Distal radial access as an alternative to conventional radial access in coronary angiography and percutaneous coronary interventions

Aim . To evaluate immediate and medium-term (3 months) results of safety and effectiveness of distal versus proximal radial access for coronary interventions. Material and methods . An analysis of 776 patients of the prospective randomized TENDERA trial was performed: distal radial access (DRA) group — 1391 patients; proximal radial access (PRA) group — 385 patients. After excluding patients with failed primary access, the primary sample sizes decreased (DRA — 371, PRA — 382). Access-site crossover rate was statistically higher in the DRA group (5,1% and 0,8%, p<0,001). The primary endpoint was immediate (inhospital) or long-term radial artery (RA) thrombosis/occlusion. There were following secondary endpoints: 1 — composite endpoint including complications from the access artery; 2 — access parameters. Results . Significant differences were obtained for the primary endpoint: DRA 2,7% (n=10), PRA 6,8% (n=26), p=0,008. Distal RA occlusion with patent RA: DRA: 1,3% (n=5), PRA: 0 (n=0), p=0,023. The secondary composite point showed significant differences in the following groups of complications: BARC type I bleeding (DRA: 3,8% (n=14), PRA: 21,7% (n=83), p<0,001); hematoma >5 cm on day 1 (DRA: 10% (n=37), PRA: 25,9% (n=98), p<0,001); hematoma >5 cm on day 7 (DRA: 12,4% (n=45), PRA: 34,6% (n=132), p<0,001). The following access parameters showed significant differences: distal RA puncture time — 19,0 (8,0; 50), proximal RA puncture time — 13,5 (5,0; 29), p<0,001; introducer insertion by DRA 42,0 (26,0; 84,0), PRA 35,0 (23,0; 55,0), p<0,001; duration of access artery hemostasis (min): DRA 180,0 (120,0; 480,0), PRA 155,0 (115,0; 195,0), p<0,001. Duration of the procedure and fluoroscopy, radiation dose, and RA spasm in both groups did not have significant differences. Conclusion . In the TENDERA study, DRA demonstrated efficacy and safety in interventional coronary procedures compared to PRA in the mid-term follow-up period — significantly lower incidence of RA occlusions and local complications.