International Journal of Cardiovascular Sciences. 21/out/2024;37:e20240084.

Distal Transradial Access for Coronary Procedures: Insights from 6,800 Consecutive All-Comers Patients from the DISTRACTION Registry

Marcos Danillo Oliveira , Ricardo Fonseca Oliveira Suruagy Motta , Adriano Caixeta

DOI: 10.36660/ijcs.20240084

Abstract

Background:

Distal transradial access (dTRA), an improvement of the conventional proximal transradial access (pTRA), has advantages in terms of faster hemostasis and lower rates of proximal radial artery occlusion (RAO).

Objectives:

We aim to describe our real-world experience with dTRA as the default approach for routine coronary angiography and percutaneous coronary interventions (PCI) in a large-scale sample of all-comers patients.

Methods:

From February 2019 to April 2024, 6,800 consecutive patients undergoing coronary procedures via dTRA were enrolled in the DISTRACTION (DIStal TRAnsradial access as default approach for Coronary angiography and intervenTIONs) Registry.

Results:

Mean patient age was 63.8 ± 15.7 years; 65% were male. Overall, 20.8% of patients had non-ST-elevation myocardial infarction (NSTEMI); 22.3% had ST-elevation myocardial infarction (STEMI), and 2.5% presented in cardiogenic shock. There were only 2% access site crossovers, mainly to ipsilateral pTRA. In only 119 patients dTRA sheath insertion could not be obtained. Right dTRA was the most frequent access, followed by redo ipsilateral dTRA, left dTRA, and simultaneous bilateral dTRA. PCI was performed in 59.5% of all cases, and the left anterior descending artery was the most treated vessel. No significant access site-related bleeding and no hand/thumb dysfunction after any procedure were documented. There were neither major complications nor major adverse cerebrovascular and cardiac events directly related to dTRA.

Conclusions:

In this real-world large-scale registry of all-comers patients, the adoption of dTRA by proficient operators as the default for routine coronary angiography and interventions was safe and feasible.