Distal Radial Artery Access (DRA) Vs. Transradial Access (TRA): Current Evidence
Abstract
Introduction: Transradial access (TRA) is currently recommended over the transfemoral (TFA)route as default, for percutaneous coronary interventions (PCI) and coronary angiography in allpatients, by the European and American Guidelines, because of reduced risk of bleeding, vascularcomplications and mortality especially in acute and high -risk patients.
Aims and objectives: Distalradial artery access (DRA) via the anatomical snuffbox is a safe and feasible alternative to standardtransradial access (TRA). This review aims to study and discuss the endpoints in recent studiescomparing DRA with TRA for coronary procedures to conclude the merits and demerits of DRA Vs.TRA.
Material and Methods: The evidence from several randomized and non-randomized studiesand meta-analyses comparing DRA with TRA is reviewed. Results: Though access failures andcrossovers are reported to be higher with DRA compared to TRA; most studies have shown nodifference in vascular complications in patients undergoing procedures via DRA or TRA.
Results ofsome randomized controlled trials between DRA Vs. TRA for coronary procedures, including PrimaryPercutaneous Coronary Intervention in ST-elevation myocardial infarction (STEMI) are available andare discussed; while others are underway for evaluation of radial artery occlusion (RAO) and otherend-points.
Conclusion: DRA takes more time, and fails more often compared to TRA; though timeto hemostasis is less and forearm hematoma is unreported with DRA. The Jury is still out on RAObetween DRA Vs. TRA; but the meticulous application of RAO prevention practices is the key toachieving low RAO
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