Distal Versus Conventional Radial Access for Coronary Angiography and Intervention: The DISCO RADIAL Trial.
distal radial access
percutaneous coronary intervention
radial artery occlusion
randomized trial
transradial access
Journal
JACC. Cardiovascular interventions
ISSN: 1876-7605
Titre abrégé: JACC Cardiovasc Interv
Pays: United States
ID NLM: 101467004
Informations de publication
Date de publication:
27 06 2022
27 06 2022
Historique:
received:
30
03
2022
revised:
15
04
2022
accepted:
21
04
2022
pubmed:
21
5
2022
medline:
28
6
2022
entrez:
20
5
2022
Statut:
ppublish
Résumé
Currently, transradial access (TRA) is the recommended access for coronary procedures because of increased safety, with radial artery occlusion (RAO) being its most frequent complication, which will increasingly affect patients undergoing multiple procedures during their lifetimes. Recently, distal radial access (DRA) has emerged as a promising alternative access to minimize RAO risk. A large-scale, international, randomized trial comparing RAO with TRA and DRA is lacking. The aim of this study was to assess the superiority of DRA compared with conventional TRA with respect to forearm RAO. DISCO RADIAL (Distal vs Conventional Radial Access) was an international, multicenter, randomized controlled trial in which patients with indications for percutaneous coronary procedure using a 6-F Slender sheath were randomized to DRA or TRA with systematic implementation of best practices to reduce RAO. The primary endpoint was the incidence of forearm RAO assessed by vascular ultrasound at discharge. Secondary endpoints include crossover, hemostasis time, and access site-related complications. Overall, 657 patients underwent TRA, and 650 patients underwent DRA. Forearm RAO did not differ between groups (0.91% vs 0.31%; P = 0.29). Patent hemostasis was achieved in 94.4% of TRA patients. Crossover rates were higher with DRA (3.5% vs 7.4%; P = 0.002), and median hemostasis time was shorter (180 vs 153 minutes; P < 0.001). Radial artery spasm occurred more with DRA (2.7% vs 5.4%; P = 0.015). Overall bleeding events and vascular complications did not differ between groups. With the implementation of a rigorous hemostasis protocol, DRA and TRA have equally low RAO rates. DRA is associated with a higher crossover rate but a shorter hemostasis time.
Sections du résumé
BACKGROUND
Currently, transradial access (TRA) is the recommended access for coronary procedures because of increased safety, with radial artery occlusion (RAO) being its most frequent complication, which will increasingly affect patients undergoing multiple procedures during their lifetimes. Recently, distal radial access (DRA) has emerged as a promising alternative access to minimize RAO risk. A large-scale, international, randomized trial comparing RAO with TRA and DRA is lacking.
OBJECTIVES
The aim of this study was to assess the superiority of DRA compared with conventional TRA with respect to forearm RAO.
METHODS
DISCO RADIAL (Distal vs Conventional Radial Access) was an international, multicenter, randomized controlled trial in which patients with indications for percutaneous coronary procedure using a 6-F Slender sheath were randomized to DRA or TRA with systematic implementation of best practices to reduce RAO. The primary endpoint was the incidence of forearm RAO assessed by vascular ultrasound at discharge. Secondary endpoints include crossover, hemostasis time, and access site-related complications.
RESULTS
Overall, 657 patients underwent TRA, and 650 patients underwent DRA. Forearm RAO did not differ between groups (0.91% vs 0.31%; P = 0.29). Patent hemostasis was achieved in 94.4% of TRA patients. Crossover rates were higher with DRA (3.5% vs 7.4%; P = 0.002), and median hemostasis time was shorter (180 vs 153 minutes; P < 0.001). Radial artery spasm occurred more with DRA (2.7% vs 5.4%; P = 0.015). Overall bleeding events and vascular complications did not differ between groups.
CONCLUSIONS
With the implementation of a rigorous hemostasis protocol, DRA and TRA have equally low RAO rates. DRA is associated with a higher crossover rate but a shorter hemostasis time.
Identifiants
pubmed: 35595673
pii: S1936-8798(22)00897-4
doi: 10.1016/j.jcin.2022.04.032
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1191-1201Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Funding Support and Author Disclosures The study is sponsored and funded by Terumo Europe. Drs Aminian, Sgueglia, and Ratib have received consulting and lecture fees from Terumo. Dr Iglesias has received an unrestricted research grant to the institution from Terumo, outside of the submitted work; is a consultant for and has received personal fees from Terumo, outside of the submitted work; has received research grants to the institution from Abbott Vascular, AstraZeneca, Biosensors, Biotronik, Concept Medical, and Philips Volcano; and has received personal fees from AstraZeneca, Biotronik, Bristol Myers Squibb/Pfizer, Cardinal Health, Medtronic, Novartis, and Philips Volcano, outside the submitted work. Dr Regazzoli has received minor speaking honoraria from Terumo, Cordis, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.