Complications of distal radial approach in percutaneous coronary angiography and intervention
Main Article Content
Abstract
Coronary artery disease is a major global health burden. The distal radial artery approach in coronary intervention is considered an innovation with the potential to reduce complication risks. Although positive data have been reported from several countries, evidence on the safety of this approach in Vietnam remains limited. Therefore, we conducted a descriptive cross-sectional study including all eligible patients at the Interventional Cardiology Department, University Medical Center Ho Chi Minh City, from November 2023 to June 2024. Among 158 patients, the complication rates of the distal radial artery approach were as follows: pain according to the VAS scale - VAS 1 point in 25%, VAS 2 points in 11%, and VAS 4 points in 0.6%. No case had VAS scores > 4 points. Bleeding classified by the EASY scale included grade 1 in 1.3%, grade 2 in 1.9%, and grade 3 in 0.6%. Radial artery occlusion occurred in 4.4% (7/158) of cases. Thus, the distal radial artery approach is a safe option for coronary angiography and percutaneous coronary intervention.
Article Details
Keywords
Percutaneous coronary intervention, distal radial artery, safe, complication
References
2. Global Burden of Cardiovascular Diseases and Risks 2023 Collaborators. Global, Regional, and National Burden of Cardiovascular Diseases and Risk Factors in 204 Countries and Territories, 1990-2023. JACC. 0(0). doi:10.1016/j.jacc.2025.08.015.
3. Gargiulo G, Giacoppo D, Jolly SS, et al. Effects on Mortality and Major Bleeding of Radial Versus Femoral Artery Access for Coronary Angiography or Percutaneous Coronary Intervention: Meta-Analysis of Individual Patient Data From 7 Multicenter Randomized Clinical Trials. Circulation. 2022; 146(18): 1329-1343. doi:10.1161/CIRCULATIONAHA.122.061527.
4. Bernat I, Aminian A, Pancholy S, et al. Best Practices for the Prevention of Radial Artery Occlusion After Transradial Diagnostic Angiography and Intervention: An International Consensus Paper. JACC Cardiovasc Interv. 2019; 12(22): 2235-2246. doi:10.1016/j.jcin.2019.07.043.
5. Sgueglia GA, Lee BK, Cho BR, et al. Distal Radial Access: Consensus Report of the First Korea-Europe Transradial Intervention Meeting. JACC Cardiovasc Interv. 2021; 14(8): 892-906. doi:10.1016/j.jcin.2021.02.033.
6. Korotkikh A, Babunashvili A, Kaledin A, et al. Distal Radiation Access as an Alternative to Conventional Radial Access for Coronary Angiography and Percutaneous Coronary Interventions (According to TENDERA Trial). Curr Probl Cardiol. 2023; 48(4): 101546. doi:10.1016/j.cpcardiol.2022.101546.
7. Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024; 45(36): 3415-3537. doi:10.1093/eurheartj/ehae177.
8. Rao SV, O’Donoghue ML, Ruel M, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025; 151(13): e771-e862. doi:10.1161/CIR.0000000000001309.
9. Silva RL da, Moreira DM, Fattah T, et al. Pain assessment during transradial catheterization using the Visual Analogue Scale. Revista Brasileira de Cardiologia Invasiva (English Edition). 2015; 23(3): 207-210. doi:10.1016/j.rbciev.2015.08.007.
10. Shroff A, Siddiqui S, Burg A, Singla I. Identification and management of complications of transradial procedures. Curr Cardiol Rep. 2013; 15(4): 350. doi:10.1007/s11886-013-0350-x.
11. Koutouzis M, Kontopodis E, Tassopoulos A, et al. Distal Versus Traditional Radial Approach for Coronary Angiography. Cardiovasc Revasc Med. 2019; 20(8): 678-680. doi:10.1016/j.carrev.2018.09.018.
12. Aminian A, Sgueglia GA, Wiemer M, et al. Distal Versus Conventional Radial Access for Coronary Angiography and Intervention: The DISCO RADIAL Trial. JACC Cardiovasc Interv. 2022; 15(12): 1191-1201. doi:10.1016/j.jcin.2022.04.032.
13. Eid-Lidt G, Rivera Rodríguez A, Jimenez Castellanos J, Farjat Pasos JI, Estrada López KE, Gaspar J. Distal Radial Artery Approach to Prevent Radial Artery Occlusion Trial. JACC Cardiovasc Interv. 2021; 14(4): 378-385. doi:10.1016/j.jcin.2020.10.013.
14. Kim Y, Ahn Y, Kim I, et al. Feasibility of Coronary Angiography and Percutaneous Coronary Intervention via Left Snuffbox Approach. Korean Circ J. 2018; 48(12): 1120-1130. doi:10.4070/kcj.2018.0181.
15. Kiemeneij F. Left distal transradial access in the anatomical snuffbox for coronary angiography (ldTRA) and interventions (ldTRI). EuroIntervention. 2017; 13(7): 851-857. doi:10.4244/EIJ-D-17-00079.
16. Al-Azizi KM, Grewal V, Gobeil K, et al. The Left Distal Transradial Artery Access for Coronary Angiography and Intervention: A US Experience. Cardiovasc Revasc Med. 2019; 20(9): 786-789. doi:10.1016/j.carrev.2018.10.023.
17. Lee JW, Kim Y, Lee BK, et al. Distal Radial Access for Coronary Procedures in a Large Prospective Multicenter Registry: The KODRA Trial. JACC Cardiovasc Interv. 2024; 17(3): 329-340. doi:10.1016/j.jcin.2023.11.021.
18. Chen T, Li L, Li F, et al. Comparison of long-term radial artery occlusion via distal vs. conventional transradial access (CONDITION): a randomized controlled trial. BMC Med. 2024; 22(1): 62. doi:10.1186/s12916-024-03281-7.
19. Eid-Lidt G, Rivera Rodríguez A, Jimenez Castellanos J, Farjat Pasos JI, Estrada López KE, Gaspar J. Distal Radial Artery Approach to Prevent Radial Artery Occlusion Trial. JACC: Cardiovascular Interventions. 2021; 14(4): 378-385. doi:10.1016/j.jcin.2020.10.013.