Distal vs Conventional Transradial Access for Coronary Procedures

Jordanian Research and Artificial Intelligence Group350 enrolled

Overview

Background: Radial artery occlusion (RAO) is a recognized complication of transradial coronary access, with reported incidence rates ranging from 5% to 30%. Distal radial access (DRA), performed at the anatomical snuffbox, has emerged as a promising alternative that may better preserve radial artery patency by maintaining antegrade perfusion through the palmar arch during hemostasis. Objective: To compare distal radial access with conventional transradial access in terms of radial artery patency and access-site outcomes in a real-world all-comers population undergoing coronary angiography or percutaneous coronary intervention. Methods: This prospective, multicenter, open-label, quasi-randomized comparative study enrolled 350 patients across three community-based hospitals in Palestine and Jordan between 2024 and 2026. Patients were allocated in a 1:1 ratio to DRA (n=183) or conventional transradial access (n=167) using an alternating sequence. The primary endpoint was radial artery patency assessed by blinded duplex ultrasonography at 24 hours and at 1 to 6 months. Secondary endpoints included access-site pain, bruising, numbness, and crossover to an alternative access site. The 24-hour outcome was analyzed by intention-to-treat and long-term outcomes by per-protocol analysis. Adjusted analyses used Firth penalized logistic regression.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

350

Conditions

Radial Artery Occlusion Following Coronary Catheterization

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Age ≥ 18 years 2. Undergoing diagnostic coronary angiography or percutaneous coronary intervention via an intended radial approach 3. Palpable radial pulse at the intended puncture site 4. Able to provide written or verbal informed consent 5. No contraindication to radial artery access at the intended site, as determined by the treating operator Exclusion Criteria: 1. Age \< 18 years 2. Inability to provide informed consent 3. Absent or non-palpable radial pulse at the intended access site 4. Active pregnancy 5. Medical condition likely to cause non-compliance with the study protocol or confound data interpretation

Outcomes

Primary Outcomes

Radial artery occlusion (RAO) assessed by duplex ultrasonography

Radial artery occlusion defined as absence of antegrade flow on duplex ultrasonography, assessed within 24 hours and at 1-6 months after the procedure.

Time frame: 24 hours and 1-6 months post procedure

Secondary Outcomes

Access-Site Pain

The patients will be asked to rate their pain on a 1-10 scale.

Time frame: 24 hours and 1-6 months post-procedure.

Crossover to Alternative Access Site

In cases where radial access is unsuccessful, crossover to an alternative access site, such as the contralateral radial or femoral artery, will be documented

Time frame: At the time of procedure

Access-Site Numbness

Number of participants with numbness at the access site assessed by physical examination.

Time frame: 24 hours and 1-6 months post-procedure

Access-Site Bruising

Number of participants with bruising at the access site assessed by physical examination.