Distal radial (DR) access during percutaneous coronary intervention (PCI) is associated with lower rates of radial artery occlusion (RAO) than traditional radial (TR) access, according to a new meta-analysis in the American Journal of Cardiology.[1]
“Optimum access for PCI has been once again under discussion with the comparisons now being drawn between TR and DR,” wrote first author Yasar Sattar, MD, of the division of cardiovascular medicine at West Virginia University, and colleagues. “DR for PCI is an emerging perspective. The choice for DR versus TR depends on the comfort and experience of the operator.”
After identifying more than 163,000 articles to consider for their meta-analysis, Sattar et al. settled on a total of 16 different studies. All studies were published before June 1, 2021.
The total study population was nearly 10,000 patients, and more than 55% of patients underwent PCI with a TR approach. The remaining patients underwent PCI with. DR approach.
The average patients ages of the two treatment groups were nearly identical — 54.1 years old among distal radial patients and 54.4 years old among TR patients. Hypertension was the most common comorbidity in both groups.
Overall, DR was tied to a lower risk of RAO than TR. It also preserves blood supply to the thumb and the hand, the team added, which can be important if a vascular complication occurs.
Related Radial Access PCI Content:
Radial access PCI, proper dosing could cut bleeding rates for frail MI patients
Radial vs. femoral access for PCI: Which is safer?
Radial access outperforms femoral access for complex PCI, but questions persist
Researchers make case for increased use of left radial access PCI
What new research tells us about distal transradial vs. transradial access for coronary procedures
Radial access bests femoral access for PCI on CKD patients
However, when it comes to outcomes such as radial artery spasm, hematoma and access failure rate, “there was no statistically significant difference” between DR access and TR access.
“Some studies have shown a higher rate of failure of puncture with DR,” the authors added. “The DATA STAR study attributes this to the smaller diameter of DR as compared with that of TR and relates this to the longer puncture time. We found no difference in the rate of failure of TR and DR in our study.”
Sattar and colleagues also highlighted the fact that a DR approach “provides insightful perspective” during PCI procedures.
“The right hand can be kept in a semi-prone position for DR, which alleviates discomfort to the patient and the need to support and secure the arm for appropriate positioning,” they wrote.
Related Interventional Cardiology Content:
What new research tells us about distal transradial vs. transradial access for coronary procedures
FDA Roundup: AAA EVAR recommendations, key approvals in stroke care and interventional cardiology
Heart Team consultations lead to better patient outcomes, fewer unexpected hospitalizations
Reference:
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.