BACKGROUND: Results from the Distal vs Conventional Radial Access (DISCO RADIAL) trial confirmed distal radial access (DRA) as a valid alternative to conventional transradial access, with equally low rates of radial artery occlusion (RAO), yet higher crossovers but shorter hemostasis. OBJECTIVES: The purpose of the study was to investigate whether patient anthropometric measures influence the effect of randomized access on key secondary outcomes. METHODS: DISCO RADIAL 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 (n = 650) or transradial access (n = 657) implementing best practices to reduce RAO. The primary endpoint of the trial was incidence of forearm RAO, which was extremely uncommon. Secondary endpoints, including sheath insertion time, radial artery spasm, crossover (failure to obtain access through assigned access site), hemostasis time, and access site complications, were the focus of the current analysis. Regression models (linear for continuous and logistic for binary outcomes) were used to determine whether anthropometric measures (weight, height, body mass index, and body surface area) influenced the effect of randomized access on outcomes. RESULTS: Across tertiles of weight, height, body mass index, and body surface area, both before and after adjustment for sex and age, the main effect of vascular access on radial artery spasm, crossover, hemostasis time, and access site complications remained, with no significant interaction effect. CONCLUSIONS: The results of this exploratory analysis are consistent with the main findings of the trial and support the use of DRA in all patients, regardless of anthropometric measures.

Cardiac and Vascular Center Semmelweis University Budapest Hungary

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 Hospitals 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 Macedonia

Invasive Cardiology Division Internal Medicine Department University of Szeged Szeged Hungary

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

University Heart Center University Hospital Basel Basel Switzerland

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Neumann F.J., Sousa-Uva M., Ahlsson A., et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40:87–165. PubMed

Lawton J.S., Tamis-Holland J.E., Bangalore S., et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. J Am Coll Cardiol. 2022;79:e21–e129. PubMed

Ferrante G., Rao S.V., Juni P., et al. Radial versus femoral access for coronary interventions across the entire spectrum of patients with coronary artery disease: a meta-analysis of randomized trials. JACC Cardiovasc Interv. 2016;9:1419–1434. PubMed

Sgueglia G.A., Di Giorgio A., Gaspardone A., Babunashvili A. Anatomic basis and physiological rationale of distal radial artery access for percutaneous coronary and endovascular procedures. JACC Cardiovasc Interv. 2018;11:2113–2119. PubMed

Kiemeneij F. Left distal transradial access in the anatomical snuffbox for coronary angiography (ldTRA) and interventions (ldTRI) EuroIntervention. 2017;13:851–857. PubMed

Sgueglia G.A., Santoliquido A., Gaspardone A., Di Giorgio A. First results of the distal radial access Doppler study. JACC Cardiovasc Imaging. 2021;14:1281–1283. PubMed

Tsigkas G.G., AΙ Moulias, Spyropoulou P.N., et al. Randomized comparison of Glidesheath Slender with conventional 5Fr arterial sheaths for coronary angiography through the distal radial artery. Minerva Cardiol Angiol. 2023;71:692–701. PubMed

Eid-Lidt G., Rivera Rodriguez A., Jimenez Castellanos J., Farjat Pasos J.I., Estrada Lopez K.E., Gaspar J. Distal radial artery approach to prevent radial artery occlusion trial. JACC Cardiovasc Interv. 2021;14:378–385. PubMed

Tsigkas G., Papageorgiou A., Moulias A., et al. Distal or traditional transradial access site for coronary procedures: a single-center, randomized study. JACC Cardiovasc Interv. 2022;15:22–32. PubMed

Aminian A., Sgueglia G.A., Wiemer M., et al. Distal versus conventional radial access for coronary angiography and intervention: the DISCO RADIAL trial. JACC Cardiovasc Interv. 2022;15:1191–1201. PubMed

Ferrante G., Condello F., Rao S.V., et al. Distal vs conventional radial access for coronary angiography and/or intervention: a meta-analysis of randomized trials. JACC Cardiovasc Interv. 2022;15:2297–2311. PubMed

Sgueglia G.A., Lee B.K., Cho B.R., et al. Distal radial access: consensus report of the first Korea-Europe transradial intervention meeting. JACC Cardiovasc Interv. 2021;14:892–906. PubMed

Aminian A., Sgueglia G.A., Wiemer M., et al. Distal versus conventional radial access for coronary angiography and intervention: design and rationale of DISCO RADIAL study. Am Heart J. 2022;244:19–30. PubMed

Bernat I., Aminian A., Pancholy S., et al. Best practices for the prevention of radial artery occlusion after transradial diagnostic angiography and intervention: an international consensus paper. JACC Cardiovasc Interv. 2019;12:2235–2246. PubMed

Aminian A., Saito S., Takahashi A., et al. Comparison of a new slender 6 Fr sheath with a standard 5 Fr sheath for transradial coronary angiography and intervention: RAP and BEAT (Radial Artery Patency and Bleeding, Efficacy, Adverse evenT), a randomised multicentre trial. EuroIntervention. 2017;13:e549–e556. PubMed

Pancholy S., Coppola J., Patel T., Roke-Thomas M. Prevention of radial artery occlusion-patent hemostasis evaluation trial (PROPHET study): a randomized comparison of traditional versus patency documented hemostasis after transradial catheterization. Catheter Cardiovasc Interv. 2008;72:335–340. PubMed

Mosteller R.D. Simplified calculation of body-surface area. N Engl J Med. 1987;317:1098. PubMed

Sgueglia G.A., Todaro D., De Santis A., et al. Identifying a better strategy for ad hoc percutaneous coronary intervention in patients with anticipated unfavorable radial access: the Little Women study. Cardiovasc Revasc Med. 2018;19:413–417. PubMed

Dehghani P., Mohammad A., Bajaj R., et al. Mechanism and predictors of failed transradial approach for percutaneous coronary interventions. JACC Cardiovasc Interv. 2009;2:1057–1064. PubMed

Abdelaal E., Brousseau-Provencher C., Montminy S., et al. Risk score, causes, and clinical impact of failure of transradial approach for percutaneous coronary interventions. JACC Cardiovasc Interv. 2013;6:1129–1137. PubMed

Gragnano F., Jolly S.S., Mehta S.R., et al. Prediction of radial crossover in acute coronary syndromes: derivation and validation of the MATRIX score. EuroIntervention. 2021;17:e971–e980. PubMed PMC

Ciurica S., Lopez-Sublet M., Loeys B.L., et al. Arterial tortuosity. Hypertension. 2019;73:951–960. PubMed

Yoo B.S., Yoon J., Ko J.Y., et al. Anatomical consideration of the radial artery for transradial coronary procedures: arterial diameter, branching anomaly and vessel tortuosity. Int J Cardiol. 2005;101:421–427. PubMed

Saito S., Ikei H., Hosokawa G., Tanaka S. Influence of the ratio between radial artery inner diameter and sheath outer diameter on radial artery flow after transradial coronary intervention. Catheter Cardiovasc Interv. 1999;46:173–178. PubMed

Lee L., Kern J., Bair J., Rosenberg J., Lee M., Nathan S. Clinical determinants of radial artery caliber assessed at the time of transradial cardiac catheterization using routine prospective radiobrachial angiography. Cardiovasc Revasc Med. 2018;19:939–943. PubMed

Ashraf T., Panhwar Z., Habib S., Memon M.A., Shamsi F., Arif J. Size of radial and ulnar artery in local population. J Pak Med Assoc. 2010;60:817–819. PubMed

Meng S., Guo Q., Tong G., et al. Development and validation of a nomogram for predicting radial artery spasm during coronary angiography. Angiology. 2023;74:242–251. PubMed

Bertrand O.F., Larose E., Rodes-Cabau J., et al. Incidence, predictors, and clinical impact of bleeding after transradial coronary stenting and maximal antiplatelet therapy. Am Heart J. 2009;157:164–169. PubMed

Achim A., Kakonyi K., Jambrik Z., et al. Distal radial artery access for coronary and peripheral procedures: a multicenter experience. J Clin Med. 2021;10:5974. PubMed PMC

Lee J.W., Son J.W., Go T.H., et al. Reference diameter and characteristics of the distal radial artery based on ultrasonographic assessment. Korean J Intern Med. 2022;37:109–118. PubMed PMC

Deora S., Sharma S.K., Choudhary R., et al. Assessment and comparison of distal radial artery diameter in anatomical snuff box with conventional radial artery before coronary catheterization. Indian Heart J. 2022;74:322–326. PubMed PMC

Ikuta A., Kubo S., Osakada K., et al. Predictors of success and puncture site complications in the distal radial approach. Heart Ves. 2023;38:147–156. PubMed

Mori S., Hirano K., Yamawaki M., et al. A comparative analysis between ultrasound-guided and conventional distal transradial access for coronary angiography and intervention. J Interv Cardiol. 2020;2020 PubMed PMC

Apostolos A., Papanikolaou A., Papageorgiou A., et al. Distal radial artery palpability and successful arterial access for coronary angiography: a post-hoc analysis from two randomized trials. J Vasc Access. Published online December 6, 2024 doi: 10.1177/11297298241296570. PubMed DOI