AUTHOR=Wang Yujie , Liu Zijing , Wu Yongxia , Li Zixuan , Wang Yuntao , Wang Senhu , Xu Rong , Zhang Libin , Wang Yuping , Guo Jincheng 

TITLE=Early prevention of radial artery occlusion via distal transradial access for primary percutaneous coronary intervention

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1071575

DOI=10.3389/fcvm.2022.1071575

ISSN=2297-055X

ABSTRACT=Background: Conventional transradial access (TRA) has been the preferred access for coronary intervention. Recently, distal radial access (DRA) is introduced as an alternative choice to reduce radial artery occlusion (RAO) risk. The study sought to assess the impact of DRA on early RAO using Doppler ultrasound in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). 
Methods: This is a prospective, single-center, open-label randomized clinical trial in which patients with indications for primary PCI from January 2022 to September 2022 were assigned to DRA or TRA group with 100 cases in each group. The primary endpoint was the incidence of forearm RAO, evaluated by Doppler ultrasound before discharge. 
Results: The rate of access success was comparable between the DRA and TRAgroups (98% vs 94%, P=0.279). Compared with the TRA group, longer puncture time was observed in the DRA group [2.4(1.7~4.2) min vs 1.7(1.4~2.3) min; P<0.001] whereas the door-to-wire time was not delayed in primary PCI [71(54~88)min vs 64(56~82)min, P=0.103]. Shorter hemostasis time was required in the DRA group [3.1(2.7~3.3)h vs. 6.2(5.9~6.4)h; P<0.001]. Significant reduction of the incidence of forearm RAO was observed in the DRA group (2.0% vs. 9.0%, P=0.030). Local hematomas ≤5 cm was similar in both groups (4.0 vs. 6.0%, P=0516), while those >5 cm were significantly more frequent in the TRA group (0 vs. 6.0%, P=0.029). 
Conclusion: DRA is associated with a comparable lower incidence of forearm RAO, shorter hemostasis time, and lower rate of vascular complications compared toTRA.