Distal Versus Conventional Radial Access for Coronary Angiography and Intervention

桡动脉 医学 止血 前臂 随机对照试验 经皮冠状动脉介入治疗 交叉研究 外科 传统PCI 心脏病学 内科学 心肌梗塞 动脉 安慰剂 病理 替代医学
作者
Adel Aminian,Gregory A. Sgueglia,Marcus Wiemer,Joëlle Kefer,Gabriele Gasparini,Zoltán Ruzsa,Maarten A.H. van Leeuwen,Claudiu Ungureanu,Gregor Leibundgut,Bert Vandeloo,Saško Kedev,Ivo Bernát,Karim Ratib,Juan F. Iglesias,Elias Al Hage,Giuseppe A. POSTERARO,Dan Pascut,Frédéric Maes,Damiano Regazzoli,Kornél Kákonyi,Thomas A. Meijers,Giuseppe Colletti,Lian Krivoshei,Stijn Lochy,Biljana Zafirovska,David Hořák,James Nolan,Sophie Degrauwe,Kazuki Tobita,Shigeru Saito
出处
期刊:Jacc-cardiovascular Interventions [Elsevier BV]
卷期号:15 (12): 1191-1201 被引量:77
标识
DOI:10.1016/j.jcin.2022.04.032
摘要

Currently, transradial access (TRA) is the recommended access for coronary procedures because of increased safety, with radial artery occlusion (RAO) being its most frequent complication, which will increasingly affect patients undergoing multiple procedures during their lifetimes. Recently, distal radial access (DRA) has emerged as a promising alternative access to minimize RAO risk. A large-scale, international, randomized trial comparing RAO with TRA and DRA is lacking. The aim of this study was to assess the superiority of DRA compared with conventional TRA with respect to forearm RAO. DISCO RADIAL (Distal vs Conventional Radial Access) was an international, multicenter, randomized controlled trial in which patients with indications for percutaneous coronary procedure using a 6-F Slender sheath were randomized to DRA or TRA with systematic implementation of best practices to reduce RAO. The primary endpoint was the incidence of forearm RAO assessed by vascular ultrasound at discharge. Secondary endpoints include crossover, hemostasis time, and access site–related complications. Overall, 657 patients underwent TRA, and 650 patients underwent DRA. Forearm RAO did not differ between groups (0.91% vs 0.31%; P = 0.29). Patent hemostasis was achieved in 94.4% of TRA patients. Crossover rates were higher with DRA (3.5% vs 7.4%; P = 0.002), and median hemostasis time was shorter (180 vs 153 minutes; P < 0.001). Radial artery spasm occurred more with DRA (2.7% vs 5.4%; P = 0.015). Overall bleeding events and vascular complications did not differ between groups. With the implementation of a rigorous hemostasis protocol, DRA and TRA have equally low RAO rates. DRA is associated with a higher crossover rate but a shorter hemostasis time.
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