Radial Artery Occlusion Following Right Distal Transradial and Conventional Transradial Coronary Procedures: Incidence, Complications, and Predictors
Background: The transradial approach is gaining popularity for reduced access-site complications, but radial artery occlusion (RAO) remains a concern. The distal transradial approach (dTRA) may preserve patency better than conventional (cTRA). This study aim was to compare RAO rates and procedural outcomes between dTRA and cTRA. Methods: This prospective observational study was conducted at NICVD, Dhaka, from March 2018 to February 2019. A total of 200 patients undergoing coronary angiography and/or percutaneous coronary intervention were divided into two equal groups: Group I (dTRA, n=100) and Group II (cTRA, n=100). Procedural variables, complications, and RAO were assessed. RAO was confirmed by duplex Doppler ultrasonography on the first post-procedural day. Multivariate logistic regression was performed to identify independent predictors of RAO. Results: Puncture time was significantly longer in dTRA (1.91±0.15 vs. 1.79±0.11 min, p=0.001), while hemostasis time was significantly shorter for both CAG (7.5±2.9 vs. 10.0±3.5 min, p=0.03) and PCI (19.0±5.6 vs. 23.0±7.2 min, p=0.03). RAO occurred significantly less in dTRA compared to cTRA (1.0% vs. 5.0%, p=0.04). Independent predictors of RAO included prolonged hemostatic compression time (OR: 8.48 for >4 hours in PCI), procedure time (OR: 1.44), access site complications (OR: 4.89), and cTRA (OR: 5.21, p=0.04). Conclusion: The distal transradial approach is a safe and feasible alternative to the conventional approach, offering significantly lower RAO rates, shorter hemostasis time, and fewer complications despite a slightly longer puncture time. It should be preferred when radial artery preservation is a priority.