Distal transradial access. Initial experience. Results

Introduction: Conventional access through the radial artery (cTRA) is a standard approach in coronary interventions. Unfortunately, it carries a risk of long-term complications such as radial artery occlusion (RAO) and local complications, usually hematomas. Aim: Sharing initial experience in the application of distal transradial access (dTRA) on 134 patients, from single operator in one center and its applicability on patients with STEMI. Number of procedures required to get experience with this access, assessed by the degree of reduction of failed procedures. Materials and methods: From 08.03.21 to 18.11.21, 134 patients with dTRA (110 successful, 24 unsuccessful) were included in the study. dTRA is comsidered to be an access to the anatomical snuffbox. Completion of the entire procedure, not just a successful puncture or insertion of an introducer, was considered the access successful. Results: It was found that the success of the method was 82% of the criteria preset. Among the successful procedures, 48% were interventions. Of these, 71% had ACS and 43.6% had STEMI. The access was used on 3 patients who had CTO. Two patients underwent rotablation using a 7 in 6 Fr introduser. On 98% of the patients a 6 Fr introducer was used. Right dTRA was used on 93% of patients. From the 134 procedures performed, it was found that 92% of failures were up to the 80th procedures. After the 80’th procedures the frequency of failures decreased significantly. Complications ‒ 3 small hematomas and 2 numbness in the thumb, which did not require additional interventions. Conclusion: The procedure with dTRA was successfully completed by high percentage of patients, including the high-risk patients with ACS and STEMI. After the 80th dTRA procedure was reached level of skills with a low frequency of failed procedures. This suggests that dTRA can be an alternative to standard radial access to prevent radial artery occlusion, which has been confirmed by previous studies, better patient comfort, and lower risk of complications. The results were achieved without the need of reduction of the introducer’s diameter or use of special devices for hemostasis.