Radial Artery Occlusion Following Coronary Catheterization
Conditions
Brief summary
Background: Radial artery occlusion (RAO) is a recognized complication of transradial coronary access, with reported incidence rates ranging from 5% to 30%. Distal radial access (DRA), performed at the anatomical snuffbox, has emerged as a promising alternative that may better preserve radial artery patency by maintaining antegrade perfusion through the palmar arch during hemostasis. Objective: To compare distal radial access with conventional transradial access in terms of radial artery patency and access-site outcomes in a real-world all-comers population undergoing coronary angiography or percutaneous coronary intervention. Methods: This prospective, multicenter, open-label, quasi-randomized comparative study enrolled 350 patients across three community-based hospitals in Palestine and Jordan between 2024 and 2026. Patients were allocated in a 1:1 ratio to DRA (n=183) or conventional transradial access (n=167) using an alternating sequence. The primary endpoint was radial artery patency assessed by blinded duplex ultrasonography at 24 hours and at 1 to 6 months. Secondary endpoints included access-site pain, bruising, numbness, and crossover to an alternative access site. The 24-hour outcome was analyzed by intention-to-treat and long-term outcomes by per-protocol analysis. Adjusted analyses used Firth penalized logistic regression.
Interventions
PROCEDUREConventional Transradial Artery Access
Using Conventional Transradial Artery Access for Cardiac Catheterization
PROCEDUREDistal Radial Artery Access
Using Distal Radial Artery access for Cardiac Catheterization
Sponsors
Jordanian Research and Artificial Intelligence Group
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
The ultrasound operator is blinded to the group of the patient.
Intervention model description
Participants were allocated using an alternating sequence (quasi-randomized, non-concealed allocation), reflecting real-world practice.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age ≥ 18 years 2. Undergoing diagnostic coronary angiography or percutaneous coronary intervention via an intended radial approach 3. Palpable radial pulse at the intended puncture site 4. Able to provide written or verbal informed consent 5. No contraindication to radial artery access at the intended site, as determined by the treating operator
Exclusion criteria
1. Age \< 18 years 2. Inability to provide informed consent 3. Absent or non-palpable radial pulse at the intended access site 4. Active pregnancy 5. Medical condition likely to cause non-compliance with the study protocol or confound data interpretation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Radial artery occlusion (RAO) assessed by duplex ultrasonography | 24 hours and 1-6 months post procedure | Radial artery occlusion defined as absence of antegrade flow on duplex ultrasonography, assessed within 24 hours and at 1-6 months after the procedure. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Access-Site Pain | 24 hours and 1-6 months post-procedure. | The patients will be asked to rate their pain on a 1-10 scale. |
| Crossover to Alternative Access Site | At the time of procedure | In cases where radial access is unsuccessful, crossover to an alternative access site, such as the contralateral radial or femoral artery, will be documented |
| Access-Site Numbness | 24 hours and 1-6 months post-procedure | Number of participants with numbness at the access site assessed by physical examination. |
| Access-Site Bruising | 24 hours and 1-6 months post-procedure | Number of participants with bruising at the access site assessed by physical examination. |
Countries
Jordan
Contacts
PRINCIPAL_INVESTIGATORMahmoud Izraiq, Medical Doctor
The Specialty Hospital
PRINCIPAL_INVESTIGATORRaed Aqel, Medical Doctor
Al-Mezan Medical Center
Outcome results
None listed