Distal radial access dramatically reduces hemostasis time and bleeding in coronary interventions: a meta-analysis of 7 randomized trials
K Keswani, H W Saqib, T Khan, E Alupei, M N Elshabrawi, A Bakhsh, D S Rajawat, R K Patel, K H Wong, M Yathindra, M Pasha, L Ramamoorthy, S Roy, U Kohli, A DasAbstract
Background
Transradial access has revolutionized interventional cardiology by reducing vascular complications compared to femoral approaches. However, as novel techniques emerge, comprehensive quantitative synthesis comparing these methodologies remains limited, creating uncertainty regarding the optimal procedural strategy.
Introduction
This meta-analysis systematically evaluated the comparative efficacy and safety of distal radial access versus proximal radial access in patients undergoing diagnostic or interventional percutaneous coronary intervention (PCI).
Methods
We conducted a random-effects meta-analysis using the DerSimonian-Laird method, synthesizing data from seven randomized controlled trials. Clinical outcomes evaluated included radial artery occlusion, hematoma formation, time to hemostasis, puncture time, vascular complications, and post-procedural bleeding, as well as sheath insertion time. Heterogeneity was assessed using I² statistics and τ² values.
Results
The meta-analysis revealed clinically significant advantages for distal radial access. Hematoma formation demonstrated a 48% risk reduction (RR=0.52, 95% CI: 0.26-0.78, I²=0.0%). Time to hemostasis decreased dramatically by 137.84 minutes (95% CI: -219.55 to -56.13), despite high heterogeneity (I²=97.6%). Post-procedural bleeding showed a 67% risk reduction (RR=0.33, 95% CI: -0.05-0.71). Radial artery occlusion trended toward 25% reduction (RR=0.75, 95% CI: 0.49-1.01). Trade-offs included modestly increased puncture time (MD=20.03 seconds, 95% CI: 2.80-37.26) and sheath insertion time (MD=12.81 seconds, 95% CI: 8.76-16.86).
Conclusion
Distal radial access significantly reduces major complications, including hematoma formation and post-procedural bleeding, while dramatically accelerating hemostasis compared to standard proximal access in patients undergoing PCI. The minimal procedural time increases are clinically negligible compared to these substantial safety benefits. These findings support adopting distal radial access protocols as a preferred standard practice in contemporary interventional cardiology.visual abstractFor image description, please refer to the figure legend and surrounding text.forest plot hematoma formationFor image description, please refer to the figure legend and surrounding text.