Assessment of the patency of the proximal and distal radial artery access after percutaneous coronary intervention

Abstract

Background: Compared to trans-femoral access (TFA), trans-radial access (TRA) decreased mortality in the 1990s. It became common practice to use proximal radial access (PRA), which is 2-3 cm above the styloid: Radial artery occlusion (RAO) (no pulse + no Doppler), hematoma, and spasm. Although RAO is frequently asymptomatic, it poses a risk of ischemia and restricts future access. Patency is frequently not evaluated after the surgery. Usability of the ulnar artery is impacted by RAO. Due to fewer difficulties than PRA, distal radial artery access (DRA) is increasingly preferred. Assessing the proximal and DRA patency following percutaneous coronary intervention was the goal of this study. Methods: 200 patients who were referred for coronary angiography with potential percutaneous coronary intervention (PCI) via radial artery access were the subjects of this prospective study. Additionally, patients were split into two equal groups: Group I received PCI or coronary angiography (CAG) by proximal radial artery access, and Group II received PCI or CAG via DRA. Results: Overall complication rates, procedural success, and baseline characteristics did not significantly differ between the two groups. However, Group I suffered more radial artery spasm, RAO, and access-site pain, and their first-attempt puncture success was higher, but their hemostasis duration was longer. Group II needed more second tries but had quicker cannulation and hemostasis times. In both groups, patient satisfaction was excellent and comparable. Conclusions: Distal radial access offers a promising alternative to proximal access in coronary procedures, with notable benefits, though wider adoption requires overcoming technical challenges and further validation through large-scale studies.