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  • Distal Radial Artery Access in comparison to Forearm Radial Artery Access for Cardiac Catheterization: A Randomized Controlled Trial (DARFORA Trial)

Distal Radial Artery Access in comparison to Forearm Radial Artery Access for Cardiac Catheterization: A Randomized Controlled Trial (DARFORA Trial)

Key Messages:

  • In regular, routine practice for coronary procedures, conventional radial access is often utilised. However, in cardiac procedures, the distal active site has now become popular.  

  • This study aims to evaluate feasibility, outcomes and complications in distal radial access compared with standard forearm radial access (FRA)  

  • The distal radial method in cardiac catheterisation seems to be demonstrating encouraging results. It is achievable and safe for both coronary angiography and interventions. However, the success rate is reliant on the patient’s selection and the operator’s expertise 

Study Design:

This single centre, parallel-group, partially blinded, randomised controlled trial was performed between December 2019 and December 2020, with a 1:1 allocation ratio (NCT04125992). A total of 209 patients were randomised into two groups: distal radial access (DRA) group (n =104) and FRA group (n = 105). 

Primary endpoint:

  • Success of the access puncture, which is defined as sheath insertion in the radial artery 

Other endpoints:

  • Puncture time, which is the time in seconds between the first and successful puncture attempt 

Inclusion criteria:

  • All patients who were hospitalised for cardiac catheterisation and had palpable proximal and distal radial pulses were included in the study 

Findings:

  • Regarding the baseline characteristics the groups were comparable in terms of age, gender, weight, and height 

  • In both groups, access was successful in 98% of patients (P=0.992) 

  • The DRA group displayed a lengthier puncture duration and an increased number of attempts (duration: 56.3 ± 58.3 s DRA vs. 20.0 ± 18.4 FRA, P<0.001, attempts: 1.9 ± 1.2 DRA vs. 1.2 ± 0.6 FRA, P<0.001). 

  • Greater puncture-associated pain was shown in the DRA group (4 ±2.2 DRA vs. 3 ± 2.1 FRA, P=0.001).  

  • Radial artery occlusions were evident in the FRA group (n=2) and there were none present in the DRA group (P=0.139) 

Conclusion:

DRA is a safe and practical alternative to FRA for coronary angiography and intervention. This study evidenced a high success rate, although this also presented an increase in puncture time, attempts, and pain. Nevertheless, shorter procedure times, fluoroscopy times, and hemostasis times were reported.

Limitations:

  • Single center 

  • Small sample size 

  • Patients were excluded from the study with STEMI and access side restriction due to prior CABG surgery and AVF  

  • Did not employ ultrasound guidance for arterial puncture 

  • Blind puncture increases the chances of tendon damage and hematoma formation 

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