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.

Centre for Prognosis Research Keele Cardiovascular Research Group Institute for Primary Care and Health Sciences Keele University United Kingdom

Department of Cardiology and Intensive Care Johannes Wesling University Hospital Ruhr University Bochum Minden Germany

Department of Cardiology Centre Hospitalier Universitaire de Charleroi Charleroi Belgium

Department of Cardiology Geneva University Hospital Geneva Switzerland

Department of Cardiology Isala Heart Center Zwolle the Netherlands

Department of Cardiology Jolimont Hospital La Louvière Belgium

Department of Cardiology Shonan Kamakura General Hospital Kanagawa Japan

Department of Cardiology Universitair Ziekenhuis Brussel Vrije Universiteit Brussel Brussels Belgium

Department of Cardiology University Hospital and Faculty of Medicine Pilsen Charles University Pilsen Czech Republic

Department of Internal Medicine Invasive Cardiology Division University of Szeged Medical Faculty Szeged Hungary; Cardiology Division Bács Kiskun County Hospital Invasive Cardiology Kecskemét Hungary

Division of Cardiology Cliniques Universitaires Saint Luc Brussels Belgium

Division of Cardiology Sant'Eugenio Hospital Rome Italy

European Medical and Clinical Division Terumo Europe N 5 Leuven Belgium

Humanitas Clinical and Research Center IRCCS Rozzano Milan Italy

Interventional Cardiology Department University Clinic of Cardiology Skopje Macedonia

Kantonsspital Baselland Liestal Switzerland

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Impact of Anthropometric Measures on Distal vs Conventional Radial Access for Percutaneous Coronary Procedures