Transradial access is currently the preferred access for diagnostic and therapeutic interventions. However, about 7% of patients experience radial artery occlusion (RAO), which is not expressed by clinical symptoms. However, RAO is a limit for future interventions; it reduces the potential use of that artery as a conduit for aorto-coronary bypass and for the creation of arterio-venous fistula for hemodialysis.
This is why distal transradial access has been introduced as an alternative for diagnostic and therapeutic procedures. Randomized studies have shown a lower rate of RAO with distal access.
The aim of this meta-analysis was to evaluate the effects of distal vs. conventional transradial access in angiographic and interventional procedures.
The primary endpoint (PEP) was RAO presence at follow-up. The secondary endpoint (SEP) was the presence of in-hospital RAO, in addition to local hematoma, radial spasm, time to successful radial artery puncture, number of radial puncture attempts, time to introducer insertion, amount of contrast administered, fluoroscopy time, and change in access.
There were 6208 patients included, from 14 randomized studies. Regarding the PEP, the use of distal transradial access was associated with a lower risk of RAO at follow-up up to 60 days (risk ratio [RR]: 0.36; 95% confidence interval [CI]: 0.23- 0.56; p < 0.001; number needed to treat [NNT] = 30), lower rate of in-hospital RAO (RR: 0.32; 95% CI: 0.19- 0.53; p < 0.001; NNT = 28), and lower rate of hematoma EASY ≥2 (RR: 0.51; 95% CI: 0.27 to 0.96; p = 0.04; NNT = 107).
Read also: Hand Function after Distal Radial Access: Is it Safe?
Regarding the SEP, there were no differences in the rate of local hematoma, radial spasm, or hemostasis time. However, the use of distal transradial access was associated with longer radial artery puncture time (p < 0.001), longer introducer insertion time (p < 0.01), higher number of puncture attempts (p < 0.001), and higher rate of access change (p < 0.001).
Conclusion
This meta-analysis of randomized studies comparing distal vs. conventional transradial access among patients undergoing an angiographic study and/or therapeutic intervention showed that distal transradial access was associated with a lower risk of RAO and hematoma. However, it required more time for puncture and insertion of the introducer and more attempted punctures, and it resulted in high rates of access change.
Dr. Andrés Rodríguez.
Member of the editorial board of SOLACI.org.
Original Title: Distal vs Conventional Radial Access for Coronary Angiography and/or Intervention A Meta-Analysis of Randomized Trials.
Reference: Giuseppe Ferrante, MD, PHD et al J Am Coll Cardiol Intv 2022;15:2297–2311.
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