LB-2
Distal versus Proximal Radial Artery Access for Cardiac Catheterization and Intervention: 1-year results of The DIPRA study
Presenter
Karim Al-Azizi, M.D., FSCAI, Baylor Scott & White Health, Frisco, TX
Karim Al-Azizi, M.D., FSCAI1, Ghadi Moubarak, M.D.2, Chadi Dib, M.D., FSCAI2, Sameh Sayfo, MD, MBA, FSCAI2, Molly Szerlip, M.D., FSCAI3, Sibi Thomas, DO4, Sarah Hale5, Kristen Chionh5, Johanna Van Zyl, PhD5, Matt Richard Settele, BS6, Uma Kelavkar5, Allison Lanfear, BS2, Shelby McCoy5, JasjitKaur Banwait5, Osniel G Ramos5, Michael J. DiMaio, M.D.7, Michael J Mack, M.D.8 and Srini Potluri, M.D., FSCAI2, (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 The Heart Hospital - Plano, Garland, TX, (7)Baylor Scott and White The Heart Hospital research institute, Plano, TX, (8)Baylor Scott & White Health, Dallas, TX
Keywords: Drug-eluting Stent (DES) and Vascular Access, Management, and Closure
Background:
Proximal radial artery (PRA) access for cardiac catheterization is safe but can jeopardize subsequent artery use due to occlusion. Distal radial artery (DRA) access in the anatomical snuffbox potentially preserves the RA, with good short-term outcomes, yet long-term effects on the hand function are unknown.We sought to assess its long-term safety at 1-year.
Methods:
In this single center trial, 300 patients were randomized 1:1 to cardiac catheterization through the DRA or PRA. The primary end point of change in hand function from baseline to 1 year 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:
Of 216 patients with completed 1-year follow-up,112 were randomized to DRA and 104 to PRA with balanced demographics and procedural characteristics. Both groups had similar access site bleeding rates (DRA 0% vs PRA 1.4%; p=0.25). Six DRA patients failed access compared to 2 PRA patients. Radial artery occlusion occurred in 1 PRA patient vs 2 in DRA. At 1 year, there was no significant difference in the change of hand function, in hand grip (DRA 0.7 [-3, 4.5] vs PRA 1.3 [-2, 4.3] kg; P=0.57), pinch grip (DRA -0.1 [-1.1, 1] vs PRA -0.3 [-1, 0.7] kg; P=0.66), and QuickDASH (DRA 0 [-6.6, 2.3] vs PRA 0 [-4.6, 2.9] points, P= 0.58). The composite of hand function was comparable between PRA and DRA at 1 year (Figure 1).
Conclusions:
This is the first randomized controlled study to confirm long term safety of DRA compared to PRA. Compared to PRA, DRA had no increased risk of hand dysfunction or RA occlusion at 1 year.
