BACKGROUND: Currently, transradial access (TRA) is the recommended access for coronary procedures because of increased safety, with radial artery occlusion (RAO) being its most frequent complication, which will increasingly affect patients undergoing multiple procedures during their lifetimes. Recently, distal radial access (DRA) has emerged as a promising alternative access to minimize RAO risk. A large-scale, international, randomized trial comparing RAO with TRA and DRA is lacking. OBJECTIVES: The aim of this study was to assess the superiority of DRA compared with conventional TRA with respect to forearm RAO. METHODS: DISCO RADIAL (Distal vs Conventional Radial Access) was an international, multicenter, randomized controlled trial in which patients with indications for percutaneous coronary procedure using a 6-F Slender sheath were randomized to DRA or TRA with systematic implementation of best practices to reduce RAO. The primary endpoint was the incidence of forearm RAO assessed by vascular ultrasound at discharge. Secondary endpoints include crossover, hemostasis time, and access site-related complications. RESULTS: Overall, 657 patients underwent TRA, and 650 patients underwent DRA. Forearm RAO did not differ between groups (0.91% vs 0.31%; P = 0.29). Patent hemostasis was achieved in 94.4% of TRA patients. Crossover rates were higher with DRA (3.5% vs 7.4%; P = 0.002), and median hemostasis time was shorter (180 vs 153 minutes; P < 0.001). Radial artery spasm occurred more with DRA (2.7% vs 5.4%; P = 0.015). Overall bleeding events and vascular complications did not differ between groups. CONCLUSIONS: With the implementation of a rigorous hemostasis protocol, DRA and TRA have equally low RAO rates. DRA is associated with a higher crossover rate but a shorter hemostasis time.

Cardio Center IRCCS Humanitas Research Hospital Rozzano Milan Italy

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 Prague Czech Republic

Division of Cardiology Cliniques Universitaires Saint Luc Brussels Belgium

Division of Cardiology Sant'Eugenio Hospital Rome Italy

Interventional Cardiology Department University Clinic of Cardiology Skopje North Macedonia

Invasive Cardiology Division Internal Medicine Department University of Szeged Szeged Hungary; Cardiac and Vascular Center Semmelweis University Budapest Hungary

Kantonsspital Baselland Liestal Switzerland

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

JACC Cardiovasc Interv. 2022 Jun 27;15(12):1202-1204. doi: 10.1016/j.jcin.2022.05.001. PubMed

Citace poskytuje Crossref.org

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