"Distal radial first": feasibility and safety for coronary angiography and PCI in Australia.

Background: Distal transradial artery (dTRA) access offers benefits to patients and operators.

Aims: We sought to determine the feasibility and safety of the dTRA as a first-line vascular access site and to evaluate predictors of dTRA approach success.

Methods: This retrospective cohort study analysed consecutive patients from three Australian centres who underwent coronary angiography and percutaneous coronary intervention via the dTRA (from November 2019 to December 2023). The primary outcome was procedural success (completion of a case using the dTRA puncture site). Secondary outcomes were access site crossover, procedural safety, arterial patency at follow-up, and predictors of procedural success.

Results: A total of 1,692 patients were included (mean age 70.6±10.5 years, 59% male [n=993], mean body mass index [BMI] 31.0±7.0 kg/m², right dTRA 85%, ultrasound guidance 99%). First pass success was achieved in 92.2% (n=1,560) of patients, and 1.5% had success on the second puncture of the ipsilateral dTRA. Crossover was required in 6.3% (n=107; proximal transradial [n=78; 4.6%], contralateral dTRA [n=22; 1.3%], femoral [n=6; 0.4%], ulnar [n=1; 0.1%]). There were no major vascular complications. Access site bleeding requiring treatment occurred in 0.3% (n=5) of cases. Proximal and distal radial occlusion occurred in 0.1% and 0.4%, respectively. Thirty-day major adverse cardiovascular events occurred in 1.4% (n=24). Radial artery patency was 98% (630/641) at follow-up. Hypertension (odds ratio [OR] 1.73; p=0.029), an experienced operator (attending/consultant and ≥4 years' experience with dTRA; OR 2.80; p<0.001), and a low BMI (OR 1.48 per 10 unit decrease in BMI; p=0.012) were predictors of technical success.

Conclusions: The "distal radial first" approach is feasible and safe for coronary procedures. Factors associated with procedural success include increased operator experience, a low BMI, and hypertension.