Photo Credit: Mr. Suphachai Praserdumrongchai

The following is a summary of “Distal Vs. Proximal Radial Arterial Access For Percutaneous Coronary Angiography and Intervention: Updated Meta-Analysis Of Randomized Controlled Trials,” published in the March 2024 issue of Cardiology by Mufarrih et al.

Researchers conducted a retrospective study and a meta-analysis of randomized controlled trials (RCTs) to compare the incidence of radial artery occlusion (RAO) and access site-related complications between the Proximal trans-radial access (p-TRA) and Distal trans-radial access (d-TRA) approaches.

They systematically searched PubMed, Web of Science, and Google Scholar for RCTs published from 2017 to October 2023, comparing d-TRA and p-TRA approaches for coronary angiography and intervention. Risk ratios (RR) and mean differences (MDs) with 95% confidence intervals were computed using a random-effects model to analyze procedural and clinical outcomes associated with both approaches.

The results showed that in the comparison between d-TRA and p-TRA, there were 18 RCTs involving 8,205 patients (d-TRA: n=4,096; p-TRA: n=4,109). The risk of RAO was significantly lower in the d-TRA group (RR: 0.31 [0.21, 0.46], P=<0.001), as was the time to hemostasis (minutes) (MD: -51.18 [-70.62, -31.73], P<0.001). The d-TRA group had higher rates of cross-over (RR: 2.39 [1.71, 3.32], P<0.001), longer access time (MD: 0.93 [0.50, 1.37], P<0.001), more procedural pain (MD: 0.46 [0.13, 0.79], P=0.006), and increased likelihood of multiple puncture attempts (RR: 2.13 [1.10, 4.11], P=0.03).

Compared to other approaches, investigators concluded that d-TRA shows promise in reducing forearm RAO risk and potentially preserving p-TRA for future interventions in select patients.

Source: ajconline.org/article/S0002-9149(24)00156-5/abstract#%20