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

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.