Distal radial access as an alternative to conventional radial access in coronary angiography and percutaneous coronary interventions

Aim. To evaluate immediate and medium-term (3 months) results of safety and effectiveness of distal versus proximal radial access for coronary interventions.

Material and methods. An analysis of 776 patients of the prospective randomized TENDERA trial was performed: distal radial access (DRA) group — 1391 patients; proximal radial access (PRA) group — 385 patients. After excluding patients with failed primary access, the primary sample sizes decreased (DRA — 371, PRA — 382). Access-site crossover rate was statistically higher in the DRA group (5,1% and 0,8%, p<0,001). The primary endpoint was immediate (inhospital) or long-term radial artery (RA) thrombosis/occlusion. There were following secondary endpoints: 1 — composite endpoint including complications from the access artery; 2 — access parameters.

Results. Significant differences were obtained for the primary endpoint: DRA 2,7% (n=10), PRA 6,8% (n=26), p=0,008. Distal RA occlusion with patent RA: DRA: 1,3% (n=5), PRA: 0 (n=0), p=0,023. The secondary composite point showed significant differences in the following groups of complications: BARC type I bleeding (DRA: 3,8% (n=14), PRA: 21,7% (n=83), p<0,001); hematoma >5 cm on day 1 (DRA: 10% (n=37), PRA: 25,9% (n=98), p<0,001); hematoma >5 cm on day 7 (DRA: 12,4% (n=45), PRA: 34,6% (n=132), p<0,001). The following access parameters showed significant differences: distal RA puncture time — 19,0 (8,0; 50), proximal RA puncture time — 13,5 (5,0; 29), p<0,001; introducer insertion by DRA 42,0 (26,0; 84,0), PRA 35,0 (23,0; 55,0), p<0,001; duration of access artery hemostasis (min): DRA 180,0 (120,0; 480,0), PRA 155,0 (115,0; 195,0), p<0,001. Duration of the procedure and fluoroscopy, radiation dose, and RA spasm in both groups did not have significant differences.

Conclusion. In the TENDERA study, DRA demonstrated efficacy and safety in interventional coronary procedures compared to PRA in the mid-term follow-up period — significantly lower incidence of RA occlusions and local complications.

1. Chiarito M, Cao D, Nicolas J, et al. Radial versus femoral access for coronary interventions: An updated systematic review and meta-analysis of randomized trials. Catheter Cardiovasc Interv. 2021;97(7):1387-96. doi:10.1002/ccd.29486.

2. Judkin MP, Gander MP. Prevention of complications of coronary arteriography. Circulation. 1974;49(4):599-602. doi:10.1161/01.cir.49.4.599.

3. Adams DF, Fraser DB, Abrams HL. The complications of coronary arteriography. Circulation. 1973;48(3):609-18. doi:10.1161/01.cir.48.3.609.

4. Dodek A, Boone JA, Hooper RO, et al. Complications of coronary arteriography. Can Med Assoc J. 1983;128(8):934-6.

5. Campeau L. Percutaneous radial artery approach for coronary angiography. Cathet Cardiovasc Diagn. 1989;16(1):3-7. doi:10.1002/ccd.1810160103.

6. Kiemeneij F, Laarman GJ. Percutaneous transradial artery approach for coronary stent implantation. Cathet Cardiovasc Diagn. 1993;30(2):173-8. doi:10.1002/ccd.1810300220.

7. Rao SV, Cohen MG, Kandzari DE, et al. The transradial approach to percutaneous coronary intervention: historical perspective, current concepts, and future directions. J Am Coll Cardiol. 2010;55(20):2187-95. doi:10.1016/j.jacc.2010.01.039.

8. Valgimigli M, Gagnor A, Calabró P, et al. MATRIX Investigators. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet. 2015;385(9986):2465-76. doi:10.1016/S0140-6736(15)60292-6.

9. Hamon M, Pristipino C, Di Mario C, et al. Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care and Thrombosis of the European Society of Cardiology. EuroIntervention. 2013; 8(11):1242-51. doi:10.4244/eijv8i11a192.

10. Gatzopoulos D, Rigatou A, Kontopodis E, et al. Alternative access site choice after initial radial access site failure for coronary angiography and intervention. J Geriatr Cardiol. 2018;15(9):585-90. doi:10.11909/j.issn.1671-5411.2018.09.001.

11. Sinha SK, Jha MJ, Mishra V, et al. Radial Artery Occlusion — Incidence, Predictors and Long-term outcome after TRAnsradial Catheterization: clinico-Doppler ultrasound-based study (RAIL-TRAC study). Acta Cardiol. 2017;72(3):318-27. doi:10.1080/00015385.2017.1305158.

12. Korotkikh AV, Babunashvili AM. Distal radial access — modern trends. Endovaskulyarnaya Khirurgiya. 2021;8(2):135-43. (In Russ.) doi:10.24183/2409-4080-2021-8-2-135-143.

13. Babunashvili A, Dundua D. Recanalization and reuse of early occluded radial artery within 6 days after previous transradial diagnostic procedure. Catheter Cardiovasc Interv. 2011; 77(4):530-6. doi:10.1002/ccd.22846.

14. Каledin AL, Коchanov IN, Seletskiy SS, et al. Peculiarities of arterial access in endovascular surgery in elderly patients. Uspekhi gerontologii. 2014;27(1):115-9. (In Russ.)

15. Korotkikh AV. New possibilities of using the radial artery in conducting angiographic studies. Materials of the scientific and practical conference with international participation "Modern aspects of diagnosis and treatment in cardiac surgery", Khabarovsk. 2015: 56-60. (In Russ.) EDN UJSVVP.

16. Korotkikh AV, Bondar VYu. Using a deep palmar branch of radial artery in the ragion of anatomical snuffbox during angiography. Far Eastern medical journal. 2016;1:24-7. (In Russ.)

17. Kim Y, Lee JW, Lee SY, et al. Feasibility of primary percutaneous coronary intervention via the distal radial approach in patients with ST-elevation myocardial infarction. Korean J Intern Med. 2021;36(Suppl 1):S53-S61. doi:10.3904/kjim.2019.420.

18. Hadjivassiliou A, Cardarelli-Leite L, Jalal S, et al. Left Distal Transradial Access (ldTRA): A Comparative Assessment of Conventional and Distal Radial Artery Size. Cardiovasc Intervent Radiol. 2020;43(6):850-7. doi:10.1007/s00270-020-02485-7.

19. Rajah GB, Lieber B, Kappel AD, et al. Distal transradial access in the anatomical snuffbox for balloon guide-assisted stentriever mechanical thrombectomy: Technical note and case report. Brain Circ. 2020;6(1):60-4. doi:10.4103/bc.bc_22_19.

20. Kühn AL, de Macedo Rodrigues K, Singh J, et al. Distal radial access in the anatomical snuffbox for neurointerventions: a feasibility, safety, and proof-of-concept study. J Neurointerv Surg. 2020;12(8):798-801. doi:10.1136/neurintsurg-2019-015604.

21. Achim A, Kákonyi K, Jambrik Z, et al. Distal Radial Artery Access for Coronary and Peripheral Procedures: A Multicenter Experience. J Clin Med. 2021;10(24):5974. doi:10.3390/jcm10245974.

22. Aminian A, Sgueglia GA, Wiemer M, et al. Distal Versus Conventional Radial Access for Coronary Angiography and Intervention: The DISCO RADIAL Trial. JACC Cardiovasc Interv. 2022;15(12):1191-201. doi:10.1016/j.jcin.2022.04.032.

23. Korotkikh AV, Babunashvili AM, Kaledin AL, et al. Analysis of intermediate results of a comparative multicenter randomized TENDERA study investigating the distal radiation access. Novosti Khirurgiithis link is disabled, 2021;29(3):285-95. (In Russ.) doi:10.18484/2305-0047.2021.3.285.

24. Eid-Lidt G, Rivera Rodríguez A, Jimenez Castellanos J, et al. Distal Radial Artery Approach to Prevent Radial Artery Occlusion Trial. JACC Cardiovasc Interv. 2021;14(4):378-85. doi:10.1016/j.jcin.2020.10.013.

25. Gasparini GL, Garbo R, Gagnor A, et al. First prospective multicentre experience with distal transradial approach for coronary chronic total occlusion interventions using a 7 Fr Glidesheath Slender. EuroIntervention. 2019;15(1):126-8. doi:10.4244/EIJ-D-18-00648.

26. Sadaka MA, Etman W, Ahmed W, et al. Incidence and predictors of radial artery occlusion after transradial coronary catheterization. Egypt Heart J. 2019;71(1):12. doi:10.1186/s43044-019-0008-0.

27. Tsigkas G, Papageorgiou A, Moulias A, et al. Distal or Traditional Transradial Access Site for Coronary Procedures: A Single-Center, Randomized Study. JACC Cardiovasc Interv. 2022;15(1):22-32. doi:10.1016/j.jcin.2021.09.037.

28. Korotkikh AV, Babunashvili AM, Kazantsev AN, et al. Distal Radial Access: Is There a Clinical Benefit? Cardiol Rev. 2024;32(2):110-3. doi:10.1097/CRD.0000000000000472.

29. Korotkikh AV, Babunashvili AM, Kazantsev AN, et al. Distal Radial Artery Access in Non-coronary Procedures. Curr Probl Cardiol. 2023;48(8):101207. doi:10.1016/j.cpcardiol.2022.101207.