LB-2
Distal vs. Proximal Radial Artery Access for Cardiac Catheterization and Intervention: 30-Day Outcomes of the DIPRA Study
Presenter
Karim Al-Azizi, M.D., FSCAI, Baylor Scott & White Health, Frisco, TX
Karim Al-Azizi, M.D., FSCAI1, Chadi Dib, M.D., FSCAI2, Sameh Sayfo, MD, MBA, FSCAI2, Molly Szerlip, M.D., FSCAI3, Sibi Thomas, DO4, Amr Idris, MD2, Jared L Christensen, MD2, Julie McCracken5, Adam Smith5, Uma Kelavkar5, Sarah Hale5, Johanna Van Zyl, PhD5, Preethi Ravindranathan5, JasjitKaur Banwait5, Kristen Chionh5, Michael J. DiMaio, M.D.5, Michael J Mack, M.D.6 and Srini Potluri, M.D., FSCAI7, (1)Baylor Scott & White Health, Frisco, TX, (2)Baylor Scott & White The Heart Hospital - Plano, Plano, TX, (3)Baylor Scott & White The Heart Hospital - Plano, Richardson, TX, (4)-, Frisco, TX, (5)Baylor Research Institute, Plano, TX, (6)Baylor Scott & White Health, Dallas, TX, (7)Baylor Scott & White The Heart Hospital - Plano, Frisco, TX
Keywords: Complications, Coronary and Vascular Access, Management, and Closure
Background
:
Proximal radial artery (PRA) access for cardiac catheterization has been shown to be safe and with a mortality benefit compared to femoral access.However, it can jeopardize subsequent use of the artery due to occlusion. Distal radial artery access (DRA) in the anatomical snuffbox has the potential of preserving the RA but its safety and potential detrimental effects on hand function is unknown. We sought to assess access feasibility, and complications including hand function post distal or proximal radial access.
Methods
:
In this single center, randomized-controlled trial, 300 patients were randomized 1:1 to undergo cardiac catheterization through the DRA or PRA. The primary endpoint was change in hand function from baseline at 30 days and 1 year. Hand function was a composite of the QuickDASH questionnaire, hand grip test, and thumb forefinger pinch test. Secondary endpoints included access feasibility, radial artery patency and complications.
Results
:
251 patients who have completed their 30 day follow up,126 were randomized to DRA and 125 to PRA with balanced demographics and procedural characteristics including the sheath size used (6 Fr 99.3% in DRA vs 99.3% in PRA) and type of the procedure completed (PCI 35.9% in DRA vs 32.9% in PRA).Both groups had similar rates of access site bleeding (DRA 0% vs PRA 1.4%; p=0.25). 6 patients randomized to DRA failed successful access and converted to PRA. 2 PRA patients failed successful access. Radial artery occlusion occurred in 2 patients in the PRA vs none in the DRA. There was no significant difference in the change of hand function in the catheterization hand, in hand grip (DRA -0 [ IQR-3, 3.3 IQR] vs PRA 0 [ IQR-2.7, 3.8] kg P=0.29), pinch grip (DRA -0.3[IQR-1.2, 0.5] vs PRA 0 [IQR-0.9, 0.9] kg P=0.051), and QuickDASH (DRA 0 [IQR-4.6, 2.3] vs PRA 0 [IQR-4.6, 2.3] points, P= 0.81).There was no significant difference in the composite of hand function between PRA and DRA.
Conclusions
:
Distal radial artery access is a safe strategy for access for cardiac catheterization with a low complication rate. Compared to proximal artery access, there is no increased risk of hand dysfunction or radial artery occlusion 30 days after the procedure.