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Distal Radial Access for Coronary Angiography
Quick Takes
- Findings from this large registry study (n = 4,977; 67% male) of patients undergoing coronary angiography showed distal radial access (DRA) was associated with high success rates of completion of coronary angiography (100%) and PCI (98.8%).
- Among patients who were not screened failures (12.5% of screened patients were excluded), the success rate of DRA was high (94.4%). Access site crossover occurred in 6.7%.
- The incidences DRA occlusion, radial artery occlusion, bleeding, and other procedure-related complications were very low. Predictors of failed DRA were weak pulse and low operator experience of DRA (<100 cases).
Study Questions:
What is the safety and feasibility of distal radial access (DRA) in daily practice?
Methods:
The KODRA (Korean Prospective Registry for Evaluating the Safety and Efficacy of Distal Radial Approach) trial was a prospective multicenter registry from 14 hospitals between September 2019 and September 2021. The primary endpoints were the success rates of coronary angiography (CAG) and percutaneous coronary intervention (PCI). The secondary endpoints included successful distal radial artery puncture, access site crossover, access site–related complications, bleeding events, and predictors of puncture failure.
Results:
A total of 4,977 among 5,712 screened patients were recruited after exclusion of 735 patients. The primary endpoints, the success rates of CAG and PCI via DRA were 100% and 98.8%, respectively, among successful punctures of the distal radial artery (94.4%). Access site crossover occurred in 333 patients (6.7%). The rates of distal radial artery occlusion (DRAO) and radial artery occlusion (RAO) by palpation were 0.8% (36/4,340) and 0.8% (33/4,340) at the 1-month follow-up. DRA-related bleeding events were observed in 3.3% without serious hematoma. Multilevel logistic regression analysis identified weak pulse (odds ratio [OR], 9.994; 95% confidence interval [CI], 7.252-13.774) and DRA experience of <100 cases (OR, 2.187; 95% CI, 1.383-3.456) as predictors of puncture failure.
Conclusions:
In this large-scale prospective multicenter registry, DRA demonstrated high success rates of CAG and PCI with a high rate of puncture success but low DRAO, RAO, bleeding events, and procedure-related complications. Weak pulse and DRA experience of <100 cases were predictors of puncture failure.
Perspective:
DRA has been reported to have a lower incidence of access site complication including RAO and bleeding compared to transradial artery (TRA) access. Findings from this large registry study (n = 4,977; 67% male) of patients undergoing CAG showed DRA was associated with high success rates of completion of CAG (100%) and PCI (98.8%). Among patients who were not screened out (12.5% of screened patients were excluded), success rate of the DRA was high (94.4%). Access site crossover occurred in 6.7%. The incidences of DRAO, RAO, bleeding, and other procedure-related complications were very low. Predictors of failed DRA were weak pulse and low operator experience of DRA (<100 cases). Although TRA remains the default access site for CAG, findings from this study provide reassurance about using DRA as an alternative option in select patients for experienced operators.
Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and Imaging, Angiography, Nuclear Imaging
Keywords: Coronary Angiography, Percutaneous Coronary Intervention
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