Radial artery occlusion rates similar between two approaches in PCI
The rate of forearm radial artery occlusion was “extremely low” after conventional transradial and distal radial access, whereas distal access was associated with higher crossover rate but a shorter hemostasis time, researchers reported.
Distal radial access (DRA) has emerged as a promising alternative to conventional radial access for a further reduction of radial artery occlusion (RAO) rates after PCI; however, large-scale, international trials investigating the benefits of distal radial compared with conventional transradial access (TRA) are lacking, according to Adel Aminian, MD, an interventional cardiologist with Centre Hospitalier Universitaire de Charleroi, Belgium, and colleagues.
“To unravel the role of DRA in current interventional practice, we performed a large, multicenter randomized controlled trial to assess the efficacy and safety of DRA compared with conventional TRA with systematic implementation of best prevention methods for the reduction of RAO,” Aminian and colleagues wrote.
The findings were presented at EuroPCR and simultaneously published in JACC: Cardiovascular Interventions.
DRA ‘valid alternative’
For the DISCO RADIAL trial, Aminian and colleagues analyzed data from 1,307 patients with indications for PCI using a 6-F Glidesheath Slender (Terumo) as the standard access sheath from 15 sites in Europe and one site in Japan (mean age, 68 years; 72.5% men; 33.8% with previous PCI with radial access). Patients were randomly assigned to DRA or TRA with a 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 included crossover, hemostasis time and access site–related complications.
Within the cohort, 657 patients underwent TRA and 650 patients underwent DRA. Forearm RAO did not differ between groups (TRA, 0.91%; DRA, 0.31%; P = .29).
“The incidence of forearm RAO in the conventional TRA group was extremely low for a multicenter TRA trial,” the researchers wrote in the simultaneous publication. “Such a finding supports the clinical application of best-practice recommendations for the reduction of RAO and sets a new benchmark for conventional TRA.”
Patent hemostasis was achieved in 94.4% of TRA patients. Crossover rates were higher with DRA (3.5% vs. 7.4%; P = .002), and median hemostasis time was shorter (180 minutes vs. 153 minutes; P < .001). Radial artery spasm occurred more with DRA vs. TRA (2.7% vs. 5.4%; P = .015).
There were no between-group differences in overall bleeding events and vascular complications.
“Conventional TRA remains the gold-standard vascular access given thorough compliance with best-practice recommendations for RAO avoidance, which establishes as a mandatory new reference in transradial practice,” Aminian and colleagues wrote. “At the same time, DRA emerges as a valid alternative developing on a noteworthy tradeoff between a more demanding and uncertain arterial puncture and safer and simpler postprocedural vascular access care.”
‘Another step closer’ to RAO prevention
In a related editorial, Grigorios Tsigkas, MD, PhD, of the University Hospital of Patras, Greece, and colleagues wrote that radial artery occlusion rates were “surprisingly low” in both arms and especially in the TRA arm.
“To the best of our knowledge, it is the lowest radial artery occlusion incidence in a such large-scale trial in the existing literature, showing that the systematic implementation of best practices for RAO prevention could drive to amazing results,” Tsigkas and colleagues wrote.
The authors noted that exposure to radiation after distal transradial access could be the main limitation of this novel vascular approach; forthcoming trials could provide more information.
“In conclusion, distal transradial approach could be considered as another step closer to radial artery occlusion prevention,” Tsigkas and colleagues wrote. “The distal transradial approach for coronary procedures in combination with the systematic implementation of best practices for radial artery occlusion prevention may be the final solution against radial artery occlusion.”
Reference:
- Aminian A, et al. JACC Cardiovasc Interv. 2022;doi:10.1016/j.jcin.2022.04.032.
- Tsigkas G, et al. JACC Cardiovasc Interv. 2022;doi:10.1016/j.jcin.2022.05.001.
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Aminian A, et al. New Insights from Clinical Trials in Coronary Artery Disease. Presented at: EuroPCR; May 17-20, 2022; Paris (hybrid meeting).
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