Coronary Angiography, Coronary Artery Disease, Puncture, Radial Artery, Vascular Access Complication
Conditions
Keywords
radial artery, distal transradial approach, access complication, anatomical snuffbox
Brief summary
The distal transradial approach (dTRA) via the anatomical snuffbox is hypothesized to be more beneficial than the conventional transradial access (cTRA) in patients undergoing coronary procedures. This prospective single-center randomized trial was designed to investigate the safety, efficacy, and various ultrasound parameters of dTRA.
Detailed description
Transradial approach (TRA) has emerged in most countries as a default strategy in urgent and elective coronary procedures. The advantages of TRA compared to the transfemoral access encompass a reduction of mortality, complications, and cost as well as improvement of patient's comfort. The aim of the present study (ANTARES, distAl vs coNventional Transradial Access for coRonary procEdures Study) was to assess the feasibility, safety and various ultrasound parameters of dTRA in the anatomical snuffbox as the first-line strategy, in comparison with cTRA, in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). The study is a non-inferiority, randomized controlled trial. There are two arms: distal transradial access and conventional transradial approach. 400 patients were enrolled.
Interventions
OTHERdistal radial artery acess side
coronary procedure (coronary angiography and/or coronary angioplasty) by the distal radial artery in the anatomical snuffbox area
OTHERconventional radial artery acess side
coronary procedure (coronary angiography and/or coronary angioplasty) by the forearm radial artery in the anatomical snuffbox area
Sponsors
Łukasz Koziński
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Intervention model description
Prospective, single-center, randomized trial
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* patients referred for CAG and/or PCI
Exclusion criteria
* ST-elevation myocardial infarction * sudden cardiac arrest * hemody-namic instability * chronic kidney disease (stages 4-5) * forearm artery occlusion * previous unsuccessful ipsilateral TRA * unfavorable RA diameter * ultrasound unavailability
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The primary composite endpoint consisted of rate of access crossover, rate of major adverse cardiovascular events (MACE) and rate of access-related vascular complications. | up to 24 hours | Access crossover from unsuccessful random arterial access (if the initial access point fails) to another one. Access-related complications after the procedure measured with Doppler Ultrasound (included radial artery occlusion, significant hematoma (EASY classification grade III-V), arteriovenous fistula, pseudoaneurysm, perforation and spasm). MACE definied as myocardial infarction, stroke, urgent revascularization, all-cause death. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| safety endpoint: patients' discomfort evaluated during access performance | during the procedure | physical discomfort at the time of vascular access performance was assessed using a numerical scale (0/1/2/3 - respectively no/mild/moderate/severe discomfort) |
| efficacy endpoint: rate of access crossover | during the procedure index | Access crossover from unsuccessful random arterial access (if the initial access point fails) to another one. |
| efficacy endpoint: duration of access performance | during the procedure index | (measured from the time of skin puncture with local anesthetic to the successful sheath insertion confirmed by an outflow of arterial blood) |
| safety endpoint: access-site vascular complications | after 24 hours post procedure | it is composed by the rate of radial artery occlusion, significant hematoma (EASY classification grade III-V), arteriovenous fistula, pseudoaneurysm, perforation and spasm; measured with Doppler Ultrasound |
Other
| Measure | Time frame | Description |
|---|---|---|
| radial artery velocity | before the procedure, 24 hours and 60 days after the procedure | parameter measured by Doppler Ultrasound at the access point |
| radial artery size | before the procedure, 24 hours and 60 days after the procedure | parameter measured by Doppler Ultrasound at the access point |
| Access-time | during procedure | counted from local anesthesia to successful insertion of the sheath |
Countries
Poland
Outcome results
None listed