A preliminary analysis of a prospective multicenter randomized controlled study of the efficacy and safety on traditional and distal radial access in interventional cardiology

Background: Despite the obvious advantages of transradial access and its widespread use, there are technical problems that force interventional surgeons to improve the methods of endovascular interventions. Aims: to analyze the effectiveness and safety of distal and traditional radial access for endovascular interventions. Methods: The study included 282 patients who underwent an endovascular intervention with distal radial access (DRA, 139 patients) or traditional radial access (TRA, 143 patients). The study is registered at www.clinicaltrials.gov, NCT04211584. Results: The median diameter of the radial artery in its proximal part, i.e. at the site of TRA, was 2.5 mm [Q1; Q3: 2.27; 2.8], in the DRA group the median was 2.28 mm [Q1; Q3: 2.06; 3.56], p <0.0001. We noted statistically significant differences in the duration of puncture (p=0.0215), but not in the duration of the introducer insertion, catheterization of the coronary artery, fluoroscopy, the total time of intervention, the dose of ionizing radiation. In total, 28 complications developed (9.9% of 282): 14 in each of the groups in one year after the intervention. Two (0.7% of 282) patients developed bleeding [1 (0.7% of 139) — DRA, 1 (0.7% of 143) — TRA], 5 (1.8% of 282) — radial artery dissection [2 (1.4% of 139) — DRA, 3 (2.1% of 143) — TRA], 9 (3.2% of 282) — puncture failure [7 (5% of 139) — DRA, 2 (1.4% of 143) — TRA], 4 (1.4% of 282) — radial artery perforation [2 (1.4% of 139) — DRA, 2 (1.4% of 143) — TRA], 7 (2.5% of 282) — hematoma more than 5 cm [2 (1.4% of 139) — DRA, 5 (3.5% of 143) — TRA], 1 (0.4% of 282) — radial artery thrombosis [(0.7% of 143) TRA]. The risk of complications did not depend on the type of access. Conclusions: Distal and traditional radial access do not differ in their efficiency and safety. At the same time, we noted a certain tendency to a longer puncture of the radial artery with distal radial access compared to the traditional one, which is due to the smaller diameter of the radial artery.