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Recently, a new approach for arterial access has been introduced using the distal transradial artery approach (dTRA), which is located at the snuffbox, around the thumb at the dorsal hand.
The distal radial approach is being recommended for the following reasons:
May reduce radial artery occlusion (RAO)1-4
Radiation exposure could decrease
With the conventional transradial approach potentially there is an elevated fluoroscopy-related radiation exposure for operators vs the transfemoral approach1
May reduce the rate of complications, (including radial artery spasm)1
Ergonomic positioning may improve
The transradial approach can require awkward positioning of operator relative to patient if left-sided access is needed whilst the operator is seated on patient's right1
Data from registries and case series are providing insights into the safety and effectiveness of dTRA, but further clinical evidence from large randomized trials will be instrumental to establish the benefits and limitations of this access method and potentially have an important clinical impact for radial operators.
The DISCO RADIAL trial is the first large international randomized trial investigating the benefits of dTRA vs conventional TRA.
DISCO RADIAL is a prospective, global, open label, multi-centre randomized controlled trial with plan to include approximately 1,300 patients across 14 sites in 10 countries on who transradial coronary angiography and/or intervention is performed.
The trial compares the novel distal radial access with conventional radial access approach, in terms of radial occlusion rates (RAO) at discharge.
Clinicaltrials.gov. NCT04171570. Available at: https://clinicaltrials.gov/ct2/show/NCT04171570; Terumo data on file.
Dr. Adel Aminian, C.H.U. de Charleroi, Belgium Dr. Shigeru Saito, Shonan Kamakura General Hospital, Japan
~1,300 patients requiring transradial coronary angiography and/or intervention
Successful sheath insertion rate
Access site crossover rate
Total procedure time
Sheath insertion time
Puncture site bleeding according to EASY criteria
Overall bleeding according to BARC criteria
Vascular access-site complication
Rate of radial artery spasm
Rate of distal RAO
Achievement or not of patent haemostasis by reverse Barbeau test
Time required to reach haemostasis
Pain associated with the procedure
≥18 years of age
Undergoing diagnostic coronary angiography and/or PCI
Suitable for both dTRA and conventional TRA using 6Fr Glidesheath Slender™
Medical condition that may cause noncompliance with the protocol and/or confound data interpretation
ST-elevated myocardial infarction
Chronic total occlusion lesions in coronary artery
Ultra-thin wall allowing
1Fr reduction in outer diameter
Retains larger inner diameter
4. Eid-Lidt G. et al. JACC Cardiovasc Interv 2021; Feb 22;14(4):378-385
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