Publication:

Comparison of puncture outcome between prolonged occlusion flow mediated dilatation method and conventional method during distal radial artery cannulation in coronary intervention

Background Distal transradial access is increasingly used for coronary angiography (CAG) and percutaneous coronary intervention (PCI), but radial artery cannulation can be technically demanding due to a steeper learning curve and smaller vessel caliber. Prolonged occlusion flow-mediated dilatation (PO-FMD) is a novel technique that may enhance distal radial artery (DRA) access by promoting vasodilatation. Aim was to compare the efficacy and vascular access-site complications of PO-FMD versus the conventional technique during distal transradial artery cannulation.

Methods This cross-sectional analytic study was conducted at the department of cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, from March 2021 to February 2022. A total of 200 purposively selected patients with coronary artery disease (CAD) undergoing CAG with or without PCI via distal radial access were enrolled. Participants divided into 2 groups: Group I (PO-FMD, n=100) and II (conventional method, n=100). Efficacy outcomes included access time, procedural time, number of attempts, 1st-attempt success rate, and crossover rate. Vascular access-site complications such as hematoma, radial artery spasm, and radial artery occlusion were also assessed.

Results Crossover to another access site was significantly lower in group I compared to group II (5% vs. 15%, p=0.030). Access time was shorter with PO-FMD (58.8±10.1 seconds vs. 78.9±7.9 seconds; p=0.006). Group I demonstrated fewer attempts and a higher first-attempt success rate (p=0.015 and p=0.021, respectively). Radial artery spasm and occlusion were significantly reduced in the PO-FMD group (p=0.048 and p=0.039). No significant differences were observed in hematoma formation or total procedural time.

Conclusions PO-FMD-mediated radial artery dilatation appears to be a safer and more effective technique than the conventional method for DRA cannulation.