UltraSound Guided Distal Radial Artery vS Conventional Transradial Access for Interventional Coronary Angiography

Current European and American guidelines issued by the European Society of Cardiology (ESC), the American Heart Association (AHA), and the Society for Cardiovascular Angiography and Interventions (SCAI) recommend transradial access (TRA) as the preferred access route for cardiac catheterization in both acute and chronic coronary syndromes, as well as in complex coronary interventions. Compared with transfemoral access, transradial access has demonstrated significant benefits regarding vascular complications, major bleeding, mortality, and earlier mobilization and discharge of patients.

In recent years, access through the distal segment of the radial artery in the anatomical snuffbox has emerged as a technique with highly beneficial characteristics comparable to conventional radial access, while also offering additional advantages. The ANGIE study demonstrated that distal radial access was associated with a statistically significant reduction in radial artery occlusion compared with conventional radial puncture. Puncture of the distal radial artery preserves antegrade blood flow in the forearm during hemostatic compression, thereby reducing the risk of arterial occlusion.

Existing literature Although the benefit of distal radial access in preventing radial artery occlusion has now been established, the same does not apply to crossover incidence, namely the need to change to an alternative vascular access site because the intervention cannot be completed through the initially selected access.

Several studies have shown higher crossover rates with distal radial access compared with conventional radial access. In the study by Koutouzis et al., distal radial access failed more often, with a crossover incidence of 30% versus 2% in the conventional radial group. Similar findings were reported in the DAPRAO study, the ANGIE trial, the DISCO RADIAL trial, the CONDITION trial, and observational studies and meta-analyses. Overall, published evidence consistently suggests that distal radial access is associated with a higher likelihood of crossover than conventional radial access when performed without ultrasound guidance.

Aim and originality of the study A common characteristic of all the above studies is that the comparison between the two access techniques was performed using anatomical guidance rather than ultrasound guidance.