Российский кардиологический журнал (Jan 2025)

Distal radial access as an alternative to conventional radial access in coronary angiography and percutaneous coronary interventions

  • A. V. Korotkikh,
  • A. M. Babunashvili,
  • A. L. Kaledin,
  • R. V. Akhramovich,
  • V. V. Derkach,
  • R. M. Portnov,
  • D. S. Kartashov

DOI
https://doi.org/10.15829/1560-4071-2024-5737
Journal volume & issue
Vol. 29, no. 12

Abstract

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Aim. To evaluate immediate and medium-term (3 months) results of safety and effectiveness of distal versus proximal radial access for coronary interventions.Material and methods. An analysis of 776 patients of the prospective randomized TENDERA trial was performed: distal radial access (DRA) group — 1391 patients; proximal radial access (PRA) group — 385 patients. After excluding patients with failed primary access, the primary sample sizes decreased (DRA — 371, PRA — 382). Access-site crossover rate was statistically higher in the DRA group (5,1% and 0,8%, p<0,001). The primary endpoint was immediate (inhospital) or long-term radial artery (RA) thrombosis/occlusion. There were following secondary endpoints: 1 — composite endpoint including complications from the access artery; 2 — access parameters.Results. Significant differences were obtained for the primary endpoint: DRA 2,7% (n=10), PRA 6,8% (n=26), p=0,008. Distal RA occlusion with patent RA: DRA: 1,3% (n=5), PRA: 0 (n=0), p=0,023. The secondary composite point showed significant differences in the following groups of complications: BARC type I bleeding (DRA: 3,8% (n=14), PRA: 21,7% (n=83), p<0,001); hematoma >5 cm on day 1 (DRA: 10% (n=37), PRA: 25,9% (n=98), p<0,001); hematoma >5 cm on day 7 (DRA: 12,4% (n=45), PRA: 34,6% (n=132), p<0,001). The following access parameters showed significant differences: distal RA puncture time — 19,0 (8,0; 50), proximal RA puncture time — 13,5 (5,0; 29), p<0,001; introducer insertion by DRA 42,0 (26,0; 84,0), PRA 35,0 (23,0; 55,0), p<0,001; duration of access artery hemostasis (min): DRA 180,0 (120,0; 480,0), PRA 155,0 (115,0; 195,0), p<0,001. Duration of the procedure and fluoroscopy, radiation dose, and RA spasm in both groups did not have significant differences.Conclusion. In the TENDERA study, DRA demonstrated efficacy and safety in interventional coronary procedures compared to PRA in the mid-term follow-up period — significantly lower incidence of RA occlusions and local complications.

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