LAUSR

BACKGROUND Distal transradial access (dTRA) has been proposed as an alternative to traditional transradial access (TRA) in cardiac catheterization. AIMS The aim of the study was to compare these two transradial approaches: TRA and dTRA in terms of clinical and biochemical aspects. METHODS Two hundred patients qualified for elective coronary procedure were included. The patients were assigned to one of the groups depending on the vascular access. The groups were compared in terms of perceived pain using Visual Analogue Scale (VAS), time of gaining the access, need for conversion and local complications. Additionally, in forty patients circulating endothelial injury markers: Endothelin-1 (ET-1), Interleukin-8 (IL-8) and Soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1) were assessed. RESULTS Successful cannulation was obtained in 84 (100%) in the TRA group and in 98 (84%) subjects in the dTRA (P <0.001). dTRA was associated with higher level of pain perceived at the time of gaining vascular approach than TRA; median VAS score (IQR): 4 (2-5) vs. 2 (2-4) (P = 0.04). The mean time (standard deviation [SD]) needed to cannulate the artery in dTRA was longer than in TRA: 81 (8) seconds vs. 50 (4) seconds (P=0.04). ET-1 concentration was (SD): 2.08 (0.19) [dTRA] vs. 2.00 (0.29) [TRA] pg/ml (P = 0.83); sVCAM-1: 12.71 (3.97) vs. 12.86 (4.29) ng/ml (P = 0.98); IL-8: 8.81 (0.42) vs. 9.15 (0.52) ng/ml (P = 0.62). Number of complications after procedures did not differ between these two approaches. CONCLUSIONS Cannulation of dTRA is associated with lower success rate and higher pain perceived. dTRA is not inferior to TRA when safety issues and vascular injury are considered.