One-Year Findings Compare Distal Versus Radial Artery Access for Cardiac Catheterization

May 18, 2023—The Distal versus Proximal Radial Artery Access for Cardiac Catheterization and Intervention (DIPRA) randomized-controlled trial compared outcomes of hand function and effectiveness of conventional proximal radial artery (PRA) access versus distal radial artery (DRA) access for cardiac catheterization, announced the Society for Cardiovascular Angiography & Interventions (SCAI).

The single-center DIPRA study randomized 300 patients 1:1 to cardiac catheterization through either DRA or PRA. The study’s 1-year findings were presented at the SCAI 2023 Scientific Sessions held May 18-20 in Phoenix, Arizona.

According to SCAI, current guidelines for patients undergoing percutaneous coronary intervention recommend PRA access; however, a complication of PRA is radial artery occlusion, which can compromise the access of the artery for future coronary bypass surgery, dialysis, or other cardiovascular procedures.

The primary endpoint of the study was change in hand function from baseline to 1 year. Hand function was a composite of the QuickDASH questionnaire, hand grip test, and thumb-forefinger pinch test. Secondary endpoints included access feasibility, radial artery patency, and complications.

As summarized in the SCAI press release, 216 patients in the study completed 1-year follow-up; of these, 112 patients had been randomized to DRA and 104 to PRA. Both groups had similar access-site bleeding rates (DRA 0% vs PRA 1.4%; P = .25). Six DRA patients failed access compared to two PRA patients. Radial artery occlusion occurred in one PRA patient versus two in DRA.

At 1 year, there were no significant differences in the change of hand function, in hand grip (DRA 0.7 [–3, 4.5] vs PRA 1.3 [–2, 4.3] kg; P = .57), pinch grip (DRA –0.1 [-1.1, 1] vs PRA –0.3 [–1, 0.7] kg; P = .66), and QuickDASH (DRA 0 [–6.6, 2.3] vs PRA 0 [–4.6, 2.9] points; P = .58). The composite of hand function was comparable between PRA and DRA at 1 year.

Karim Al-Azizi, MD, an interventional cardiologist at Baylor Scott & White Health in Plano, Texas, is lead author of the study.

“We know that radial artery occlusion is a potential complication of repeated heart catheterizations through the wrist,” commented Dr. Al-Azizi in the SCAI press release. “We also know that distal radial artery access in the base of the thumb carries a lower risk for this complication.”

Dr. Al-Azizi continued, “The 1-year safety results presented at SCAI are reassuring and offer physicians an alternative approach for patients who need radial access, such as patients with chronic kidney disease for dialysis access or coronary artery disease patients who need bypass grafting.”