BACKGROUND Currently, transradial access (TRA) is the recommended access for coronary
procedures because of increased safety, with radial artery occlusion (RAO) being its
most frequent complication, which will increasingly affect patients undergoing multiple
procedures during their lifetimes. Recently, distal radial access (DRA) has emerged
as a promising alternative access to minimize RAO risk. A large-scale, international,
randomized trial comparing RAO with TRA and DRA is lacking. OBJECTIVES The aim of
this study was to assess the superiority of DRA compared with conventional TRA with
respect to forearm RAO. METHODS DISCO RADIAL (Distal vs Conventional Radial Access)
was an international, multicenter, randomized controlled trial in which patients with
indications for percutaneous coronary procedure using a 6-F Slender sheath were randomized
to DRA or TRA with systematic implementation of best practices to reduce RAO. The
primary endpoint was the incidence of forearm RAO assessed by vascular ultrasound
at discharge. Secondary endpoints include crossover, hemostasis time, and access site-related
complications. RESULTS Overall, 657 patients underwent TRA, and 650 patients underwent
DRA. Forearm RAO did not differ between groups (0.91% vs 0.31%; P = 0.29). Patent
hemostasis was achieved in 94.4% of TRA patients. Crossover rates were higher with
DRA (3.5% vs 7.4%; P = 0.002), and median hemostasis time was shorter (180 vs 153
minutes; P < 0.001). Radial artery spasm occurred more with DRA (2.7% vs 5.4%; P =
0.015). Overall bleeding events and vascular complications did not differ between
groups. CONCLUSIONS With the implementation of a rigorous hemostasis protocol, DRA
and TRA have equally low RAO rates. DRA is associated with a higher crossover rate
but a shorter hemostasis time. (C) 2022 The Authors. Published by Elsevier on behalf
of the American College of Cardiology Foundation.
