Evaluation of the distal radial approach in percutaneous coronary interventions. A controlled, randomized non-inferiority trial

##plugins.themes.academic_pro.article.sidebar##

Published Oct 14, 2023
Download
pdf
Vol. 101 No. 6 (2023): Tunis med jun 2023

##plugins.themes.academic_pro.article.main##

Aymen Noamen
Department of Cardiology, Military hospital of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
Ahmed Ben Amara
Department of Cardiology , Military hospital of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
Houssem Ben AYed
Department of Cardiology , Military hospital of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
Taha Yassine Jabloun
Department of Cardiology, Military hospital of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
Nadhem Hajlaoui
Department of Cardiology , Military hospital of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
Wafa Fehri
Department of Cardiology, Military hospital of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.

Abstract

Introduction: The conventional radial approach (CRA), the gold standard approach for percutaneous coronary interventions (PCI), is associated with the risk of radial artery occlusion (RAO). The distal radial approach (DRA) is an effective alternative with fewer complications.


Aim: To evaluate the efficacy in terms of puncture success and safety by RAO rate of the DRA in elective PCI in Tunisian patients.


Methods: It was a randomized controlled non-inferiority trial including patients hospitalized for elective PCI. The protocol was previously published (Tunis Med 2022; 100(3): 192-202). The primary endpoints were puncture success and RAO rate at 30 days.


Results: Overall, 250 patients were included and the groups were comparable. The preprocedural examination of the radial pulse and the Barbeau test were similar. The majority of PCIs were coronary angiography (82%). In ITT, respectively in CRA versus DRA, puncture success rates were similar (97.6% versus 96.8%; p≤0.500). RAO rates were similar (2.4% versus 3.2%; p≤0.500). Crossovers were similar. PCI through DRA lasted longer but was not more irradiating, however it required more contrast. Overall bleeding and vascular complications were similar.


Conclusion: This study demonstrated the non-inferiority of DRA compared to CRA for elective PCIs in a Tunisian population regarding puncture success and RAO rate at 30 days. Multicenter trials including urgent PCI with systematic ultrasound screening for RAO are needed.

Keywords:

Radial artery, radial approach, anatomical snuff box, coronary angiography, angioplasty, transluminal, percutaneous coronary, safety, efficacy, treatment, Northern Africa, Tunisia

##plugins.themes.academic_pro.article.details##

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

  1. Neumann F-J, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87‑165. DOI: 10.1093/eurheartj/ehy394
  2. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(3):e18‑114. DOI: 10.1161/CIR.0000000000001038
  3. Kotowycz MA, Dzavík V. Radial artery patency after transradial catheterization. Circ Cardiovasc Interv. 2012;5(1):127‑33. DOI: 10.1161/CIRCINTERVENTIONS.111.965871
  4. Markovic S, Imhof A, Kunze M, Rottbauer W, Wöhrle J. Standardized radial approach reduces access site complications: a prospective observational registry. Coron Artery Dis. 2015;26(1):56‑9. DOI: 10.1097/MCA.0000000000000166
  5. Koutouzis M, Kontopodis E, Tassopoulos A, Tsiafoutis I, Katsanou K, Rigatou A, et al. Distal Versus Traditional Radial Approach for Coronary Angiography. Cardiovasc Revasc Med. 2019;20(8):678‑80. DOI: 10.1016/j.carrev.2018.09.018
  6. Vefalı V, Sarıçam E. The Comparison of Traditional Radial Access and Novel Distal Radial Access for Cardiac Catheterization. Cardiovasc Revasc Med. 2020;21(4):496‑500. DOI: 10.1016/j.carrev.2019.07.001
  7. Cao J, Cai H, Liu W, Zhu H, Cao G. Safety and Effectiveness of Coronary Angiography or Intervention through the Distal Radial Access: A Meta-Analysis. J Intervent Cardiol. 2021;2021:4371744. DOI: 10.1155/2021/4371744
  8. Hammami R, Zouari F, Abdessalem MAB, Sassi A, Ellouze T, Bahloul A, et al. Distal radial approach versus conventional radial approach: a comparative study of feasibility and safety. Libyan J Med. Taylor & Francis; 2021;16(1):1830600. DOI: 10.1080/19932820.2020.1830600
  9. Bertrand OF, Larose E, Rodés-Cabau J, Gleeton O, Taillon I, Roy L, et al. Incidence, predictors, and clinical impact of bleeding after transradial coronary stenting and maximal antiplatelet therapy. Am Heart J. janv 2009;157(1):164 9.
  10. Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Researc;h Consortium. Circulation. 14 juin 2011;123(23):2736 47.
  11. Ben Amara A, Noamen A, Anouar Y, Chenik S, Hajlaoui N, Fehri W. Evaluation of the Distal Radial Approach in percutaneous coronary interventions. Controlled, randomized non-inferiority trial. Tunis Med. 2022;100:10.
  12. Ziakas A, Koutouzis M, Didagelos M, Tsiafoutis I, Kouparanis A, Gossios T, et al. Right arm distal transradial (snuffbox) access for coronary catheterization: Initial experience. Hell J Cardiol HJC Hell Kardiologike Epitheorese. 2020;61(2):106‑9. DOI: 10.1016/j.hjc.2018.10.008
  13. Bhambhani A, Pandey S, Nadamani AN, Tyagi K. An observational comparison of distal radial and traditional radial approaches for coronary angiography. J Saudi Heart Assoc. 2020;32(1):17‑24. DOI: 10.37616/2212-5043.1004
  14. Chugh Y, Kanaparthy NS, Piplani S, Chugh S, Shroff A, Vidovich M, et al. Comparison of distal radial access versus standard transradial access in patients with smaller diameter radial Arteries(The distal radial versus transradial access in small transradial ArteriesStudy: D.A.T.A - S.T.A.R study). Indian Heart J. 2021;73(1):26‑34. DOI: 10.1016/j.ihj.2020.11.002
  15. Aminian A, Sgueglia GA, Wiemer M, Kefer J, Gasparini GL, Ruzsa Z, et al. Distal Versus Conventional Radial Access for Coronary Angiography and Intervention: The DISCO RADIAL Trial. JACC Cardiovasc Interv. 2022;15(12):1191‑201. DOI: 10.1016/j.jcin.2022.04.032
  16. Schenke K, Viertel A, Joghetaei N, Prog R, Matthiesen T, Ohm S, et al. Distal Transradial Access for Coronary Angiography and Interventions in Everyday Practice: Data From the TRIANGLE Registry (TwitteR Initiated registry for coronary ANgiography in Germany via distaL radial accEss). Cardiol Ther. 2021;10(1):241‑53. DOI: 10.1007/s40119-021-00218-6
  17. Sharma AK, Razi MM, Prakash N, Sharma A, Sarraf S, Sinha S, et al. A comparative assessment of Dorsal radial artery access versus classical radial artery access for percutaneous coronary angiography-a randomized control trial (DORA trial). Indian Heart J. 2020;72(5):435‑41. DOI: 10.1016/j.ihj.2020.06.002
  18. Coghill EM, Johnson T, Morris RE, Megson IL, Leslie SJ. Radial artery access site complications during cardiac procedures, clinical implications and potential solutions: The role of nitric oxide. World J Cardiol. 2020;12(1):26‑34. DOI: 10.4330/wjc.v12.i1.26
  19. Hage F, Badaoui G, Routledge H, Benamer H, Cheaito R, Monségu J. [Radial artery occlusion ofter coronarography: is it really a problem?]. Ann Cardiol Angeiol (Paris). 2020;69(1):46‑50. DOI: 10.1016/j.ancard.2020.01.006
  20. Bernat I, Aminian A, Pancholy S, Mamas M, Gaudino M, Nolan J, et al. Best Practices for the Prevention of Radial Artery Occlusion After Transradial Diagnostic Angiography and Intervention: An International Consensus Paper. JACC Cardiovasc Interv. 2019;12(22):2235‑46. DOI: 10.1016/j.jcin.2019.07.043
  21. Eid-Lidt G, Rivera Rodríguez A, Jimenez Castellanos J, Farjat Pasos JI, Estrada López KE, Gaspar J. Distal Radial Artery Approach to Prevent Radial Artery Occlusion Trial. JACC Cardiovasc Interv. 2021;14(4):378‑85. DOI: 10.1016/j.jcin.2020.10.013
  22. Bertrand OF, Bernat I. Radial artery occlusion: still the Achille’s heel of transradial approach or is it? Coron Artery Dis. 2015;26(2):97‑8. DOI: 10.1097/MCA.0000000000000229
  23. Lindner SM, McNeely CA, Amin AP. The Value of Transradial: Impact on Patient Satisfaction and Health Care Economics. Interv Cardiol Clin. 2020;9(1):107‑15. DOI: 10.1016/j.iccl.2019.08.004
  24. Lee O-H, Kim Y, Son N-H, Roh JW, Im E, Cho D-K, et al. Comparison of Distal Radial, Proximal Radial, and Femoral Access in Patients with ST-Elevation Myocardial Infarction. J Clin Med. 2021;10(15):3438. DOI: 10.3390/jcm10153438
  25. Kim Y, Bae S, Cho S-G, Shiono Y, Hyun DY, Cho KH, et al. Invasive physiological assessment of myocardial bridge via the left snuffbox approach. Kardiol Pol. 2019;77(9):892‑3. DOI: 10.33963/KP.14916
  26. Noamen A, Ben Amara A, Lajmi M, Hajlaoui N, Fehri W. Simulation versus theoretical learning for the transradial approach: a randomized controlled trial in interventional cardiology. Tunis Med. 2023;101(01):47‑7.