Distal transradial access for coronary angiography and percutaneous coronary intervention: an observational study in a Latin-American center

Introduction: The distal radial technique which consists of canalizing the radial artery through the anatomical snuffbox has recently emerged as an alternative arterial access for diagnostic and therapeutic coronary catheterization. This study aimed to evaluate the feasibility and safety of the distal transradial approach (dTRA) as a default route for coronary angiography (CAG) and percutaneous coronary intervention (PCI) in a Latin-American center. Material and methods: Between November 2017 and December 2018, 100 consecutive patients were enrolled in this single-center observational study. The distal radial artery was punctured with a 20, 21 or 22-gauge puncture needle, using a transfixion or anterior wall technique by four expert radial approach operators, 32% of the procedures were PCI. Results: The arterial crossover was presented in 19% of patients. The median puncture time and fluoroscopic time were 6.36 minutes and 16 minutes, respectively. Haemostasis median time was 180 minutes. A total of 12 puncture site complications occurred, including 11 minor hematomas and one major hematoma. No distal radial artery occlusion, perforation, pseudoaneurysm, or arteriovenous fistula occurred. Conclusions: Even the crossover and complications in our center dTRA is feasible and safe. In a near future this procedure could be a default route for elective CAG and interventions. Large randomized studies should be performed to support it.