Comparison of Conventional Transradial Access versus Distal Transradial Access in the Anatomical Snuffbox for Coronary Angiography and Angioplasty

Background
Coronary Angiogram and Interventions are commonly performed via the femoral route. Now transradial coronary catheterization became a popular & default technique due to less vascular access site complications. Distal transradial (the anatomical snuffbox access) has advantages over standard proximal access for patients and operators. Radial artery preservation could be another relevant issue in patients requiring multiple radial artery procedures , future use for coronary bypass and construction of Arterio-Venous fistula in chronic kidney disease.Study aim to compare the feasibility, safety and complications of coronary angiogram and intervention between the distal transradial(DTR) and conventional transradial access (CTR).

Methods
In this cross sectional study a total of 320 patients were assigned to perform coronary angiogram or angioplasty through CTR and DTR access from July 2018 to December 2018 in the Department of Cardiology, Tribhuvan University. Institute of Medicine , Manmohan Cardithoracic Vascular and transplant center,Nepal . We divided the total patient in 2 groups, with 160 patients in each group. All patients underwent an Allen test and all of them had normal radial pulse . The primary endpoints were to access difficulties and in-hospital access-site complications.

Results
In 6 months study duration 470 patients underwent coronary procedures and only 320 were eligible for the study. There were 96.88% successful accesses for traditional radial and 97.5% for distal snuffbox approach. There was failure to access of DTR in 4 cases (2.5%) that may be due to new technique and small artery. Failure to access in CTR approach was 5 cases (3.12%) which were due to arterial spasm. There were no vascular complications in DTR group and 4 (2.5%) major vascular complication in traditional radial group. Patients of traditional radial access had more arterial spasm, hematoma and distal numbness (p< 0.001) than distal radial access. DTR access was safe, more comfortable to patient because of less ischemia, hematoma and numbness.

Conclusions
Distal transradial access for coronary angiogram and intervention is a better alternative, safe and feasible option to conventional transradial access for both patients and operators.