Distal transradial approach improves radial artery occlusion rate in PCI
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Compared with the conventional transradial strategy for PCI, the distal transradial approach lowered the rate of forearm radial artery occlusion and shortened hemostasis time, according to new data.
However, the distal approach was associated with less successful sheath insertion, more punctures and longer procedure time.
Currently, the recommended approach for coronary procedures is the conventional transradial approach (TRA), the researchers wrote, despite the strategy’s association with radial artery occlusion (RAO).
For the ANGIE study, Grigorios Tsigkas, MD, PhD, of the University Hospital of Patras, Greece, and colleagues compared the efficacy and safety of distal TRA (dTRA) with TRA for coronary angiography and PCI. They randomly assigned 1,042 consecutive patients to either dTRA (n = 518) or TRA (n = 524). The rate of RAO, as determined by Doppler ultrasound at 60 days after randomization, served as the primary endpoint.
At follow-up, researchers performed Doppler evaluation of the radial artery in 78% of patients in the dTRA group and 74.8% of those in the TRA group.
Compared with TRA, dTRA significantly lowered the rate of RAO (3.7% vs. 7.9%; P = .014). The researchers found that dTRA also significantly decreased the rate of successful sheath insertion (78.7% vs. 94.8%; P < .001), with more punctures (P < .001) and longer time (120 seconds vs. 75 seconds, P < .001) required for access and sheath insertion in this group.
Furthermore, the dTRA group demonstrated shorter hemostasis time (60 minutes vs. 120 minutes; P < .001) and higher dose area product (DAP; P = .02). Researchers did not report any significant differences in the secondary safety endpoints of Bleeding Academic Research Consortium bleeding 2 and severe radial artery spasm.
“dTRA compared to TRA proved superior regarding late RAO and hemostasis time, in expense for a higher crossover rate, DAP and longer total procedure time,” the researchers wrote. “Potential approaches for improvement of the success rate of dTRA (use of coated wires, hydrophilic dedicated sheaths, etc), and the increased DAP issue should be studied further.”
In an accompanying editorial, Marco Valgimigli, MD, PhD, and Antonio Landi, MD, both with Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale in Lugano, Switzerland, wrote that this trial represents an important step forward in the management of patients undergoing coronary procedures.
“The results confirm preliminary data demonstrating a benefit in terms of RAO with distal over conventional TRA,” Valgimigli and Landi wrote. “The present study highlights that the higher crossover rate and longer procedural time compared with conventional TRA are today the major Achilles’ heel of this newer arterial access. Further investigations are warranted to define the potential impact of distal TRA on delayed revascularization and clinical outcomes in ACS patients. The journey of distal radial access site is still at the dawning and only the future will tell how distally it will finally land.”
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