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DISTAL TRANSRADIAL ACCESS FOR CORONARY ANGIOGRAPHY AND INTERVENTIONS: PROSPECTIVE REAL-WORLD EXPERIENCE WITH 2,913 ALL-COMERS PATIENTS FROM THE DISTRACTION REGISTRY.
Distal transradial access (dTRA) as a refinement of the conventional transradial approach has several potential advantages in terms of patient and operator comfort, faster hemostasis, and lower risk of proximal radial artery occlusion. We aim to describe our prospective real-world experience with dTRA as default for routine coronary angiography and percutaneous coronary interventions (PCI) in a broad sample of all-comers patients.
Material e Método
From February 2019 to June 2021, 2,913 consecutive all-comers patients submitted to coronary angiography and/or PCI via dTRA have been enrolled into the DISTRACTION registry.
Mean patient age was 63±14.1-year-old, most male (66.5%) and with acute coronary syndromes (51%) at admission. Overall, 596 (20.5%) patients had non-ST-elevation myocardial infarction, 668 (22.9%) had ST-elevation myocardial infarction, and 73 (2.5%) presented in cardiogenic shock. There were 2.4% access site crossovers, 20% of those performed via contralateral dTRA; thus, in only 57 (2%) patients dTRA sheath insertion could not be obtained. Right dTRA was the most frequent access (79.8%), followed by left dTRA (10.3%), redo ipsilateral dTRA (9.2%) and simultaneous bilateral dTRA (0.7%). For 60% of all patients, PCI was performed and left anterior descending was the most prevalent target coronary territory (47.7%). No major adverse cardiac and cerebrovascular events and no major complications directly related to dTRA were recorded.
Discussão e Conclusões
The adoption of dTRA as default for routine coronary angiography and PCI in a real-world fashion of all-comers patients by experienced transradial operators appears to be feasible and safe.
distal transradial access; coronary angiography; percutaneous coronary interventions.
Department of Interventional Cardiology, Hospital Regional do Vale do Paraíba - São Paulo - Brasil, Department of Interventional Cardiology, Hospital Universitario I, Escola Paulista de Medicina, Universidade Federal de São Paulo - São Paulo - Brasil
MARCOS DANILLO PEIXOTO OLIVEIRA, EDNELSON CUNHA NAVARRO, NATHALIA DA GRAÇA OLIVEIRA PRÓSPERO, ADRIANO CAIXETA