Distal Radial Artery Access for Coronary Artery Assessment and Intervention: A Single-Centre Retrospective Experience

Arterial access options for coronary angiography (CAG) and percutaneous coronary intervention (PCI) include femoral, brachial, ulnar, and radial arteries. First reported in 2010 and more intentionally as the first line in 2017, distal transradial artery (dTRA) access through the anatomic snuffbox is a novel approach for coronary interventions. The purpose of this retrospective, single-centre, observational study was to evaluate the safety, feasibility, duration to haemostasis, and time to access the distal radial artery through the anatomical snuffbox. The inclusion criterion was the presence of a distal radial pulse. We analysed patient characteristics, procedural outcomes, and complications of diagnostic angiograms with dTRA access through the anatomical snuffbox. We identified 131 patients with dTRA access from February 2019 to February 2020. Of the 131 patients, 77% were male with a mean age of 64.3 ± 11.8 years (range, 35–91). Our average time to access was 2:01 min. Five attempts at dTRA were unsuccessful but were converted to proximal transradial access successfully. The mean duration to haemostasis was 145 ± 91 min. Four cases (3.1%) had small (< 3 cm) haematomas post-procedurally that resolved prior to discharge. There was no incidence of radial artery occlusion, hand ischemia, numbness, infection, arteriovenous fistula, or pseudoaneurysm at discharge and 6-week follow-up. Secondary analysis of patients with known follow-up data revealed similar safety and feasibility findings. This is Australia’s first large-scale study demonstrating that the anatomic snuffbox approach for dTRA access had a low 6-week complication rate. dTRA should be considered as an access method for coronary angiography and intervention when possible.