A randomised controlled trial comparing the safety of distal versus proximal radial artery access for cardiac catheterisation has concluded that there is no increased risk of hand dysfunction or radial artery occlusion at one year.
This is among the headline findings from the DIPRA—Distal versus Proximal Radial Artery Access for Cardiac Catheterization and Intervention—study, presented as late-breaking clinical research at the Society for Cardiovascular Angiography & Interventions (SCAI) 2023 scientific sessions (18–20 May, Phoenix, USA).
The single-centre, randomised trial evaluated outcomes of hand function and effectiveness of conventional proximal radial artery access compared to distal radial artery access for cardiac catheterisation.
Current guidelines for patients undergoing percutaneous intervention recommend proximal artery access, one complication of which is radial artery occlusion, which can compromise the access of the artery for future coronary bypass surgery, dialysis or other cardiovascular procedures.
The DIPRA study randomised 300 patients 1:1 to cardiac catheterisation through either distal or proximal radial artery access. The primary endpoint was change in hand function from baseline to one year. Hand function was a composite of the QuickDASH questionnaire, hand grip test, and thumb-forefinger pinch test. Secondary endpoints included access feasibility, radial artery patency, and complications.
Of 216 patients who completed one-year follow-up, 112 were randomised to distal radial artery access and 104 to proximal radial artery access. Both groups had similar access site bleeding rates (distal 0% vs. proximal 1.4%; p=0.25).
Six distal radial artery patients failed access compared to 2 proximal radial artery patients. Radial artery occlusion occurred in 1 proximal patient vs. 2 in distal access. At one year, there was no significant difference in the change of hand function, in hand grip (distal 0.7 [-3, 4.5] vs. proximal 1.3 [-2, 4.3] kg; P=0.57), pinch grip (distal -0.1 [-1.1, 1] vs. proximal -0.3 [-1, 0.7] kg; p=0.66), and QuickDASH (distal 0 [-6.6, 2.3] vs. proximal 0 [-4.6, 2.9] points, p=0.58). The composite of hand function was comparable between proximal and distal access at one year.
“We know that radial artery occlusion is a potential complication of repeated heart catheterisations through the wrist. We also know that distal radial artery access in the base of the thumb carries a lower risk for this complication,” said Karim Al-Azizi (Baylor Scott & White Health, Plano, USA), lead author of the study. “The one-year safety results presented at SCAI are reassuring and offer physicians an alternative approach for patients who need radial access, such as patients with chronic kidney disease for dialysis access or coronary artery disease patients who need bypass grafting.”
