Study on Radial Access Approaches

The standard proximal radial approach (PRA) is now generally recommended over transfemoral access for both stable and acute patients in percutaneous myocardial revascularization. However, in a recent study, researchers have found that distal radial approach (DRA) is better than PRA in preventing the radial artery occlusion (RAO). The study findings were published in the JACC: Cardiovascular Intervention in February 2021.

The standard proximal radial approach (PRA) from the wrist has many advantages over the femoral approach, especially for significant reduction of access site bleeding and vascular complications. Some observational studies have shown that distal radial access has a low rate of RAO, but this had not previously been compared against the standard proximal (conventional) approach in a randomized clinical trial. Therefore, Dr. Guering Eid-Lidt and team conducted a study to compare the rate of proximal radial artery occlusion (RAO) with Doppler ultrasound between distal and conventional radial access 24 h and 30 days after a trans-radial coronary procedure.

It was a prospective, comparative, longitudinal, randomized study of 282 patients. Researchers randomized them to either proximal radial access (n = 142) or distal radial access (n = 140) and evaluated the superiority of the distal approach in the prevention of PRAO with Doppler ultrasound 24 hours and 30 days after a trans-radial coronary procedure.

In the per-protocol analysis, the researchers noted that the rates of proximal RAO (PRAO) at 24 h and 30 days were 8.4% and 5.6% in the proximal group and 0.7% and 0.7% in the distal group, respectively (24 h: odds ratio [OR]: 12.8; 30 days: OR: 8.2).

In an intention-to-treat analysis, they noted that the 24-h and 30-day rates of PRAO were 8.8% and 6.4% for proximal radial access and 1.2% and 0.6% in the distal radial access group (24 h: OR: 7.4; 30 days: OR: 10.6).

The authors concluded, "Distal radial access prevents RAO in the proximal segment at 24 h and 30 days after the procedure compared with conventional radial access."

Editorial of this study further added, "Although this single-center trial with a moderate number of randomized patients has obvious limitations to draw a general recommendation for the routine practice, it is necessary to highlight its importance. If these results are confirmed by the ongoing large international multicenter randomized DISCO Radial (DIStal Versus COnventional RADIAL Access for Coronary Angiography and Intervention) trial, this will mean a significant next step in minimally invasive strategy, not only in percutaneous coronary catheterizations and interventions, but also for other endovascular procedures."

For further information:

• JACC: Cardiovascular Intervention