Distal Radial Artery Access (DRA) Vs. Transradial Access (TRA): Current Evidence

  • Yashasvi Chugh Interventional Cardiologist and Structural Heart Disease Interventionist, Baylor Scott &White Heart and VascularHospital, Dallas Fortworth, Texas, USA
  • Sunita Chugh Principal MO, Non–invasive cardiology, Heart and Vascular Institute, Fortis Memorial Research Institute, Gurugram,Haryana, India
  • Sanjay Kumar Chugh Director of Cardiology and Interventional Cardiology, Aarvy Healthcare Superspeciality Hospital, Gurugram,Haryana, India
Keywords: Distal radial artery access (DRA), standard transradial access (TRA), radial artery occlusion (RAO), anatomical snuffbox, Primary Percutaneous Coronary Intervention, randomized and non-randomized studies, meta-analyses

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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How to Cite
1.
Yashasvi Chugh, Sunita Chugh, Sanjay Kumar Chugh. Distal Radial Artery Access (DRA) Vs. Transradial Access (TRA): Current Evidence. Int J Med Res Rev [Internet]. 2022Nov.7 [cited 2022Nov.28];10(5):147-53. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/1400
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Review Article