compared DRA versus TRA in patients who underwent coronary procedures. The statistical analysis was performed using a random effect model to calculate risk ratios (RRs) with 95% confidence intervals (CIs). A total of 5 RCTs were included with a total of 1,005 patients. A pooled analysis of the data showed that the rate of successful cannulation was similar between the 2 arms (RR 0.85, 95% CI 0.68 to 1.07, p = 0.16, I2 = 94%). The rate of radial artery spasm significantly favored the DRA arm as compared with TRA (RR 0.51, 95% CI 0.34 to 0.75, p = 0.0007, I2 = 0%). Significantly more patients from the DRA arm required alternative arterial access. Moreover, the DRA group had an insignificantly decreased rates of radial artery occlusion (RR 0.24, 95% CI 0.05 to 1.20, p = 0.08, I2 = 46%) and early discharge after transradial stenting of coronary arteries access-site hematomas (RR 0.52, 95% CI 0.18 to 1.149, p = 0.22, I2 = 0%). The mean time for hemostasis was significantly shorter in the DRA arm (mean difference -6.64, 95% CI -10.37 to -2.90, p = 0.0005, I2 = 88%). In conclusion, DRA should be considered as a viable, effective, and safe arterial access method for patients who underwent coronary procedures.
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45
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Aminian A, Sgueglia GA, Wiemer M, Gasparini GL, Kefer J, Ruzsa Z, van Leeuwen MA, Vandeloo B, Ungureanu C, Kedev S, Iglesias JF, Leibundgut G, Ratib K, Bernat I, Barriocanal I, Borovicanin V, Saito S. Distal versus conventional radial access for coronary angiography and intervention: Design and rationale of DISCO RADIAL study. Am Heart J 2022; 244:19-30. [PMID: 34666014 DOI: 10.1016/j.ahj.2021.10.180] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/02/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Transradial access (TRA) has become the default access method for coronary diagnostic and interventional procedures. As compared to transfemoral access, TRA has been shown to be safer, cost-effective and more patient-friendly. Radial artery occlusion (RAO) represents the most frequent complication of TRA, and precludes future coronary procedures through the radial artery, the use of the radial artery as a conduit for coronary artery bypass grafting or as arteriovenous fistula for patients on hemodialysis. Recently, distal radial access (DRA) has emerged as a promising alternative to TRA, yielding potential for minimizing the risk of RAO. However, an international multicenter randomized comparison between DRA, and conventional TRA with respect to the rate of RAO is still lacking. TRIAL DESIGN DISCO RADIAL is a prospective, multicenter, open-label, randomized, controlled, superiority trial. A total of 1300 eligible patients will be randomly allocated to undergo coronary angiography and/or percutaneous coronary intervention (PCI) through DRA or TRA using the 6 Fr Glidesheath Slender sheath introducer. Extended experience with both TRA and DRA is required for operators' eligibility and optimal evidence-based best practice to reduce RAO systematically implemented by protocol. The primary endpoint is the incidence of forearm RAO assessed by vascular ultrasound at discharge. Several important secondary endpoints will also be assessed, including access-site cross-over, hemostasis time, and access-site related complications. SUMMARY The DISCO RADIAL trial will provide the first large-scale multicenter randomized evidence comparing DRA to TRA in patients scheduled for coronary angiography or PCI with respect to the incidence of RAO at discharge.
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Yoshimachi F, Kawamura Y, Nagamatsu H, Karasawa Y, Murotani N, Kasai S. Distal radial approach treating a left main lesion during hemostasis of the forearm radial artery on the same side in a case of unstable angina. J Cardiol Cases 2022; 25:52-54. [PMID: 35024071 PMCID: PMC8721261 DOI: 10.1016/j.jccase.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/25/2021] [Accepted: 06/09/2021] [Indexed: 12/05/2022] Open
Abstract
Conventional radial access (cRA) for percutaneous coronary intervention (PCI) has become the current standard due to low bleeding complications, although recently, distal radial access (dRA) has attracted attention as an alternative. Here, the usefulness of dRA is shown in a case in whom neither side could be used for cRA. The patient was a woman in her 70 s diagnosed with unstable angina pectoris at another hospital. Although ad hoc PCI was attempted via her right forearm radial artery, her hemodynamics deteriorated and the procedure was abandoned. After an intra-aortic balloon pumping device was inserted via the left femoral approach and hemostasis was established with a dedicated device, the patient was transferred to our hospital. Her right radial artery was being used for hemostasis and her left radial artery was poorly palpable. Because her right distal radial artery was palpable, access via that location was attempted after confirming sufficient blood vessel diameter and blood flow by ultrasound. A 6Fr sheath was inserted and PCI was safely accomplished. Hemostasis on dRA was completed without complications using a hemostasis device. Thus, dRA may be an option as an alternative access site in an emergency. <Learning objective: Radial access is recommended by the guidelines for coronary intervention in order to prevent access site complications. We report a case of unstable angina successfully treated for a left main lesion via the distal radial artery during hemostasis of the forearm radial artery on the same side. Distal radial access, little considered for catheterization, may be an alternative option when conventional radial access cannot be employed. It is important to share this conclusion with all physicians.>
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Affiliation(s)
- Fuminobu Yoshimachi
- Department of Cardiology, Tokai University Hachioji Hospital, 1838 Ishikawa Machi, Hachioji City, Tokyo 192-0032, Japan
| | - Yota Kawamura
- Department of Cardiology, Tokai University Hachioji Hospital, 1838 Ishikawa Machi, Hachioji City, Tokyo 192-0032, Japan
| | - Hirofumi Nagamatsu
- Department of Cardiology, Tokai University Hachioji Hospital, 1838 Ishikawa Machi, Hachioji City, Tokyo 192-0032, Japan
| | - Yuka Karasawa
- Department of Cardiology, Tokai University Hachioji Hospital, 1838 Ishikawa Machi, Hachioji City, Tokyo 192-0032, Japan
| | - Nana Murotani
- Department of Cardiology, Tokai University Hachioji Hospital, 1838 Ishikawa Machi, Hachioji City, Tokyo 192-0032, Japan
| | - Satoshi Kasai
- Department of Cardiology, Tokai University Hachioji Hospital, 1838 Ishikawa Machi, Hachioji City, Tokyo 192-0032, Japan
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Distal or Traditional Transradial Access Site for Coronary Procedures: A Single-Center, Randomized Study. JACC Cardiovasc Interv 2021; 15:22-32. [PMID: 34922888 DOI: 10.1016/j.jcin.2021.09.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVES This study aimed to compare the efficacy and safety of the distal transradial approach (dTRA) versus the conventional transradial approach (TRA) for coronary angiography and percutaneous coronary interventions. BACKGROUND The recommended approach for coronary procedures is TRA. However, it is associated with radial artery occlusion (RAO). The dTRA could potentially decrease the incidence of RAO. METHODS One thousand forty-two consecutive patients were randomized (1:1) to right dTRA or TRA. The primary endpoint was the rate of RAO, which was evaluated by Doppler ultrasound at 60 days after randomization. RESULTS Five hundred eighteen and 524 patients were randomized to dTRA and TRA, respectively. Follow-up Doppler evaluation of the radial artery was accomplished in 404 (78.0%) patients in the dTRA group and 392 (74.8%) in the TRA group. The rate of RAO was significantly reduced in the dTRA group compared with TRA group (3.7% vs 7.9%, respectively; P = 0.014). The rate of successful sheath insertion was lower in the dTRA group compared with the TRA group (78.7% vs 94.8%, respectively; P < 0.001). More punctures (median = 2 [IQR: 1-3] vs median = 1 [IQR: 1-2]; P < 0.001) and a longer time (120 vs 75 seconds; P < 0.001) were required for sheath insertion in the dTRA group compared with the TRA group. The hemostasis time was shorter in the dTRA group compared with the TRA group (60 vs 120 minutes; P < 0.001). The dose area product was higher in the dTRA group (median = 32,729 in the dTRA vs 28,909 cGy/cm2 in the TRA group; P = 0.02). No significant differences were observed in the secondary safety endpoints (bleeding [Bleeding Academic Research Consortium ≥ 2] and severe radial artery spasm). CONCLUSIONS According to our study, dTRA was associated with a lower rate of forearm RAO, a shorter time of hemostasis, a higher crossover rate and dose area product, and a longer procedural time compared with TRA.
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Valgimigli M, Landi A. Distal Transradial Access for Coronary Procedures: Old Certainties, Novel Challenges, and Future Horizons. JACC Cardiovasc Interv 2021; 15:33-38. [PMID: 34922887 DOI: 10.1016/j.jcin.2021.10.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Marco Valgimigli
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland.
| | - Antonio Landi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
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Mhanna M, Beran A, Nazir S, Al-Abdouh A, Barbarawi M, Sajdeya O, Ayesh H, Nesheiwat Z, Malhas SE, Eltahawy EA. Outcomes of distal versus conventional transradial access for coronary angiography and intervention: An updated systematic review and meta-analysis. Int J Cardiol 2021; 344:47-53. [PMID: 34626744 DOI: 10.1016/j.ijcard.2021.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/06/2021] [Accepted: 10/04/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Distal transradial artery access (DTRA) has recently gained attention due to potential benefits in terms of local complications. In this meta-analysis, we aimed to evaluate the utility of DTRA compared to conventional transradial artery access (CTRA) for coronary angiography and intervention. METHOD Multiple databases were searched from inception through May 2021 for all the studies that evaluated the efficacy and safety of DTRA in the coronary field. The primary outcome was the access success rate. The secondary outcomes were periprocedural local complications (site hematoma, radial artery occlusion, and spasm) and procedural characteristics (cannulation, fluoroscopy, procedure, and radial artery compression times). All meta-analyses were conducted using a random-effect model. RESULTS A total of 12 studies (including four randomized control trials) with 1634 patients who underwent DTRA vs. 1657 with CTRA were included in the final analysis. The access success rate was similar between the two groups (odds ratio (OR):0.62; 95% confidence interval (CI):0.30-1.26; P = 0.18; I2 = 61%). DTRA was associated with a statistically significant lower rate of radial artery occlusion (OR:0.36; 95% CI: 0.22-0.59; P < 0.001; I2 = 0%) but similar rates of radial artery spasm and site hematoma when compared to CTRA. Regarding the procedural characteristics, despite having a longer canulation time (mean difference (min.) [MD] 0.89, 95% CI 0.36-1.42; P < 0.0001), DTRA was associated with shorter compression time and comparable fluoroscopy and procedure times. CONCLUSIONS Our meta-analysis demonstrates that the DTRA is effective and safe with superiority in preventing radial artery occlusion when compared to CTRA.
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Affiliation(s)
- Mohammed Mhanna
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA.
| | - Azizullah Beran
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Salik Nazir
- Department of Cardiovascular Medicine, The University of Toledo, Toledo, OH, USA
| | - Ahmad Al-Abdouh
- Department of Internal Medicine, Saint Agnes Hospital, Baltimore, MD, USA
| | - Mahmoud Barbarawi
- Department of Cardiovascular Medicine, University of Connecticut, Farmington, CT, USA
| | - Omar Sajdeya
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Hazem Ayesh
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Zeid Nesheiwat
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Saif-Eddin Malhas
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Ehab A Eltahawy
- Department of Cardiovascular Medicine, The University of Toledo, Toledo, OH, USA
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Hoffman H, Bunch KM, Mikhailova T, Cote JR, Kumar AA, Masoud HE, Gould GC. Comparison of the Safety, Efficacy, and Procedural Characteristics Associated with Proximal and Distal Radial Access for Diagnostic Cerebral Angiography. J Stroke Cerebrovasc Dis 2021; 31:106204. [PMID: 34781204 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/11/2021] [Accepted: 10/21/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Radial access is an increasingly popular approach for performing cerebral angiography. There are two sites for radial artery puncture: proximal transradial access (pTRA) in the wrist and distal transradial access (dTRA) in the snuffbox. These approaches have not been directly compared. MATERIALS AND METHODS Consecutive diagnostic cerebral angiograms performed at a single institution were retrospectively reviewed. Outcomes included fluoroscopy time, radiation dose, contrast volume, time to obtain access, procedure duration, and time to discharge home. Success rates as well as minor and major complication rates associated with each approach were also compared. Multivariate linear regression models were used to determine the relationship between access site and outcomes while adjusting for covariates. RESULTS A total of 287 angiograms on 244 patients met the inclusion criteria. pTRA was associated with shorter fluoroscopy time (ß -2.54, 95% CI -4.18 - -0.9, p = 0.003) and lower radiation dose (ß -242.89, 95% CI -351.55 - -134.24, p < 0.001), but not contrast volume. Time to obtain access, procedure duration, and time to discharge home were similar between approaches. A total of 10 minor complications occurred with similar rates for each approach (8 for dTRA, 2 for pTRA, p = 0.168) and there were no major complications. The conversion rate to femoral access was low (1.05% overall) and did not differ with approach. CONCLUSION dTRA and pTRA are associated with similarly high rates of safety and efficacy. Procedure duration, time to obtain access, and time to discharge did not differ between approaches.
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Affiliation(s)
- Haydn Hoffman
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY, USA.
| | - Katherine M Bunch
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Tatiana Mikhailova
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - John R Cote
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Apeksha Ashok Kumar
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Hesham E Masoud
- Department of Neurology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Grahame C Gould
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY, USA
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