Comparative analysis of the dorsopalmar (modified distal) and transradial access in primary percutaneous coronary interventions in patients with acute coronary syndrome

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Abstract

Background: Primary percutaneous coronary interventions (PCI) in acute coronary syndrome (ACS) with transradial access (TRA) are associated with the risk of local complications, such as occlusion of the radial artery (ORA), hematomas, pseudoaneurysms, and arteriovenous fistulas.

Aim: To perform comparative assessment of clinical efficacy and safety of the TRA and dorsopalmar (modified distal) radial access (DpRA) for primary percutaneous coronary intervention in in-patients with ACS.

Materials and methods: This was a randomized, dynamic, single-center, prospective study in two parallel groups. The patients were randomized in a 1:1 ratio into two groups with different types of the radiation access: TRA (n = 100) or DpRA (n = 100). TRA was made at the distal third of the forearm and DpRA on the dorsal palm surface. After the access zone was evaluated by angiography, the pressure bandage was placed on the zone for 6 hours for hemostasis. The comfort of hemostasis was assessed by the Gaston-Johansson 10-point verbal-descriptive pain rating scale. On the 5–7th day after PCI, all patients were examined with palpation and ultrasound assessment of the access artery.

Results: The number of attempts, average duration of the radial artery puncture, duration of the fluoroscopy procedure, and the conversion rate did not depend on the access type. The scoring of the subjective hemostasis comfort showed a significant advantage of DpRA over TRA (6.4 [4; 10] in the TRA group vs 1.7 [0; 6] in the DpRA group, p < 0.001). The rate of EASY III hematomas was 15 (15%) in the TRA group vs 3 (3%) in the DpRA group (p = 0.004). There were no EASY IV–V hematomas, occlusion of the radial artery of the forearm, pseudoaneurysms and arteriovenous fistulas in the DpRA group. The diameter of the forearm radial artery was significantly larger than the diameter on the dorsal palm surface in the patients of both groups, regardless of the type of access chosen (2.75 ± 0.32 mm and 2.38 ± 0.36 mm in the TRA group, p < 0.001; 2.84 ± 0.38 mm and 2.45 ± 0.36 mm in the DpRA group, p < 0.001). In the patients with access conversion in both groups, the diameter of the radial artery at both levels was less than the average one.

Conclusion: DpRA for PCI in ACS patients is a safe alternative to conventional radiation access. Ultrasound examination of the radial artery diameter in its distal and forearm parts before PCI could reduce the conversion rate.

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About the authors

Ruslan V. Akhramovich

Mytischi City Clinical Hospital

Author for correspondence.
Email: russlann2908@rambler.ru
ORCID iD: 0000-0002-0026-6998

Physician, Department of Roentgen-Endovascular Methods of Diagnosis and Treatment

Russian Federation, ul. Kominterna 24, Mytischi, Moscow Region, 141009

Sergey P. Semitko

Scientific and Practical Center for Interventional Cardioangiology of I.M. Sechenov First Moscow State Medical University

Email: semitko@mail.ru
ORCID iD: 0000-0002-1268-5145

Semitko – MD, PhD, Professor, Chair of Interventional Cardioangiology, Institute of Professional Education; Director

Russian Federation, per. Sverchkov 5, Moscow, 101000

Alexey V. Azarov

Scientific and Practical Center for Interventional Cardioangiology of I.M. Sechenov First Moscow State Medical University; Moscow Regional Research and Clinical Institute (MONIKI)

Email: azarov_al@mail.ru
ORCID iD: 0000-0001-7061-337X

MD, PhD, Associate Professor, Chair of Interventional Cardioangiology, Institute of Professional Education; Head of Department of Roentgen-Endovascular Methods of Diagnosis and Treatment

Russian Federation, per. Sverchkov 5, Moscow, 101000; ul. Shchepkina 61/2, Moscow, 129110

Anton I. Analeev

Mytischi City Clinical Hospital

Email: anton-analeev@yandex.ru
ORCID iD: 0000-0002-8500-5569

Head of Department of Roentgen-Endovascular Methods of Diagnosis and Treatment

Russian Federation, ul. Kominterna 24, Mytischi, Moscow Region, 141009

Ilya S. Melnichenko

Mytischi City Clinical Hospital

Email: ilyamel55@gmail.com
ORCID iD: 0000-0002-3081-7201

Physician, Department of Roentgen-Endovascular Methods of Diagnosis and Treatment

Russian Federation, ul. Kominterna 24, Mytischi, Moscow Region, 141009

Irina E. Chernysheva

Scientific and Practical Center for Interventional Cardioangiology of I.M. Sechenov First Moscow State Medical University

Email: avstreyh@yahoo.co
ORCID iD: 0000-0002-9707-0691

MD, PhD, Deputy Director for Clinical Care

Russian Federation, per. Sverchkov 5, Moscow, 101000

Andrey A. Tretyakov

Mytischi City Clinical Hospital

Email: mz_mtsh_gkb@mosreg.ru

MD, PhD, Chief Physician

Russian Federation, ul. Kominterna 24, Mytischi, Moscow Region, 141009

David G. Iosseliani

Scientific and Practical Center for Interventional Cardioangiology of I.M. Sechenov First Moscow State Medical University

Email: davidgi@mail.ru
ORCID iD: 0000-0001-6425-7428

MD, PhD, Professor, Member of Russ. Acad. Sci., Head of Chair of Interventional Cardioangiology, Institute of Professional Education

Russian Federation, per. Sverchkov 5, Moscow, 101000

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Supplementary files

Supplementary Files
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1. Fig. 1. Dorsopalmar (modified distal) radial access. 6Fr sheath introduced into the radial artery on the dorsal surface of the hand

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2. Fig. 2. Dorsopalmar (modified distal) radial access: control access angiography (the red arrow indicates the area of the radial artery puncture, the green arrow indicates the superficial palmar branch of the radial artery r. superficialis)

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3. Fig. 3. Aberrant radial artery originating from the axillary artery (the level of origin is indicated by the red arrow)

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4. Fig. 4. Occlusion of the distal parts of the radial artery according to the ultrasound examination of the access artery performed on the 5th day (indicated by a red arrow), blood flow in the superficial palmar branch of the radial artery (indicated by a green arrow) is preserved [17]

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Copyright (c) 2022 Akhramovich R.V., Semitko S. ., Azarov A.V., Analeev A.I., Melnichenko I.S., Chernysheva I.E., Tretyakov A.A., Iosseliani D.G.

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