Marcos Danillo Oliveira1,2, Ednelson C Navarro2, Adriano Caixeta1,3. 1. Discipline of Cardiology, Interventional Cardiology Unit, Hospital Universitário I, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil. 2. Department of Interventional Cardiology, Hospital Regional do Vale do Paraíba, Taubaté, Brazil. 3. Hospital Israelita Albert Einstein, São Paulo, Brazil.
Abstract
Background: Distal transradial access (dTRA) as an improvement of the traditional transradial approach has several potential advantages including operator and patient comfort, faster hemostasis, and lower risk of proximal radial artery occlusion (RAO). We aim to describe our real-world experience with dTRA as default approach for routine coronary angiography and percutaneous coronary interventions (PCI) in a broad and prospective cohort of all-comers patients. Methods: In the DISTRACTION registry, a total of 3,683 consecutive all-comers patients who underwent coronary procedures via dTRA were included. Results: The mean patient age was 63.3±13.5-year-old, 66.1% were male, 39.7% had diabetes, and 50.2% presented with acute coronary syndromes (ACS). Overall, 20% of patients had non-ST-elevation myocardial infarction (NSTEMI), 22.9% had ST-elevation myocardial infarction (STEMI), and 2.6% presented in cardiogenic shock. There were 2.5% access site crossovers, 16% of those were performed via contralateral dTRA; thus, in only 77 (2.1%) patients dTRA sheath insertion could not be obtained. Right dTRA (rdTRA) was the most frequent access (80.2%), followed by redo ipsilateral dTRA (10.5%), left dTRA (ldTRA) (8.6%) and simultaneous bilateral dTRA (0.7%). PCI was performed in 60.4% of all cases, and left anterior descending was the most treated vessel (29%). No access site-related hematoma type ≥2, according to EASY classification was recorded. No hand/thumb dysfunction after any procedure was documented. One patient developed a pseudoaneurysm, and one had guidewire-induced forearm radial artery perforation. There were neither major complications nor major adverse cerebrovascular and cardiac events directly related to dTRA. Conclusions: In this large, prospective, all-commers patients registry the adoption of dTRA as standard for routine coronary interventions appears to be safe and feasible. 2022 Cardiovascular Diagnosis and Therapy. All rights reserved.
Background: Distal transradial access (dTRA) as an improvement of the traditional transradial approach has several potential advantages including operator and patient comfort, faster hemostasis, and lower risk of proximal radial artery occlusion (RAO). We aim to describe our real-world experience with dTRA as default approach for routine coronary angiography and percutaneous coronary interventions (PCI) in a broad and prospective cohort of all-comers patients. Methods: In the DISTRACTION registry, a total of 3,683 consecutive all-comers patients who underwent coronary procedures via dTRA were included. Results: The mean patient age was 63.3±13.5-year-old, 66.1% were male, 39.7% had diabetes, and 50.2% presented with acute coronary syndromes (ACS). Overall, 20% of patients had non-ST-elevation myocardial infarction (NSTEMI), 22.9% had ST-elevation myocardial infarction (STEMI), and 2.6% presented in cardiogenic shock. There were 2.5% access site crossovers, 16% of those were performed via contralateral dTRA; thus, in only 77 (2.1%) patients dTRA sheath insertion could not be obtained. Right dTRA (rdTRA) was the most frequent access (80.2%), followed by redo ipsilateral dTRA (10.5%), left dTRA (ldTRA) (8.6%) and simultaneous bilateral dTRA (0.7%). PCI was performed in 60.4% of all cases, and left anterior descending was the most treated vessel (29%). No access site-related hematoma type ≥2, according to EASY classification was recorded. No hand/thumb dysfunction after any procedure was documented. One patient developed a pseudoaneurysm, and one had guidewire-induced forearm radial artery perforation. There were neither major complications nor major adverse cerebrovascular and cardiac events directly related to dTRA. Conclusions: In this large, prospective, all-commers patients registry the adoption of dTRA as standard for routine coronary interventions appears to be safe and feasible. 2022 Cardiovascular Diagnosis and Therapy. All rights reserved.
Authors: Olivier F Bertrand; Robert De Larochellière; Josep Rodés-Cabau; Guy Proulx; Onil Gleeton; Can Manh Nguyen; Jean-Pierre Déry; Gérald Barbeau; Bernard Noël; Eric Larose; Paul Poirier; Louis Roy Journal: Circulation Date: 2006-12-04 Impact factor: 29.690
Authors: Ivo Bernat; Adel Aminian; Samir Pancholy; Mamas Mamas; Mario Gaudino; James Nolan; Ian C Gilchrist; Shigeru Saito; George N Hahalis; Antonio Ziakas; Yves Louvard; Gilles Montalescot; Gregory A Sgueglia; Maarten A H van Leeuwen; Avtandil M Babunashvili; Marco Valgimigli; Sunil V Rao; Olivier F Bertrand Journal: JACC Cardiovasc Interv Date: 2019-11-25 Impact factor: 11.195