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Background <p>Distal transradial access (dTRA) is increasingly utilized for coronary angiography and percutaneous coronary intervention, but its technical maturation and residual failure mechanisms remain incompletely defined. This study evaluated the learning process and residual failure profile of dTRA in a real-world consecutive cohort.</p> Methods <p>This single-center retrospective observational registry included 3422 consecutive dTRA attempts performed between July 2022 and May 2026. Attempts were ordered by procedure date, with de-identified unique patient identifiers used as deterministic tie-breakers for attempts performed on the same date, and divided chronologically into five consecutive case phases. Technical maturation was assessed using study-start-anchored calendar intervals, cumulative case-phase analysis, 200-attempt rolling windows, and exploratory observed-minus-expected cumulative sum analysis. Failure mechanisms were classified using predefined criteria.</p> Results <p>The overall technical success rate was 94.48% (95% CI 93.66–95.19%). Failure rates from phases 1 to 5 were 9.34%, 5.11%, 4.38%, 4.09%, and 4.69%, respectively. Compared with the early learning phase, the relatively stable phase had lower failure risk (RR, 0.49; 95% CI 0.37–0.65). The highest 200-attempt rolling-window failure rate was 16.00%, and the final window rate was 4.00%. Failure to puncture or obtain effective blood return and guidewire/support-wire failure accounted for 56.08% and 37.57% of failures, respectively.</p> Conclusions <p>dTRA achieved a high technical success rate in real-world coronary procedures. Failure rates declined after the initial case phase and subsequently fluctuated within a relatively narrow range, while residual failures remained concentrated in early access-building steps. These findings may inform dTRA adoption and quality-improvement strategies in centers expanding this access route.</p>

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Technical maturation and residual failure mechanisms of distal transradial access for coronary angiography and percutaneous coronary intervention: a real-world study of 3422 consecutive attempts

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月5日

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  • Wenfang Zhu,
  • Jinpeng Xu,
  • Yuhong Chen,
  • Xiaoliang Han,
  • Huijuan Shang,
  • Xiaofei Xie,
  • Liang Zhang

摘要

Background

Distal transradial access (dTRA) is increasingly utilized for coronary angiography and percutaneous coronary intervention, but its technical maturation and residual failure mechanisms remain incompletely defined. This study evaluated the learning process and residual failure profile of dTRA in a real-world consecutive cohort.

Methods

This single-center retrospective observational registry included 3422 consecutive dTRA attempts performed between July 2022 and May 2026. Attempts were ordered by procedure date, with de-identified unique patient identifiers used as deterministic tie-breakers for attempts performed on the same date, and divided chronologically into five consecutive case phases. Technical maturation was assessed using study-start-anchored calendar intervals, cumulative case-phase analysis, 200-attempt rolling windows, and exploratory observed-minus-expected cumulative sum analysis. Failure mechanisms were classified using predefined criteria.

Results

The overall technical success rate was 94.48% (95% CI 93.66–95.19%). Failure rates from phases 1 to 5 were 9.34%, 5.11%, 4.38%, 4.09%, and 4.69%, respectively. Compared with the early learning phase, the relatively stable phase had lower failure risk (RR, 0.49; 95% CI 0.37–0.65). The highest 200-attempt rolling-window failure rate was 16.00%, and the final window rate was 4.00%. Failure to puncture or obtain effective blood return and guidewire/support-wire failure accounted for 56.08% and 37.57% of failures, respectively.

Conclusions

dTRA achieved a high technical success rate in real-world coronary procedures. Failure rates declined after the initial case phase and subsequently fluctuated within a relatively narrow range, while residual failures remained concentrated in early access-building steps. These findings may inform dTRA adoption and quality-improvement strategies in centers expanding this access route.