Distal vs Conventional Transradial Access for Coronary Procedures

Comparison of Distal and Conventional Transradial Access for Coronary Catheterization: A Multicenter, Quasi-Randomized Study

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.

Inclusion Criteria:

1. Age ≥ 18 years
2. Undergoing diagnostic coronary angiography or percutaneous coronary intervention via an intended radial approach
3. Palpable radial pulse at the intended puncture site
4. Able to provide written or verbal informed consent
5. No contraindication to radial artery access at the intended site, as determined by the treating operator

Exclusion Criteria:

1. Age < 18 years
2. Inability to provide informed consent
3. Absent or non-palpable radial pulse at the intended access site
4. Active pregnancy
5. Medical condition likely to cause non-compliance with the study protocol or confound data interpretation