Feasibility of Distal Radial Access in High Bleeding Risk Patients Who Underwent Percutaneous Coronary Intervention.

Backgrounds And Objectives: The distal radial access (DRA), a potential alternative to the trans-radial approach (TRA), may offer advantages in terms of access site complications due to its smaller vessel diameter, especially for high bleeding risk (HBR) patients. This study aims to investigate the feasibility of DRA in HBR patients.

Methods: Based on data from the KODRA registry, a prospective, multicenter cohort, this study analyzed 1,586 patients who underwent successful percutaneous coronary intervention (PCI) via DRA. Patients were categorized into HBR and non-HBR groups. The primary endpoint of the study is DRA-related bleeding, and the secondary endpoints of the study are overall access site complications and each component of the access site complications. To reduce the effect of potential confounders, a multivariable adjustment analysis was performed.

Results: The mean age of the total population was 71.1±10.8 years, and 40.3% of patients were female. Both DRA-related bleeding (odds ratio [OR], 1.15; 95% confidence interval [CI], 0.67-1.97; p=0.616) and overall access site complications (OR, 1.08; 95% CI, 0.67-1.72; p=0.761) were not significantly different between the HBR group and non-HBR group after multivariable adjustment. No major bleeding before discharge was observed in both groups. Furthermore, the incidence of distal and conventional radial artery occlusion was less than 1% at 1-month follow-up in both groups.

Conclusions: Our study results showed the safety of DRA for both DRA-related bleeding and access site complications among HBR patients who underwent PCI.

Trial Registration: ClinicalTrials.gov Identifier: NCT04080700.