Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. May 26, 2021; 13(5): 144-154
Published online May 26, 2021. doi: 10.4330/wjc.v13.i5.144
Efficacy and safety of distal radial approach for cardiac catheterization: A systematic review and meta-analysis
Toshihide Izumida, Jun Watanabe, Ryo Yoshida, Kazuhiko Kotani
Toshihide Izumida, Division of Community Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi 935-8531, Toyama, Japan
Jun Watanabe, Kazuhiko Kotani, Center for Community Medicine, Jichi Medical University, Shimotsuke-City 329-0498, Tochigi, Japan
Ryo Yoshida, Department of Internal Medicine, Iwami Hospital, Iwami-Town 681-0003, Tottori, Japan
Author contributions: Izumida T contributed acquisition of data, analysis and interpretation of data, drafting the article, and final approval; Watanabe J contributed conception and design of the study, acquisition of data, analysis and interpretation of data, drafting the article, and final approval; Yoshida R contributed analysis and interpretation of data, and final approval; Kotani K contributed interpretation of data, critical revision, and final approval.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kazuhiko Kotani, MD, PhD, Doctor, Full Professor, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City 329-0498, Tochigi, Japan. kazukotani@jichi.ac.jp
Received: January 11, 2021
Peer-review started: January 11, 2021
First decision: February 28, 2021
Revised: March 9, 2021
Accepted: April 26, 2021
Article in press: April 26, 2021
Published online: May 26, 2021
Processing time: 133 Days and 6.4 Hours
Abstract
BACKGROUND

The traditional radial approach (RA) is recommended as the standard method for coronary angiography (CAG), while a distal RA (DRA) has been recently used for CAG.

AIM

To assess the efficacy and safety of the DRA vs RA during CAG.

METHODS

The following databases were searched through December 2020: MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, the World Health Organization International Clinical Trials Platform Search Portal, and ClinicalTrials.gov. Individual randomized-controlled trials for adult patients undergoing cardiac catheterization were included. The primary outcomes were the successful cannulation rate and the incidence of radial artery spasm (RAS) and radial artery occlusion (RAO). Study selection, data abstraction and quality assessment were independently performed using the Grading of Recommendations, Assessment, Development, and Evaluation approach.

RESULTS

Three randomized control trials and 13 registered trials were identified. The two approaches showed similar successful cannulation rates [risk ratio (RR) 0.90, 95% confidence interval (CI): 0.72-1.13]. The DRA did not decrease RAS (RR 0.43, 95%CI: 0.08-2.49) and RAO (RR 0.48, 95%CI: 0.18-1.29). Patients with the DRA had a shorter hemostasis time in comparison to those with the RA (mean difference -6.64, 95%CI: -10.37 to -2.90). The evidence of certainty was low.

CONCLUSION

For CAG, the DRA would be safer than the RA with comparable cannulation rates. Given the limited data, additional research, including studies with standard protocols, is necessary.

Keywords: Radial artery; Cardiac catheterization; Coronary angiography; Snuff box; Systematic review; Meta-analysis

Core Tip: No consensus is available in the literature about which technique for coronary angiography—distal radial approach (DRA) or radial approach (RA)—is more beneficial to patients. This is the first systematic review and meta-analysis to compare clinical data on the DRA and RA. We investigated the successful cannulation rate, the incidence of radial artery spasm and radial artery occlusion, the mean number of punctures, and the mean time for hemostasis with the two approaches. The present study indicated the DRA to be safer than the RA, with comparable procedure rates. Further research, including studies with standard protocols, is required to establish clinical practice using the DRA.