Distal vs Conventional Radial Access for Coronary Angiography and/or Intervention A Meta-Analysis of Randomized Trials

BACKGROUND Emerging evidence from randomized clinical trials (RCTs) comparing distal radial access (DRA) with conventional radial access (RA) is available. OBJECTIVES The aim of this study was to provide a quantitative appraisal of the effects of DRA) vs conventional RA for coronary angiography with or without intervention. METHODS The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for RCT comparing DRA vs conventional RA for coronary angiography and/or intervention. Data were pooled by meta-analysis using a random-effects model. The primary endpoint was radial artery occlusion (RAO) at the longest available follow-up. RESULTS Fourteen studies enrolling 6,208 participants were included. Compared with conventional RA, DRA was associated with a significant lower risk of RAO, either detected at latest follow-up (risk ratio [RR]: 0.36; 95% CI: 0.23-0.56; P < 0.001; number needed to treat [NNT] <1/4> 30) or in-hospital (RR: 0.32; 95% CI: 0.19-0.53; P < 0.001; NNT <1/4> 28), as well as EASY (Early Discharge After Transradial Stenting of Coronary Arteries) $II hematoma (RR: 0.51; 95% CI: 0.27-0.96; P 1/4 0.04; NNT 1/4 107). By contrast, DRA was associated with a higher risk of access site crossover (RR: 3.08; 95% CI: 1.88-5.06; P < 0.001; NNT <1/4> 12), a longer time for radial puncture (standardized mean difference [SMD]: 3.56; 95% CI: 0.96-6.16; P < 0.001), a longer time for sheath insertion (SMD: 0.37; 95% CI: 0.16-0.58; P < 0.001), and a higher number of puncture attempts (SMD: 0.59, 95% CI: 0.48-0.69; P < 0.001). CONCLUSIONS Compared with conventional RA, DRA is associated with lower risks of RAO and EASY $II hematoma but requires longer time for radial artery cannulation and sheath insertion, more puncture attempts, and a higher access site crossover. (J Am Coll Cardiol Intv 2022;15:2297-2311) (c) 2022 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.

Automated summary

Compared with conventional RA, DRA is associated with lower risks of RAO and EASY II hematoma but requires longer time for radial artery cannulation and sheath insertion, more puncture attempts, and a higher access site crossover.