A preliminary analysis of a prospective multicenter randomized controlled study of the efficacy and safety on traditional and distal radial access in interventional cardiology


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Abstract

Background: Despite the obvious advantages of transradial access and its widespread use, there are technical problems that force interventional surgeons to improve the methods of endovascular interventions. Aims: to analyze the effectiveness and safety of distal and traditional radial access for endovascular interventions. Methods: The study included 282 patients who underwent an endovascular intervention with distal radial access (DRA, 139 patients) or traditional radial access (TRA, 143 patients). The study is registered at www.clinicaltrials.gov, NCT04211584. Results: The median diameter of the radial artery in its proximal part, i.e. at the site of TRA, was 2.5 mm [Q1; Q3: 2.27; 2.8], in the DRA group the median was 2.28 mm [Q1; Q3: 2.06; 3.56], p <0.0001. We noted statistically significant differences in the duration of puncture (p=0.0215), but not in the duration of the introducer insertion, catheterization of the coronary artery, fluoroscopy, the total time of intervention, the dose of ionizing radiation. In total, 28 complications developed (9.9% of 282): 14 in each of the groups in one year after the intervention. Two (0.7% of 282) patients developed bleeding [1 (0.7% of 139) — DRA, 1 (0.7% of 143) — TRA], 5 (1.8% of 282) — radial artery dissection [2 (1.4% of 139) — DRA, 3 (2.1% of 143) — TRA], 9 (3.2% of 282) — puncture failure [7 (5% of 139) — DRA, 2 (1.4% of 143) — TRA], 4 (1.4% of 282) — radial artery perforation [2 (1.4% of 139) — DRA, 2 (1.4% of 143) — TRA], 7 (2.5% of 282) — hematoma more than 5 cm [2 (1.4% of 139) — DRA, 5 (3.5% of 143) — TRA], 1 (0.4% of 282) — radial artery thrombosis [(0.7% of 143) TRA]. The risk of complications did not depend on the type of access. Conclusions: Distal and traditional radial access do not differ in their efficiency and safety. At the same time, we noted a certain tendency to a longer puncture of the radial artery with distal radial access compared to the traditional one, which is due to the smaller diameter of the radial artery.

About the authors

Dmitry S. Kartashov

Center of Endosurgery and Lithotripsy; Moscow Regional Research and Clinical Institute

Author for correspondence.
Email: dima.kartashov@gmail.com
ORCID iD: 0000-0002-9932-4106
Russian Federation, Moscow; Moscow

Avtandil M. Babunashvili

Center of Endosurgery and Lithotripsy; The First Sechenov Moscow State Medical University (Sechenov University)

Email: avtandil.babunashvili@gmail.com
ORCID iD: 0000-0003-2269-7059

MD, PhD

Russian Federation, Moscow; Moscow

Dmitry V. Shumakov

Moscow Regional Research and Clinical Institute

Email: sdvtranspl@rambler.ru
ORCID iD: 0000-0003-4204-8865
SPIN-code: 5678-0839

MD, PhD, Corresponding Member of the Russian Academy of Sciences, Head of the Department

Russian Federation, Moscow

Alexander V. Korotkikh

Surgery Clinic of the Amur State Medical Academy

Email: ssemioo@rambler.ru
ORCID iD: 0000-0002-9709-1097
Russian Federation, Blagoveshchensk

Alexander L. Kaledin

I.I. Mechnikov North-Western State Medical University

Email: alkaledin@mail.ru
ORCID iD: 0000-0003-0581-6132

MD, PhD

Russian Federation, Saint Petersburg

Vladislav V. Derkach

Clinic of Innovative Surgery

Email: derkachvlad@rambler.ru
ORCID iD: 0000-0002-0367-3628
Russian Federation, Klin

Roman M. Portnov

Clinic of Innovative Surgery

Email: portnov182@gmail.com
ORCID iD: 0000-0001-5360-3815
Russian Federation, Klin

Ruslan V. Ahramovich

Center for Interventional Cardioangiology

Email: russlann2908@rambler.ru
ORCID iD: 0000-0002-0026-6998
Russian Federation, Moscow

Alexey B. Zulkarnaev

Moscow Regional Research and Clinical Institute

Email: 7059899@gmail.com
ORCID iD: 0000-0001-5405-7887
SPIN-code: 3752-8070

MD, PhD, Assistant Professor

Russian Federation, Moscow

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Copyright (c) Kartashov D., Shumakov D., Babunashvili A., Korotkih A., Kaledin A., Derkach V., Portnov R., Ahramovich R., Zulkarnaev A.

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