Traditional Versus Distal Radial Access for Coronary Diagnostic and Revascularization Procedures: Final Results of the TENDERA Multicenter, Randomized Controlled Study.

Background: Traditional transradial access (TRA) is widely used for coronary and non-coronary interventions with significant improvements in procedural outcomes; however, it is associated with RAO that precludes repeat use of the same artery for possible future TRI and other purposes. Distal radial access (DRA) has been proposed as an effective alternative to decrease RAO rates. Published literature describing the RAO rate after DRA versus TRA from various RCT and clinical registries has shown conflicting results.

Distal Radial Access: Is There a Clinical Benefit?

For decades, the femoral artery has been the most common vascular access for diagnostic and therapeutic endovascular procedures. However, over the past 20 years, radial access has been gaining popularity, as it is a safer and allows practical access with more benefits. Recently, the new distal radial access has proven to be an equal or perhaps even safer vascular access for diagnostic and therapeutic coronary and noncoronary interventions.

Distal Radiation Access as an Alternative to Conventional Radial Access for Coronary Angiography and Percutaneous Coronary Interventions (According to TENDERA Trial).

The aim of this study was to assess the immediate and medium-term (3 months) results of the safety and efficacy of distal radial access (DRA) in coronary interventions compared with conventional transradial radial access (TRA). TRA is the recommended access for coronary procedures because of increased safety: fewer local complications, large and small bleeding. Recently, DRA has emerged as a promising alternative access to minimize radial artery occlusion (RAO) risk, as well as other complications.

A narrative review of history, advantages, future developments of the distal radial access.

This article presents a historical excursus and a review of modern literature on distal radial access for interventional surgery, discussing the anatomical and physiological substantiation of the use of this access point in endovascular surgery, its advantages and disadvantages. The main considerations directly related to distal puncture, choice of instrumentation, hemostasis, possible complications, and prevention are analyzed. The major areas of interventional surgery (coronary, vascular, oncological, and neurointerventional), where the distal radial approach is actively used, are reflected and their characteristics are highlighted.

Distal Radial Artery Access in Noncoronary Procedures.

Since the beginning of interventional cardiology and for decades, the femoral artery has been the access of choice for both diagnostic and interventional endovascular procedures. Due to an extensive evidence base accumulated over the last 20 years, the majority of interventional cardiologists around the world prefer classical radial artery access for both elective and emergency procedures. A similar trend has been observed for distal radial artery access over the last 5 years.