A comparative study on the efficacy and safety of the distal transradial access and conventional transradial access in primary percutaneous coronary intervention

Santhosh KS, Ravi M, Unni TG, Benjamin B, Cenchery PK

Pdf Page Numbers :- 59-65

Santhosh KS¹, Manoj Ravi^1,*, Govindan Unni T¹, Bino Benjamin¹ and Prasanna Kumar Cenchery¹

¹Department of Cardiology, Jubilee Mission Medical College & Research Institute, Thrissur, Kerala, India, 680005

*Corresponding author: Dr. Manoj Ravi, Associate Professor, Department of Cardiology, Jubilee Mission Medical College & Research Institute, Thrissur, India. Email: drmanojravicardio@gmail.com.

Received 7 October 2024; Revised 25 November 2024; Accepted 3 December 2024; Published 11 December 2024

Citation: Santhosh KS, Ravi M, Unni TG, Benjamin B, Cenchery PK. A comparative study on the efficacy and safety of the distal transradial access and conventional transradial access in primary percutaneous coronary intervention. J Med Sci Res. 2025; 13(1):59-65. DOI: http://dx.doi.org/10.17727/JMSR.2024/13-11

Copyright: © 2025 Santhosh KS et al. Published by KIMS Foundation and Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Introduction: Distal transradial access (dTRA) in anatomical snuff box has advantages over the conventional transradial access at wrist (wTRA). There is limited data of dTRA in primary Percutaneous Coronary Intervention (PCI). The objective was to study the efficacy and safety of dTRA as compared to wTRA in primary percutaneous coronary intervention.

Methods: 100 patients undergoing primary PCI were randomly allocated into dTRA and wTRA groups with 50 each in a group. The procedural characteristics and complications were comparatively analyzed.

Results: Access success in dTRA group was 86% vs 100% in wTRA (p-0.012). Access crossover from dTRA to wTRA was 14%. Overall higher puncture attempts were needed in dTRA group (p<0.001). First attempt success in dTRA was 46% vs 80% in wTRA (p<0.001). Median puncture attempts in both groups was ‘one’. Mean puncture time (73.56±55.52 sec vs 30.06±16.79 sec, p<0.001) and mean access time (94.95±60.02 sec vs 45.7±17.96 sec, p<0.001) were higher in dTRA group. 6F introducer sheaths used in all cases in both groups. In both the groups mean total procedure time, fluoroscopy time and dose area product (DAP) were similar. Lower incidence of hematoma was noted in dTRA group (4.7% vs 14%) (p-0.169).

Conclusion: dTRA offers to be a promising alternative with better ergonomics and lower vascular complications in Acute Coronary Syndromes (ACS). Access time has a learning curve effect, which can ease with experience.

Keywords: anatomical snuff box; conventional transradial access; distal transradial access; primary percutaneous; coronary intervention