Switching From Proximal to Distal Radial Artery Access for Coronary Chronic Total Occlusion Recanalization

Alexandru Achim; Tímea Szigethy; Dorottya Olajos; Levente Molnár; Roland Papp; György Bárczi; Kornél Kákonyi; István F Édes; Dávid Becker; Béla Merkely; Jef Van den Eynde; Zoltán Ruzsa

doi:10.3389/fcvm.2022.895457

Switching From Proximal to Distal Radial Artery Access for Coronary Chronic Total Occlusion Recanalization

Front Cardiovasc Med. 2022 May 9:9:895457. doi: 10.3389/fcvm.2022.895457. eCollection 2022.

Authors

Affiliations

¹ Division of Invasive Cardiology, Internal Medicine Department, University of Szeged, Szeged, Hungary.
² "Niculae Stancioiu" Heart Institute, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
³ Cardiac and Vascular Center, Semmelweis University, Budapest, Hungary.
⁴ Bács-Kiskun County Hospital, Teaching Hospital of the Szent-Györgyi Albert Medical University, Kecskemét, Hungary.
⁵ Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.

Abstract

Background: Distal radial access (DRA) was recently introduced in the hopes of improving patient comfort by allowing the hand to rest in a more ergonomic position throughout percutaneous coronary interventions (PCI), and potentially to further reduce the rate of complications (mainly radial artery occlusion, [RAO]). Its safety and feasibility in chronic total occlusion (CTO) PCI have not been thoroughly explored, although the role of DRA could be even more valuable in these procedures.

Methods: From 2016 to 2021, all patients who underwent CTO PCI in 3 Hungarian centers were included, divided into 2 groups: one receiving proximal radial access (PRA) and another DRA. The primary endpoints were the procedural and clinical success and vascular access-related complications. The secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE) and procedural characteristics (volume of contrast, fluoroscopy time, radiation dose, procedure time, hospitalization time).

Results: A total of 337 consecutive patients (mean age 64.6 ± 9.92 years, 72.4% male) were enrolled (PRA = 257, DRA = 80). When compared with DRA, the PRA group had a higher prevalence of smoking (53.8% vs. 25.7%, SMD = 0.643), family history of cardiovascular disease (35.0% vs. 15.2%, SMD = 0.553), and dyslipidemia (95.0% vs. 72.8%, SMD = 0.500). The complexity of the CTOs was slightly higher in the DRA group, with higher degrees of calcification and tortuosity (both SMD >0.250), more bifurcation lesions (45.0% vs. 13.2%, SMD = 0.938), more blunt entries (67.5% vs. 47.1%, SMD = 0.409). Contrast volumes (median 120 ml vs. 146 ml, p = 0.045) and dose area product (median 928 mGy×cm² vs. 1,300 mGy×cm², p < 0.001) were lower in the DRA group. Numerically, local vascular complications were more common in the PRA group, although these did not meet statistical significance (RAO: 2.72% vs. 1.25%, p = 0.450; large hematoma: 0.72% vs. 0%, p = 1.000). Hospitalization duration was similar (2.5 vs. 3.0 days, p = 0.4). The procedural and clinical success rates were comparable through DRA vs. PRA (p = 0.6), moreover, the 12-months rate of MACCE was similar across the 2 groups (9.09% vs. 18.2%, p = 0.35).

Conclusion: Using DRA for complex CTO interventions is safe, feasible, lowers radiation dose and makes dual radial access more achievable. At the same time, there was no signal of increased risk of periprocedural or long-term adverse outcomes.

Keywords: CTO; chronic total occlusion; distal radial access; proximal radial access; radial artery occlusion; radiation dose; snuffbox approach.