Transradial access (TRA) is now the preferred approach for percutaneous coronary procedures. Limitations of TRA include ergonomic challenges in some patients and radial-artery occlusion (RAO).
Distal radial access (DRA) has been proposed as an alternative to TRA to improve ergonomics and radial-artery patency. Two recent single-center randomized studies showed reductions of forearm RAO after DRA as compared with conventional TRA. Yet the potential for DRA to harm hand function has not been studied.
The findings from the RATATOUILLE (International Hand Function Study Following Distal Radial Access) study are based on 313 patients (70% men) with clinical indications for coronary angiography or percutaneous coronary intervention (PCI) who underwent DRA (54% left and 46% right DRA) performed by experienced operators.
The study used validated instruments to comprehensively assess hand function and pain before the procedure and at one, six and 12 months of follow-up.
The results show that DRA does not impair hand function, report Dr. Gregory Sgueglia of Sant'Eugenio Hospital, in Rome, Italy and colleagues in JACC: Cardiovascular Interventions.
Sensory function did not show a significant change from baseline to follow-up assessments at all stimulated sites in both hands; there was a small improvement in the second and third fingers of the left hand.
Touch pressure sensory threshold improved slightly in all stimulated sites in both the DRA hand and the contralateral one, with no significant difference between them.
Periprocedural bleeding occurred in 6.4% of cases, access-site hematoma in 1.3% and the rate of RAO was less than 1%. Patient-reported access-related pain was 1 on the 10-point visual analog scale.
These findings indicate the "exceptional safety of DRA during percutaneous coronary procedures performed by experienced operators in carefully selected patients," write the authors of a linked editorial.
"All findings from this study taken together support the investigators' inference that DRA does not adversely affect hand dysfunction more than life circumstances, with no evidence for delayed worsening up to one year," say Dr. Subhash Banerjee and Dr. McCall Walker of the Veterans Affairs North Texas Health Care System, in Dallas.
"Although DRA for percutaneous coronary procedures is not yet mainstream, data from this study are likely to generate excitement for this approach," they add.
"Decreased rates of DRO, easy hemostasis, unaffected hand function, and improved patient comfort can be important considerations for adopting this approach. Availability of specialized hydrophilic smaller caliber and shorter DRA sheaths with flexible and tapered dilators may further adoption," they note.
"Although the investigators' claim of lower RAO with DRA compared with TRA cannot be accepted prima facie on the basis of this single-arm study with its inherent limitations, it certainly sets the stage for a head-to-head comparison," the editorial writers say.
The study had no specific funding.
SOURCE: https://bit.ly/3wzr0fa and https://bit.ly/3FP1iHL JACC: Cardiovascular Interventions, online May 17, 2022.
By Reuters Staff
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