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Background: Radial artery occlusion (RAO) is a recognized complication of transradial coronary access, with reported incidence rates ranging from 5% to 30%. Distal radial access (DRA), performed at the anatomical snuffbox, has emerged as a promising alternative that may better preserve radial artery patency by maintaining antegrade perfusion through the palmar arch during hemostasis.
Objective: To compare distal radial access with conventional transradial access in terms of radial artery patency and access-site outcomes in a real-world all-comers population undergoing coronary angiography or percutaneous coronary intervention.
Methods: This prospective, multicenter, open-label, quasi-randomized comparative study enrolled 350 patients across three community-based hospitals in Palestine and Jordan between 2024 and 2026. Patients were allocated in a 1:1 ratio to DRA (n=183) or conventional transradial access (n=167) using an alternating sequence. The primary endpoint was radial artery patency assessed by blinded duplex ultrasonography at 24 hours and at 1 to 6 months. Secondary endpoints included access-site pain, bruising, numbness, and crossover to an alternative access site. The 24-hour outcome was analyzed by intention-to-treat and long-term outcomes by per-protocol analysis. Adjusted analyses used Firth penalized logistic regression.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Conventional Transradial Access Group | Experimental |
| |
| Distal Radial Artery Access Group | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Conventional Transradial Artery Access | Procedure | Using Conventional Transradial Artery Access for Cardiac Catheterization |
|
| Measure | Description | Time Frame |
|---|---|---|
| Radial artery occlusion (RAO) assessed by duplex ultrasonography | Radial artery occlusion defined as absence of antegrade flow on duplex ultrasonography, assessed within 24 hours and at 1-6 months after the procedure. | 24 hours and 1-6 months post procedure |
| Measure | Description | Time Frame |
|---|---|---|
| Access-Site Pain | The patients will be asked to rate their pain on a 1-10 scale. | 24 hours and 1-6 months post-procedure. |
| Crossover to Alternative Access Site | In cases where radial access is unsuccessful, crossover to an alternative access site, such as the contralateral radial or femoral artery, will be documented |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Mahmoud Izraiq, Medical Doctor | The Specialty Hospital | Principal Investigator |
| Raed Aqel, Medical Doctor | Al-Mezan Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Specialty Hospital | Amman | Shmeisani | Jordan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 28636520 | Background | Sinha SK, Jha MJ, Mishra V, Thakur R, Goel A, Kumar A, Singh AK, Sachan M, Varma CM, Krishna V. Radial Artery Occlusion - Incidence, Predictors and Long-term outcome after TRAnsradial Catheterization: clinico-Doppler ultrasound-based study (RAIL-TRAC study). Acta Cardiol. 2017 Jun;72(3):318-327. doi: 10.1080/00015385.2017.1305158. Epub 2017 Mar 30. |
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Participants were allocated using an alternating sequence (quasi-randomized, non-concealed allocation), reflecting real-world practice.
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The ultrasound operator is blinded to the group of the patient.
| Distal Radial Artery Access | Procedure | Using Distal Radial Artery access for Cardiac Catheterization |
|
| At the time of procedure |
| Access-Site Numbness | Number of participants with numbness at the access site assessed by physical examination. | 24 hours and 1-6 months post-procedure |
| Access-Site Bruising | Number of participants with bruising at the access site assessed by physical examination. | 24 hours and 1-6 months post-procedure |