Feasibility of distal trans-radial access in the setting of acute ST-elevation myocardial infarction

Abstract

Background: Trans-radial access (TRA) has been recommended as a preferential route for all cardiac catheterization procedures however with few disadvantages. Distal TRA (dTRA) through the “anatomic snuffbox” might be a better alternative, it has proved its efficiency in different cardiac catheterization procedures but very little is known regarding efficacy in acute ST-elevation myocardial infarction (STEMI) patients. The aim of this study is to determine the utility and efficacy of dTRA in acute STEMI settings. Methods: After obtaining the Institutional Review Board (IRB) approval, a retrospective identification of all consecutive acute STEMI cases which were operated on by a single transradial interventional cardiologist through dTRA approach between January 2019 through September 2019 was performed, and 25 consecutive cases were identified, all utilizing the dTRA route for catheterization. Access time as well as other variables were studied. Results: All patients had successful right distal radial artery catheterization without ultrasound guidance (100% success rate). No mortality was reported. All patients upon discharge had no thumb, hand or arm symptoms, no clinical vascular complications, and intact radial artery pulses. Distal radial artery access time was 45±15 seconds. Conclusions: dTRA is feasible, safe, and time-efficient in most cardiac catheterization procedures including acute STEMI settings.