Ultra-low contrast strategy for routine coronary procedures via distal transradial access: real-world experience with consecutive all-comers patients from the DISTRACTION registry.

Abstract

Objectives: The association of contrast volume to the risk of contrast-related acute kidney injury (CR-AKI) appears to have resulted in a change in daily practice toward using lower contrast volume for all patients. Distal transradial access (dTRA) has advantages in terms of faster haemostasis and lower rates of proximal radial artery occlusion. The present study aimed to describe the authors' experience with the combination of ultra-low contrast (ULC) strategy and dTRA for routine coronary procedures in a real-world and broad population of all-comers patients.

Methods: Of 6852 patients consecutively included into the DISTRACTION registry from February 2019 to July 2024, successful ULC coronary procedures via dTRA were achieved in 4328 (63.2%). Related data were retrospectively assessed.

Results: Most patients were male with acute coronary syndromes, and the mean patient age was 63.6 ± 15 years. Access-site crossover occurred in only 3% of cases. Right dTRA was the most frequently utilized primary access site, and was almost always performed with standard 6-French radial sheaths. ULC strategy was feasible for every scenario, with the overall contrast volume less than or equal to 40 mL for 96.4% of all patients, regardless of coronary bypass surgical grafts presence, percutaneous coronary intervention immediately following coronary angiography, anatomical or clinical complexity, or unavailability of intravascular ultrasound guidance. Neither major complications nor major adverse cerebrovascular and cardiac events directly related to dTRA were recorded. The rates of CR-AKI were very low (1.1%).

Conclusions: When performed by experienced operators, the minimalist combination of ULC strategy and dTRA for routine coronary procedures, regardless of baseline creatinine clearance, appears to be safe and feasible.