• Distal Radial Access Safe, with Low Complication Rates, Similar Success to Proximal Radial Access, DIPRA Study Finds

    Distal radial artery (DRA) access is a safe strategy for cardiac catheterization, with a low complication rate and similar rate of success to proximal radial artery (PRA) access, according to early results from the DIPRA study.

    Karim Al-Azizi, MD, Baylor Scott & White Health – The Heart Hospital Plano, Texas, and the Texas A&M University College of Medicine, presented the trial’s 30-day findings Thursday at the Society for Cardiovascular Angiography & Interventions (SCAI) 2022 Scientific Sessions in Atlanta.

    Proximal radial artery access (PRA) for cardiac catheterization has been shown to be safe and have a mortality benefit in comparison with femoral access, he said.

    Radial access is now a Class I indication for PCI in acute coronary syndromes and stable ischemic heart disease to reduce the risk of death, vascular complications or bleeding, according to the 2021 American College of Cardiology/American Heart Association, SCAI Guideline for Coronary Artery Revascularization.

    However, PRA can jeopardize subsequent use of the radial artery because of radial artery occlusion. DRA in the anatomical snuffbox has the potential to preserve the artery, but its safety and potential detrimental effects on hand function are unknown, Al-Azizi said.

    Therefore, the DIPRA study sought to assess access feasibility and complications, including hand function, after DRA or PRA.

    DIPRA (Distal versus Proximal Radial Artery Access for cardiac catheterization and intervention) is a single-center, prospective randomized controlled trial that enrolled 300 adults at Baylor Scott & White Health – The Heart Hospital Plano.

    Patients were randomized to either DRA or PRA, and follow-up visits were conducted at 1 and 12 months to assess clinical change, reinterventions using the radial artery, measurement of PRA and DRA patency with Doppler ultrasound, assessment of hand function and strength, and pinch grip and Jamar hand hydraulic dynamometer tests.

    Of the 300 patients who were enrolled, 46 were excluded from the evaluation (27 were lost to follow-up, 10 withdrew, four missed follow-up due to COVID-19 restrictions, four were classified as protocol deviations and one experienced a serious adverse event).

    Of the 254 remaining patients, 128 were in the DRA arm and 126 in the PRA group.

    At baseline, the patients had a mean age of 66.6 ± 9.6 years, 75% were male, 32% had diabetes mellitus, 77% had hypertension, and 19% had prior PCI.

    The primary outcome was a composite of hand function change. The DRA group showed worsening hand function as compared to the PRA group, but the difference was not statistically significant (change in average Z-score: DRA -0.04 [95% confidence interval (CI): -0.32, 0.25] vs. PRA 0.10 [95% CI -0.30, 0.53]; p=0.07).

    Among secondary outcomes, only median change in pinch grip strength was significantly better in the PRA group (DRA -0.2 kg [95% CI -1.2, 0.5] vs. PRA 0 kg [95% CI -0.9, 0.9]; p=0.05). There was no significant difference between the groups in change in hand grip strength and QuickDASH survey score.

    There was also no significant difference in intervention outcomes. Both groups had low rates of bleeding (DRA 0% vs. PRA 1.4%, p=0.25) and high rates of successful radial artery access (DRA 96.7% vs. PRA 98%; p=0.72).

    “Recently, we’ve seen growing interest in the distal artery as a unique access for cardiac catheterization,” Al-Azizi said in a news release announcing the study results. “This study serves as reassurance for physicians that should we choose distal radial access over proximal access, it is safe at 30 days and provides minimal risk to hand function.”

    He said the study will assess long-term outcomes, with data to be collected at 1 year.

    Image Credit: iushakovsky – stock.adobe.com

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