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Supported by compelling evidence, conventional TransRadial Access (TRA) and the radial first strategy are now advocated as the default approach by both the ESC/EACTS & ACC/AHA/SCAI Guidelines. Prevention of Radial Artery Occlusion (RAO), the most frequent complication of TRA, is becoming a central consideration for achieving a successful radial program. However, real-world incidence of RAO remains high. Distal Radial Access (DRA) has emerged as a promising alternative to conventional TRA, to help further reduce RAO.
The aim of the DISCO RADIAL trial is to assess the superiority of DRA compared to conventional TRA with respect to the incidence of forearm RAO at discharge, while systematically implementing best practices to reduce RAO.
The DISCO RADIAL trial is a prospective, multicenter, international, open label, randomized, controlled study involving experienced operators qualified for TRA & DRA procedures.
Radial artery occlusion preventive measures included:
The primary endpoint was the incidence of forearm RAO at hospitalization discharge, assessed by an independent investigator not involved in the procedure. For DRA patients, occlusion of both forearm and distal arteries were assessed.
The secondary endpoints included:
* If the initial attempt to obtain vascular access at the randomized access site (DRA or TRA) failed, all further attempts were considered as cross-over. This included the use of the contralateral arm, other arteries or cross-over to the other group
**Defined according to the Bleeding Academic Research Consortium (BARC) criteria
*** Defined according to the Early Discharge After Transradial Stenting of Coronary Arteries Study (EASY) criteria
**** Rated according to self-reported visual analogue scale (VAS)
A total of 1307 patients were randomized in the ITT (Intention-To-Treat) population: 657 in the TRA group & 650 in the DRA group. Patient enrolment aimed for a population representative of routine clinical practice. The percentages below represent the baseline patient characteristics among both groups:
Primary Endpoint Result: Rao at Discharge
More frequent cross over with DRA
More frequent radial artery spasms with DRA
Procedural time was not significantly different, but median time to hemostasis was shorter with DRA
No difference in bleedings, vascular complications, or access-related pain between TRA & DRA
DISCO RADIAL is the first large international randomized clinical trial to -
Provide information on current practice of DRA in experienced radial centers
Support distal radial access as a valid alternative to conventional radial access
Demonstrate equally low forearm RAO rates with conventional & distal radial access, highlighting the importance and clinical benefits of a rigorous hemostasis protocol.
DISCO RADIAL is also the first large international trial implementing best practice recommendations for the reduction of RAO after conventional TRA, including the use of
DISCO RADIAL establishes a new reference in transradial practice for radial artery occlusion prevention, with the lowest ever reported forearm RAO in any multicenter TRA trial, confirming TRA as the gold standard for vascular access.
Link to full publication: https://www.sciencedirect.com/science/article/pii/S1936879822008974
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