Comparative analysis of the dorsopalmar (modified distal) and transradial access in primary percutaneous coronary interventions in patients with acute coronary syndrome

Abstract

Background: Primary percutaneous coronary interventions (PCI) in acute coronary syndrome (ACS) with transradial access (TRA) are associated with the risk of local complications, such as occlusion of the radial artery (ORA), hematomas, pseudoaneurysms, and arteriovenous fistulas. Aim: To perform comparative assessment of clinical efficacy and safety of the TRA and dorsopalmar (modified distal) radial access (DpRA) for primary percutaneous coronary intervention in in-patients with ACS. Materials and methods: This was a randomized, dynamic, single-center, prospective study in two parallel groups. The patients were randomized in a 1:1 ratio into two groups with different types of the radiation access: TRA (n = 100) or DpRA (n = 100). TRA was made at the distal third of the forearm and DpRA on the dorsal palm surface. After the access zone was evaluated by angiography, the pressure bandage was placed on the zone for 6 hours for hemostasis. The comfort of hemostasis was assessed by the Gaston-Johansson 10-point verbal-descriptive pain rating scale. On the 57th day after PCI, all patients were examined with palpation and ultrasound assessment of the access artery. Results: The number of attempts, average duration of the radial artery puncture, duration of the fluoroscopy procedure, and the conversion rate did not depend on the access type. The scoring of the subjective hemostasis comfort showed a significant advantage of DpRA over TRA (6.4 [4; 10] in the TRA group vs 1.7 [0; 6] in the DpRA group, p 0.001). The rate of EASY III hematomas was 15 (15%) in the TRA group vs 3 (3%) in the DpRA group (p = 0.004). There were no EASY IVV hematomas, occlusion of the radial artery of the forearm, pseudoaneurysms and arteriovenous fistulas in the DpRA group. The diameter of the forearm radial artery was significantly larger than the diameter on the dorsal palm surface in the patients of both groups, regardless of the type of access chosen (2.75 0.32 mm and 2.38 0.36 mm in the TRA group, p 0.001; 2.84 0.38 mm and 2.45 0.36 mm in the DpRA group, p 0.001). In the patients with access conversion in both groups, the diameter of the radial artery at both levels was less than the average one. Conclusion: DpRA for PCI in ACS patients is a safe alternative to conventional radiation access. Ultrasound examination of the radial artery diameter in its distal and forearm parts before PCI could reduce the conversion rate.

Keywords

• distal radial access
• percutaneous coronary intervention
• acute coronary syndrome