Distal Radial Artery Access: The Future of Cardiovascular Intervention
The entry point for coronary interventions has changed over the decades, from the femoral artery to the radial artery to the distal radial artery. Distal radius access, first used for
In 2017, it was still not recommended by the guidelines, showing a higher success rate and fewer complications than other parts. So it could be the future of cardiovascular intervention.
Over the last several years, many changes have occurred in the treatment of ischemic heart diseases; one of these changes is the route of arterial access for both coronary angiography and percutaneous coronary interventions.
Access changed from transfemoral to transradial approach (TRA), as it has less bleeding complications,
decreased hospital mortality rate, less access site complications, and is cost-effective as compared to the transfemoral approach . In 2015, the European Society of Cardiology guidelines for the management of acute coronary syndrome gave class I recommendation to use the TRA as the preferred method of access for any percutaneous coronary intervention irrespective of clinical presentation .
However, the use of TRA is not free of limitations; many complications have been associated with the TRA due to small diameter, such as radial artery occlusion (RAO) (The reported incidence of RAO is highly variable in the range of 2%-10%, and a meta-analysis by Rashid showed that the RAO incidence within 24 hours was 7.7%), radial artery spasm, radial arterial perforation, radial artery pseudoaneurysm, arteriovenous fistula, bleeding, nerve damage, and complex regional pain syndrome.