Distal Transradial Access in Anatomical Snuffbox for Coronary Angiography and Intervention: An Updated Meta-Analysis

Chendi Liang, Qinghua Han, Yongping Jia, Chunyu Fan, Gang Qin, Chendi Liang, Qinghua Han, Yongping Jia, Chunyu Fan, Gang Qin

Abstract

Objective: The previous meta-analysis has assessed that distal transradial access (dTRA) in anatomical snuffbox is safe and effective for coronary angiography and intervention and can reduce radial artery occlusion. However, since the publication of the previous meta-analysis, several observational studies have been added, so we performed an updated meta-analysis to include more eligible studies to compare distal transradial access in anatomical snuffbox with conventional transradial access (cTRA).

Method: Pubmed, Embase, and Cochrane Library databases were searched for relevant studies from the literature published until 5 January 2021 to evaluate catheterization/puncture failure, hematoma, radial artery spasm, radial artery occlusion (RAO), access time, fluoroscopy time, radiation dose area product, total procedure time, and hemostatic device removal time. The pooled odds ratio (OR), weighted mean difference (WMD), and standardized mean difference (SMD) with 95% confidence interval (95% CI) were calculated for dichotomous and continuous variables, respectively.

Results: A total of 9,054 patients from 14 studies were included in the meta-analysis, and we found no significant difference in catheterization/puncture failure (OR = 1.94, 95CI [0.97, 3.86], P=0.06), hematoma (OR = 0.97, 95CI [0.55, 1.73], P=0.926), radial artery spasm (OR = 0.76, 95CI [0.43, 1.36], P=0.354), total procedure time (SMD = 0.23, 95CI [-0.21, 0.68], P=0.308), or radiation dose area product (WMD = 216.88 Gy/cm2, 95CI [-126.24, 560.00], P=0.215), but dTRA had a lower incidence of RAO (OR = 0.39, 95CI [0.23, 0.66], P < 0.001), shorter hemostatic device removal time (WMD = -66.62 min, 95CI [-76.68, -56.56], P < 0.001), longer access time (SMD = 0.32, 95CI [0.08, 0.56], P=0.008), and longer fluoroscopy time (SMD = 0.16, 95CI [-0.00, 0.33], P=0.05) than cTRA.

Conclusion: Compared with the cTRA, the dTRA has a lower incidence of radial artery occlusion and shorter hemostatic device removal time, which is worthy of further evaluation in clinical practice.

Conflict of interest statement

The authors declare no conflicts of interest.

Copyright © 2021 Chendi Liang et al.

Figures

Figure 1
Figure 1
Flow chart of the search process.
Figure 2
Figure 2
(a) Forest plot of catheterization/puncture failure for dTRA compared to cTRA. (b) Egger test was used to quantitatively assess publication bias in catheterization/puncture failure (P=0.015). (c) Trim and fill funnel plot showed that no new studies were added.
Figure 3
Figure 3
(a) Forest plot of hematoma for dTRA compared to cTRA. (b) Egger test was used to quantitatively assess publication bias in hematoma (P=0.004). (c) Trim and fill funnel plot showed that no new studies were added.
Figure 4
Figure 4
Forest plot of radial artery spasm for dTRA compared to cTRA.
Figure 5
Figure 5
Forest plot of radial artery occlusion for dTRA compared to cTRA.
Figure 6
Figure 6
Forest plot of access time for dTRA compared to cTRA.
Figure 7
Figure 7
Forest plot of fluoroscopy time for dTRA compared to cTRA.
Figure 8
Figure 8
Forest plot of radiation dose area product for dTRA compared to cTRA.
Figure 9
Figure 9
Forest plot of total procedure time for dTRA compared to cTRA.
Figure 10
Figure 10
Forest plot of hemostatic device removal time for dTRA compared to cTRA.

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Source: PubMed

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