Proximal and distal radial access for endovascular interventions in patients with ACS
Objective. To compare efficacy and safety of distal and proximal radial accesses during coronary endovascular interventions in patients with acute coronary syndrome with a “non-inferiority”/ “superiority” assessment of the distal radial access. Materials and methods. The analysis was performed in 476 patients with acute coronary syndrome. The efficacy and safety of radial arterial accesses in the distal parts (anatomical snuffbox and back of the hand) and in the proximal part (forearm) during hospitalization were compared. Efficacy was assessed by the following parameters: technical failure of radial artery catheterization and access conversion, time of access artery catheterization, time from patient admission to the X-ray operating room to manipulations on the infarct-associated artery. Safety was assessed by the presence or absence of local hemorrhagic complications, damage of the radial artery wall, and post-catheterization occlusion of the radial artery. Conclusions. In patients with acute coronary syndrome, endovascular interventions with the distal radial access were non-inferior to the proximal radial access in terms of “efficacy”, and superior in terms of “safety”. Access conversion was observed more frequently with distal radial access. The time of radial artery catheterization with proximal or distal radial accesses did not differ significantly. Local hemorrhagic complications were observed more frequently with distal radial access. Incidence of radial artery occlusions was higher with proximal radial access. Duration of endovascular coronary intervention did not affect the risk of post-catheterization occlusion of the radial artery.