Distal radial artery lowers risk of hematomas, occlusion: JACC

Coronary access through the distal radial artery for interventional procedures also has some challenges, such as requiring a longer time for radial artery cannulation and sheath insertion, a higher access site crossover, and more puncture attempts.

Major vascular complications and bleeding are reported in 1% and 0.2% of patients undergoing transradial coronary angiography and intervention, respectively.

Radial artery occlusion is the most common nonbleeding vascular complication seen with RA access. RAO's incidence varies widely across studies, partly due to differences in technique and partly due to variable ascertainment; it often goes noticed in clinical practice. Hematoma is the most common bleeding complication reported in trials, albeit with variable definition and ascertainment. The Early Discharge After Transradial Stenting of Coronary Arteries (EASY) grading system classifies hematomas as I, II, III, IV, and V.

Giuseppe Ferrante, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy, and colleagues conducted the study to provide a quantitative appraisal of the DRA effects compared to conventional radial access for coronary angiography with or without intervention.

Radial artery occlusion (RAO) was the primary endpoint at the longest available follow-up. For this purpose, the researchers searched online databases for randomized controlled trials comparing DRA with conventional RA for coronary angiography and intervention. Data pooling by meta-analysis was done using a random-effects model. Fourteen studies enrolling 6,208 participants were included.

The authors reported the following findings:

• DRA was associated with a significantly lower risk of RAO compared with conventional RA, either detected at the latest follow-up (risk ratio [RR]: 0.36; number needed to treat [NNT] = 30) or in-hospital (RR: 0.32; NNT = 28), as well as EASY (Early Discharge After Transradial Stenting of Coronary Arteries) ≥II hematoma (RR: 0.51; NNT = 107).
• DRA was tied to a higher risk of access site crossover (RR: 3.08; NNT = 12), a longer time for a radial puncture (standardized mean difference [SMD]: 3.56), a longer time for sheath insertion (SMD: 0.37), and a higher number of puncture attempts (SMD: 0.59).

The study stated that DRA compared with conventional RA, is tied to lower risks of EASY ≥II hematoma and radial artery occlusion but needs more extended time for radial artery cannulation and sheath insertion, a higher access site crossover, and more puncture attempts.

Reference:

Ferrante G, Condello F, Rao SV, et al. Distal vs conventional radial access for coronary angiography and/or intervention: a meta-analysis of randomized trials. J Am Coll Cardiol Intv. 2022;15:2297-2311.