Retrospective investigation of percutaneous coronary intervention (PCI) via distal radial approach/artery(dRA) in daily practice: possible adaptability of variety of patients, diagnosis, devices
Authors: Kikuchi H , Katsushika S , Kamon T , Shinohara H , Kiriyama H , Saito A , Miura M , Minatsuki S , Kodera S , Takeda N , Komuro I 
Published: November 2023

Abstract

Background
Distal radial approach(dRA) that features puncturing radial artery at snuff box is becoming well known gradually and widely in the fields of interventional cardiology. Although there are some reports about dRA, safety, feasibility and compatibility of this procedure are still unclear.

Methods
Total of consecutive 90 PCI attempted via dRA procedure done by the operators who has experience of more than 20 dRA catheterization before from December 2020 to January 2023 at the University of Tokyo Hospital were retrospectively investigated. Distal radial artery puncture was done with echo-guided method just before the PCI procedure. Diameter of conventional radial artery(cRA) and dRA were measured. PCI strategy and devices were decided by the operators.

Results
About patient characteristics, mean age was 73±10 years old, consisting of 82.2%(74/90) male and 17.8%(16/90) female. Mean height/weight/BMI was 162.8±8.5 cm, 64.1±12.4 kg and 24.0±3.5, respectively. LVEF was 56.6±15.7%. Approach side of dRA was right in 74.4%(67/90) and left in 25.6%(23/90). Former dRA prcedeure of the same side was 20.0%(18/90). There were 7 cases(7.8%) of hemodialysis patients(non-AV fistula side). Concerning antithrombotics, 100%(80/80) were on DAPT and 18.9%(17/90) were on triple therapy(DAPT + warfarin or any DOAC:direct oral anticoagulant). The dRA success rate was 90.0%(81/90) and the procedure success rate was 100%(90/90). Diagnosis were STEMI: 5.6%(5/90), NSTEMI: 2.2%(2/90), unstable AP: 10.0%(9/90), stable(effort) AP: 18.9%(17/90), staged PCI: 25.6%(23/90) and other: 37.8%(34/90). Mean sheath insertion time was about 4 minutes (255±139 seconds). There are 3 CTO cases. Rotational atherectomy was used in 3.3%(3/80) and orbital atherectomy device was used in 5.0%(4/80). ELCA(excimer laser coronary angioplasty) was used in 6.3%(5/80). More than 1 DES was deployed in 75.0%(60/80), DCB(drug coated balloon) was used in 23.8%(19/80). Imaging devices were used in 100%(80/80) consists of IVUS: 92.5%(74/80), OCT: 12.5%(10/80) and both: 10.0%(8/80). Mean total radiation dose was 1324±809 mGy and mean volume of contrast medium was 141.6±55.6 ml. Bleeding, neurological and other major complication was 0%(0/80). Blood transfusion was performed in 1 case that is not related to procedure. Procedure related dissection or perforation of dRA was observed in 2 cases(2.2%). Occlusion of dRA was observed in 1 case(1.1%). Diameter of cRA and dRA was 2.6±0.7 mm and 2.3 mm±0.7 mm, respectively.

Conclusions
PCI via dRA had high rate of dRA and procedure success when it is performed by experienced physicians. It is effective regardless of the preprocedural diagnosis(STEMI/NETEMI/uAP/eAP/other). As far as this study is concerned, no device(including Rota, OAC and ELCA) had limitation or malfunction during procedure. No major complications was observed. PCI via dRA seemed to be safe, feasible, and compatible for various situations and devices.