Distal radial approach via anatomical snuffbox is associated with higer rate of radial spasm and greater patient discomfort

Abstract

Background/Introduction

Conventional transradial approach (c-TRA) at the wrist is considered as the default strategy for catheter-based procedures providing less serious access-related complications and better patients' comfort than transfemoral route. A novel distal transradial artery approach (d-TRA) via the anatomical snuffbox has been proposed recently as an noteworthy alternative. It is hypothesised that d-TRA may provide additional benefits without losing the efficacy of c-TRA.

Purpose

To assess consecutive patients' comfort undergoing coronary angiography or intervention by novel d-TRA in comparison with c-TRA.

Methods

In a span of 4 months, out of 465 caucasian subjects, 400 patients were included in a prospective, single-center, randomized (1:1) distAl vs traditioNal Transradial Access for coRonary procEdures Study (ANTARES). Hemodynamic instability, ST-elevation myocardial infarction, forearm artery occlusion or prior radial access failure were the exclusion criteria. An artery was punctured with anterior wall modified Seldinger technique, and standard 5F or 6F vascular sheaths were used.

Pain/discomfort when access gaining, radial spasm, early (within 24 hours) postprocedural local neuropathy (thumb numbness) were the analyzed parameters determining patients' comfort in both groups.

Results

Baseline characteristics of patients were matched.

Conclusion(s)

Coronary procedures performed in consecutive patients via novel d-TRA are associated with worse patient's comfort determined by higer rate of radial spasm and early postprocedural local neuropathy, and greater pain/discomfort when access gaining, in comparison with c-TRA.

Results

	d-TRA (n=200)	c-TRA (n=200)	p value
Age, years – median	67	66	ns
Female	80 (40%)	79 (39.5%)	ns
Left-sided procedure	82 (41%)	78 (39%)	ns
Radial spasm	38 (19%)	9 (4.5%)	<0,005
Pain/discomfort when access gaining (none / mild / moderate / huge)	176 (88%) / 13 (6.5%) / 11 (5.5%) / 0	194 (97%) / 3 (1.5%) / 3 (1.5%) / 0	<0.05
Postprocedural local neuropathy (thumb numbness)	58	29	<0.005

Funding Acknowledgement

Type of funding source: None

Coronary Intervention: Vascular Access