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Clinical experience with distal transradial access for endovascular treatment of various noncoronary interventions in a multicenter study.

ABSTRACT: BACKGROUND:Transradial access is a well-known alternative to conventional transfemoral access for interventional procedures. Recently, transradial access through the "snuffbox", which lies in the radial dorsal aspect of the hand, has been introduced as a new technique with positional versatility. In this study, we aimed to evaluate the clinical feasibility and safety of distal transradial access for interventional procedures in a retrospective, multicenter study. MATERIAL & METHODS:Distal transradial access was attempted in 46 patients (36 men and 10 women; mean age, 64 years) who underwent 47 consecutive procedures from January 2018 to December 2019. Procedures included chemoembolization (19/47, 40.4%), bronchial artery embolization (7/47, 14.9%), renal intervention (3/47, 6.4%), arteriovenous fistula angioplasty (7/47, 14.9%), subclavian artery stenting (5/47, 10.6%), other embolization (5/47, 10.6%), and uterine artery embolization (1/47, 2.1%). We recorded the success rate of the procedures, complications, and postprocedural hemostasis time during the follow-up period. RESULTS:The technical success of distal transradial access without major complications was 97.9% (46/47). Of the 46 patients, one patient (2.2%) had a minor complication, which was a thrombotic segmental occlusion of the distal radial artery. Of the enrolled patients, only one patient did not complete the transradial access procedure via the snuffbox because the left proximal subclavian artery was occluded and a crossover to conventional transfemoral access was performed. The mean postprocedural hemostasis time was 131.7 minutes (range, 120-360 minutes). CONCLUSION:Distal transradial access can be a valid option for the endovascular treatment of various noncoronary interventions with technical feasibility and safety.

SUBMITTER: Park SE

PROVIDER: S-EPMC7444561 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Clinical experience with distal transradial access for endovascular treatment of various noncoronary interventions in a multicenter study.

Park Sung Eun SE Cho Soo Buem SB Baek Hye Jin HJ Moon Jin Il JI Ryu Kyeong Hwa KH Ha Ji Young JY Lee Sangmin S Won Jungho J Ahn Jong-Hwa JH Kim Ran R Choi Sun Young SY

PloS one 20200821 8

<h4>Background</h4>Transradial access is a well-known alternative to conventional transfemoral access for interventional procedures. Recently, transradial access through the "snuffbox", which lies in the radial dorsal aspect of the hand, has been introduced as a new technique with positional versatility. In this study, we aimed to evaluate the clinical feasibility and safety of distal transradial access for interventional procedures in a retrospective, multicenter study.<h4>Material & methods</h ...[more]

PMID: 32822396

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Project description:ObjectiveThe previous meta-analysis has assessed that distal transradial access (dTRA) in anatomical snuffbox is safe and effective for coronary angiography and intervention and can reduce radial artery occlusion. However, since the publication of the previous meta-analysis, several observational studies have been added, so we performed an updated meta-analysis to include more eligible studies to compare distal transradial access in anatomical snuffbox with conventional transradial access (cTRA).MethodPubmed, Embase, and Cochrane Library databases were searched for relevant studies from the literature published until 5 January 2021 to evaluate catheterization/puncture failure, hematoma, radial artery spasm, radial artery occlusion (RAO), access time, fluoroscopy time, radiation dose area product, total procedure time, and hemostatic device removal time. The pooled odds ratio (OR), weighted mean difference (WMD), and standardized mean difference (SMD) with 95% confidence interval (95% CI) were calculated for dichotomous and continuous variables, respectively.ResultsA total of 9,054 patients from 14 studies were included in the meta-analysis, and we found no significant difference in catheterization/puncture failure (OR = 1.94, 95CI [0.97, 3.86], P=0.06), hematoma (OR = 0.97, 95CI [0.55, 1.73], P=0.926), radial artery spasm (OR = 0.76, 95CI [0.43, 1.36], P=0.354), total procedure time (SMD = 0.23, 95CI [-0.21, 0.68], P=0.308), or radiation dose area product (WMD = 216.88 Gy/cm2, 95CI [-126.24, 560.00], P=0.215), but dTRA had a lower incidence of RAO (OR = 0.39, 95CI [0.23, 0.66], P < 0.001), shorter hemostatic device removal time (WMD = -66.62 min, 95CI [-76.68, -56.56], P < 0.001), longer access time (SMD = 0.32, 95CI [0.08, 0.56], P=0.008), and longer fluoroscopy time (SMD = 0.16, 95CI [-0.00, 0.33], P=0.05) than cTRA.ConclusionCompared with the cTRA, the dTRA has a lower incidence of radial artery occlusion and shorter hemostatic device removal time, which is worthy of further evaluation in clinical practice.

Project description:BackgroundDistal transradial access (dTRA) has been suggested to have great advantages over cTRA. However, there is a lack of preliminary data on dTRA in patients undergoing emergency coronary angiography (CAG) or percutaneous coronary intervention (PCI). To explore the feasibility and safety of distal transradial access in patients with acute chest pain.MethodsA total of 1269 patients complaining of acute chest pain in our emergency department from January 2020 to February 2022 were retrospectively included. The patients who met the inclusion criteria were divided into the conventional transradial access (cTRA) group (n = 238) and the dTRA group (n = 158). Propensity score matching was used to minimize the baseline differences.ResultsThe cannulation success rate in the dTRA group was significantly lower than that in the cTRA group (87.41% vs. 94.81%, p < 0.05). No significant differences in the puncture time and total procedure time were noted between the two groups (p > 0.05). Compared with the cTRA group, the hemostasis duration was significantly shorter [4(4, 4) h vs. 10(8, 10) h, p < 0.001) and the incidence of minor bleeding (BARC Type I and II) was significantly lower in the dTRA group than that in the cTRA group (0.85% vs. 5.48%, p = 0.045). Asymptomatic radial artery occlusion was observed in six patients (5.83%) in the cTRA group and one patient (1.14%) in the dTRA group (p = 0.126). The subgroup analysis of ST-elevation myocardial infarction (STEMI) showed no significant differences in the puncture time, D-to-B time or total procedure time between the two groups.ConclusionsThe dTRA for emergency CAG or PCI has an acceptable success rate and puncture time, a shorter hemostasis time, and a downward trend in RAO rate compared to the cTRA. The dTRA did not increase the D-to-B time in emergency coronary interventions in STEMI patients. On the contrary, a low incidence of RAO by the dTRA created an opportunity for future coronary interventions in non-culprit vessels in the same access.Trial registrationRetrospectively registered in Chinese Clinical Trial Registry (registry number: ChiCTR2200061104, date of registration: June 15, 2022).

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Clinical experience with distal transradial access for endovascular treatment of various noncoronary interventions in a multicenter study.

Publications

Clinical experience with distal transradial access for endovascular treatment of various noncoronary interventions in a multicenter study.

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