Distal Versus Conventional Radial Access for Coronary Angiography and Intervention: The DISCO RADIAL Trial
Adel Aminian, Gregory A Sgueglia, Marcus Wiemer, Joëlle Kefer, Gabriele L Gasparini, Zoltan Ruzsa, Maarten A H van Leeuwen, Claudiu Ungureanu, Gregor Leibundgut, Bert Vandeloo, Sasko Kedev, Ivo Bernat, Karim Ratib, Juan F Iglesias, Elias Al Hage, Giuseppe A Posteraro, Dan Pascut, Frederic Maes, Damiano Regazzoli, Kornél Kakonyi, Thomas A Meijers, Giuseppe Colletti, Lian Krivoshei, Stijn Lochy, Biljana Zafirovska, David Horák, James Nolan, Sophie Degrauwe, Kazuki Tobita, Shigeru Saito, Adel Aminian, Gregory A Sgueglia, Marcus Wiemer, Joëlle Kefer, Gabriele L Gasparini, Zoltan Ruzsa, Maarten A H van Leeuwen, Claudiu Ungureanu, Gregor Leibundgut, Bert Vandeloo, Sasko Kedev, Ivo Bernat, Karim Ratib, Juan F Iglesias, Elias Al Hage, Giuseppe A Posteraro, Dan Pascut, Frederic Maes, Damiano Regazzoli, Kornél Kakonyi, Thomas A Meijers, Giuseppe Colletti, Lian Krivoshei, Stijn Lochy, Biljana Zafirovska, David Horák, James Nolan, Sophie Degrauwe, Kazuki Tobita, Shigeru Saito
Abstract
Background: Currently, transradial access (TRA) is the recommended access for coronary procedures because of increased safety, with radial artery occlusion (RAO) being its most frequent complication, which will increasingly affect patients undergoing multiple procedures during their lifetimes. Recently, distal radial access (DRA) has emerged as a promising alternative access to minimize RAO risk. A large-scale, international, randomized trial comparing RAO with TRA and DRA is lacking.
Objectives: The aim of this study was to assess the superiority of DRA compared with conventional TRA with respect to forearm RAO.
Methods: DISCO RADIAL (Distal vs Conventional Radial Access) was an international, multicenter, randomized controlled trial in which patients with indications for percutaneous coronary procedure using a 6-F Slender sheath were randomized to DRA or TRA with systematic implementation of best practices to reduce RAO. The primary endpoint was the incidence of forearm RAO assessed by vascular ultrasound at discharge. Secondary endpoints include crossover, hemostasis time, and access site-related complications.
Results: Overall, 657 patients underwent TRA, and 650 patients underwent DRA. Forearm RAO did not differ between groups (0.91% vs 0.31%; P = 0.29). Patent hemostasis was achieved in 94.4% of TRA patients. Crossover rates were higher with DRA (3.5% vs 7.4%; P = 0.002), and median hemostasis time was shorter (180 vs 153 minutes; P < 0.001). Radial artery spasm occurred more with DRA (2.7% vs 5.4%; P = 0.015). Overall bleeding events and vascular complications did not differ between groups.
Conclusions: With the implementation of a rigorous hemostasis protocol, DRA and TRA have equally low RAO rates. DRA is associated with a higher crossover rate but a shorter hemostasis time.
Keywords: distal radial access; percutaneous coronary intervention; radial artery occlusion; randomized trial; transradial access.
Conflict of interest statement
Funding Support and Author Disclosures The study is sponsored and funded by Terumo Europe. Drs Aminian, Sgueglia, and Ratib have received consulting and lecture fees from Terumo. Dr Iglesias has received an unrestricted research grant to the institution from Terumo, outside of the submitted work; is a consultant for and has received personal fees from Terumo, outside of the submitted work; has received research grants to the institution from Abbott Vascular, AstraZeneca, Biosensors, Biotronik, Concept Medical, and Philips Volcano; and has received personal fees from AstraZeneca, Biotronik, Bristol Myers Squibb/Pfizer, Cardinal Health, Medtronic, Novartis, and Philips Volcano, outside the submitted work. Dr Regazzoli has received minor speaking honoraria from Terumo, Cordis, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.
Source: PubMed