Safety and efficacy of percutaneous coronary interventions performed via anatomical snuffbox access in elderly patients
Authors: Berezhnoi K , Vanyukov A , Kokov L 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Radial artery thrombosis is a potential complication of transradial catheterization. For elderly patients greater attention should be paid to preserve radial arteries due to rather common comorbidities, such as renal failure and systemic atherosclerosis. Radial arteries in such cases may be required for hemodialysis, coronary artery bypass grafting and vascular reconstruction surgery. Presumably, the distal radial access can provide additional benefits in reducing the incidence of radial artery occlusion.

Purpose
To evaluate the radial artery thrombosis incidence and other complications in elderly patients undergone a percutaneous coronary intervention via anatomical snuffbox radial access.

Methods
This research (Jan 2018 – Aug 2020) was conducted as a single-center, prospective study in 141 patients over the age of 75 who had a percutaneous coronary intervention via the conventional radial access (n = 57) and radial access in the anatomic snuffbox (n = 84).
The primary endpoints were:
thrombosis;
radial artery spasm;
cannulation site hematoma with a diameter larger than 1 cm;
crossover to the different access.
We also evaluated the time for access establishment and total duration of the procedure.

Results
The groups had no significant differences in age and sex (the mean age was 81.9 ± 4.6 years, 67.9% females). The percutaneous coronary intervention was performed for STEMI in 73 (51.2%) patients, NSTEMI in 39 (27.7%) patients, or CAD in 35 (21.1%) patients. Two (2.4%) cases of vascular access crossover were reported in the anatomical snuffbox group compared with two (2.6%) cases in the conventional radial access group (p = 0.684).
There were no statistically significant differences in the access time between the groups. It was 3.43 ± 0.78 min in the conventional radial access group versus 3.28 ± 0.76 min (p = 0.891) in the anatomical snuffbox access group. The total duration of percutaneous coronary intervention was also comparable in two groups (44.1 ± 15.6 min versus 45.9 ± 16.5 min, p = 0.936).
The radial artery occlusion incidence was significantly lower in the anatomical snuffbox access group compared with the conventional radial access group (2 (2.4%) versus 8 (14.5%), respectively, p = 0.008). Also, radial artery spasm occurred significantly less frequently in the anatomical snuffbox access group compared with the conventional one (2 (2.4%) versus 7 (12.7%), respectively, p = 0.018). The incidence of cannulation site hematoma was significantly lower in the anatomical snuffbox access group than in the conventional access group (5 (6%) versus 10 (18.2%), respectively, p = 0.025).

Conclusion
Access via the anatomical snuffbox reduces the incidence of radial artery occlusion, cannulation-related spasm, and cannulation site hematoma. So it may be considered preferred to conventional radial access in elderly patients. However, randomized studies are needed to further investigate these results.