Conventional proximal radial access works well for coronary angiography but carries risks like occlusion. Distal radial access via anatomical snuffbox gains traction for potential safety gains. Debate persists on which route best balances efficacy, feasibility, and complications.
In the meta-analysis published in the Clinical Research in cardiology, the researchers compared distal radial access (DRA) to proximal radial access (PRA) for safety, success rates, and practicality in heart procedures. They focused on real-world randomized trials and registries to settle the access debate.
Methods Pool Recent High-Quality Data
Teams searched PubMed, Web of Science, clinicaltrials.gov, and Cochrane from January 2017 to April 2024 for relevant RCTs and registries. They included 44 studies with 21,081 patients. Two investigators extracted data on primary endpoint radial artery occlusion plus access failure, times, spasm, hematoma, and hemostasis. Random effects models computed relative risks with meta-regression for moderators.
Findings Spotlight DRA Strengths and Tradeoffs
DRA showed 1.28% RAO rate vs. 4.76% PRA (p<0.001), with 2.92 times lower risk (Log RR -1.07, p<0.001). Access failure risk rose 2.42 times for DRA (Log RR 0.88, p<0.001).
Conclusions Shape Future Cath Lab Choices
DRA reduces radial occlusion effectively but access challenges persist. Operator training may tip scales toward routine use in select cases.