Comparing distal and proximal radial access for percutaneous coronary intervention and angiography: a comprehensive meta-analysis and systematic review of randomized controlled trials

Mostafa Adel T Mahmoud; Nada G Hamam; Thoria I Essa Ghanm; Ahmed Khaled; Ahmed S A Osman; Ahmad Beddor; Islam Mohsen Elhaddad; Afnan Ismail Ibrahim

doi:10.1097/MCA.0000000000001489

Comparing distal and proximal radial access for percutaneous coronary intervention and angiography: a comprehensive meta-analysis and systematic review of randomized controlled trials

Coron Artery Dis. 2024 Dec 24. doi: 10.1097/MCA.0000000000001489. Online ahead of print.

Authors

Mostafa Adel T Mahmoud^{1

2}, Nada G Hamam^{2

3}, Thoria I Essa Ghanm^{2

4}, Ahmed Khaled^{1

2}, Ahmed S A Osman^{2

5}, Ahmad Beddor^{2

6}, Islam Mohsen Elhaddad^{2

7}, Afnan Ismail Ibrahim^{2

8}

Affiliations

¹ Faculty of Medicine, Beni Suef University, Beni Suef, Egypt.
² Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, Massachusetts, USA.
³ Faculty of Medicine, Kasr Al-Ainy, Cairo University, Cairo, Egypt.
⁴ Faculty of Medicine, Mansoura University, Mansoura, Egypt.
⁵ Faculty of Medicine, Minia University, Minia, Egypt.
⁶ Faculty of Medicine, Yarmouk University, Irbid, Jordan.
⁷ Damietta Faculty of Medicine, Al-Azhar University, Damiettta, Egypt.
⁸ National heart institute, Giza, Egypt.

PMID: 39711359
DOI: 10.1097/MCA.0000000000001489

Abstract

Background: Distal radial access (DRA) through the anatomical snuff-box is a novel technique for coronary procedures. Emerging evidence suggests that DRA is associated with a lower risk of certain complications compared to proximal radial access (PRA).

Methods: A systematic review was conducted to compare clinical and procedural outcomes between both access sites for coronary angiography and percutaneous coronary intervention. We searched PubMed, Web of Science, Cochrane, and Scopus to identify relevant randomized controlled trials.

Results: We included 23 randomized controlled trials enrolling 10 062 patients (DRA group: 5042; PRA group: 5020) in this review. DRA was associated with a lower risk for radial artery occlusion (RAO) at the longest reported follow-up [risk ratio (RR): 0.30, P < 0.00001], in-hospital RAO (RR: 0.28, P < 0.00001), any bleeding (RR: 0.40, P = 0.04), hand clumsiness (RR: 0.05, P < 0.00001), and shorter time to hemostasis [mean difference (MD): -40.93, P < 0.00001]. However, DRA showed a higher access failure rate (RR = 2.64, P < 0.00001), longer access time (MD = 0.77, P < 0.00001), more puncture attempts (MD: 0.60, P < 0.0001), and greater access-related pain [standardized mean difference (SMD) = 0.23, P = 0.02]. Both approaches were comparable in terms of major adverse cardiac events (RR = 0.74, P = 0.60), and hand function (SMD = -0.05, P = 0.68).

Conclusion: DRA is a safe alternative to PRA for coronary procedures, with a lower risk of complications, including RAO. However, it is limited by access-related challenges.