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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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Batista S, Oliveira LDB, Sousa MP, Pinheiro AC, Borges J, Santana L, Bertani R, Andreão FF, Simões A, Almeida Filho JA. Transradial artery access for carotid artery stenting: A pooled analysis. Neuroradiol J 2024:19714009231224410. [PMID: 38171509 DOI: 10.1177/19714009231224410] [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: 01/05/2024] Open
Abstract
INTRODUCTION Carotid artery stenting (CAS) through transradial access (TRA) is emerging as an alternative to carotid endarterectomy. However, the current evidence base is limited, mainly comprising single-center studies. OBJECTIVE This systematic review and meta-analysis aim to assess the safety and effectiveness of TRA for CAS, providing evidence to support clinical decisions. METHODS We conducted searches on PUBMED, Cochrane Library, Embase, and Web of Science databases, including studies on TRA for CAS. Studies with fewer than 20 patients, non-primary outcomes, and non-full-text articles were excluded. RESULTS We analyzed 14 studies involving 1,166 patients who underwent CAS via TRA. Procedural success rate was high in 13 studies, with a 95% rate (95% CI; 92%-98%). Crossover to TFA access was observed in 12 studies at 6% (95% CI: 3%-9%). Transradial access failure was reported in four studies, with a rate of 0% (95% CI: 0%-0%). Cannulation failure resulted in a rate of 4% (95% CI: 2%-7%). Asymptomatic radial artery occlusion (ARAO) occurred at a rate of 2% based on eight studies (95% CI: 0%-5%). Forearm hematoma was reported in 10 studies, with an occurrence of 1% (95% CI: 0%-2%). Cerebral vascular attacks (CAV) within 30 days were assessed in 13 studies, indicating a 2% occurrence (95% CI: 1%-2%). CONCLUSION The findings suggest that TRA for CAS yields promising outcomes with high success rates and low complication rates. Further research should focus on randomized controlled trials and long-term outcomes to validate and extend findings.
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Affiliation(s)
- Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Marcelo Porto Sousa
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agostinho C Pinheiro
- Department of Neurology, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Laís Santana
- Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, Brazil
| | - Filipi Fim Andreão
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Adria Simões
- Department of Neurosurgery, Hospital Geral de Palmas, Tocantins, Brazil
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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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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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Bukhari SN, Javed I, Usman M. Incidence of Radial Artery Occlusion in Patients Undergoing Percutaneous Coronary Intervention via Trans Radial Access. Pak J Med Sci 2023; 39:377-379. [PMID: 36950426 PMCID: PMC10025722 DOI: 10.12669/pjms.39.2.7219] [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: 10/05/2022] [Revised: 10/17/2022] [Accepted: 01/06/2023] [Indexed: 02/01/2023] Open
Abstract
Objective To determine the incidence of radial artery occlusion (RAO) in patients undergoing percutaneous coronary intervention (PCI) via trans-radial access (TRA). Method A descriptive study was carried out at the Department of interventional cardiology, Chaudhary Pervaiz Elahi Institute of Cardiology, Multan from 30-April 2019 to 30-October 2020. One hundred and twenty-five patients, who underwent PCI by TRA were selected for this study. The presence of Radial artery occlusion was noted 24 hours after the procedure by Doppler ultrasonography. SPSS version 23 was used for data analysis. A Chi-square test was applied. P-value < 0.05 was taken as statistically significant. Results Gender distribution revealed 109 (87.2%) males and 16 (12.8%) females. The mean age of the patients was 65.22 ± 11.54 years. The mean BMI of the patients was 29.93±4.87 kg/m2. 84 (67.2%) patients were hypertensive, 40 (32%) patients were diabetics, 22 (17.6%) patients were smoker and 24 (19.2%) patients were having dyslipidemia. RAO after 24 hours was found in 5(4.0%) patients. Conclusion Radial artery occlusion is a common complication of trans-radial access so radial artery patency must be checked before using it for transcatheter procedures.
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Affiliation(s)
- Syed Naseem Bukhari
- Syed Naseem Bukhari, MBBS, FCPS, Assistant Professor, Department of Cardiology, Ch, Pervaiz Elahi Institute of Cardiology, Multan, Pakistan
| | - Imran Javed
- Imran Javed, MBBS, FCPS, Assistant Professor, Nishtar Medical University & Hospital Multan, Pakistan
| | - Muhammad Usman
- Muhammad Usman, MBBS, Department of Cardiology, Nishtar Medical University & Hospital Multan, Pakistan
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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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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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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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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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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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Safety and Effectiveness of Coronary Angiography or Intervention through the Distal Radial Access: A Meta-Analysis. J Interv Cardiol 2021; 2021:4371744. [PMID: 34867106 PMCID: PMC8604602 DOI: 10.1155/2021/4371744] [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: 08/07/2021] [Accepted: 10/26/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives Searching the literature for coronary angiography (CAG) or intervention through distal radial access (DRA) and performing a meta-analysis. Background Coronary angiography (CAG) or intervention through distal radial access (DRA) may have a similar success rate, low radial artery occlusion rate, low radial artery spasm rate, and low rate of puncture site hematoma for patients with coronary heart disease. Therefore, the randomized controlled trials (RCTs) were searched, and the data were pooled for meta-analysis to evaluate the effectiveness and safety of DRA. Methods RCTs comparing the CAG or intervention through DRA vs. transradial access (TRA) published between January 1, 2017, and May 4, 2021, were searched in the PubMed, Embase, and Cochrane databases. The endpoints included the rate of access success and the number of radial artery occlusions, radial artery spasms, and puncture site hematomas. The data were extracted, and a random-effects model was used for analysis. Results Among 204 studies, 6 RCTs (with 2825 participants) met the inclusion criteria. Compared to TRA, the access success rate in DRA (p=0.1) and the lower rate of puncture site hematoma were not significantly different (p=0.646), while the radial artery occlusion rate (p < 0.001) and radial artery spasm rate (p=0.029) were significantly lower. Conclusion In summary, DRA has a similar access success rate and incidence of hematoma at the puncture site, but a lower incidence of RAO and spasm compared to TRA. These findings demonstrated that DRA is a safe and effective access for CAG or intervention.
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