• Standard (proximal) radial artery access for cardiac catheterization has been shown to decrease vascular access complications, have similar success rates compared to femoral approach, and demonstrate mortality benefit in acute coronary syndrome. Proximal radial artery approach (PRA) has become the dominant strategy for most institutions and operators across the world. 
  • Distal radial artery access, which gained favor starting in 2017 as a potential ergonomic solution to left radial artery access, has also become many operators’ first line approach.  Potential benefits of distal radial artery access (DRA) include more comfortable positioning for both patient and operator for left radial access as well as potential preservation of the radial artery. However, the safety and drawbacks of DRA are not well described. 
  • Grip strength, pinch strength and a QuickDASH survey score were utilized to assess changes in hand function and will be repeated at 12 months in addition to the 30-day results.  
  • Karim Al-Azizi, MD reported the trial's 30-day results of their trial comparing distal versus proximal radial artery access in terms of procedural success rate, safety and complications. 

Why is this study important? 

  • The distal radial approach is a relatively new access technique which gained popularity initially through social media but has never been directly compared to standard radial approach in terms of safety or procedural success rate, in a randomized fashion. 
  • DIPRA is a single center, prospective randomized control trial that enrolled 300 adults at Baylor Scott and White Health - the Heart Hospital Plano. 
  • The radial artery has become the dominant strategy in many places across the world because of its safety in terms of bleeding and patient preference. However, there is evidence to support repeated interventions using standard radial approach may be detrimental in terms of re-access and utilization of a surgical conduit in coronary artery bypass graft surgery. 
  • What question was the study supposed to answer? 
  • The distal radial artery access approach allows the operator to pronate the left hand and work from the right side of the table yielding a clear ergonomic advantage for both patient and operator. 

It is not clear whether DRA has a similar procedural success rate. is associated with an increased risk of complications at the access site or hand dysfunction at a later date. 


What did the study show? 

  • The primary outcome was a composite of hand function change.  The DRA group demonstrated worsening hand function but not to a statistically significant degree. 
  • Secondary endpoint of pinch grip strength was significantly worse in the DRA group at 30 days (DRA -0.2 kg [95% CI -1.2, 0.5] vs. PRA 0 kg [95% CI -0.9, 0.9]; p=0.05).
  • There was no significant difference in the secondary endpoint of grip strength at 30 days 
  • Rates of bleeding were similar in both groups (DRA 0% vs. PRA 1.4%, p=0.25).
  • Rates of procedural success were similar in both groups as well (DRA 96.7% vs. PRA 98%; p=0.72).
  • At 30 days, distal radial artery access is safe and is not associated with significant hand dysfunction.

All authors: Jordan Safirstein, MD, FSCAI

Other Specialist Resources for Coronary Heart Disease

Including recently published studies, coverage of late-breaking science, updates from clinical trials and registries, and complex case presentations.