Safety And Efficacy Of Distal Transradial Access In Anatomical Snuffbox For Coronary Angiography And Intervention:a Meta-analysis

Objective:As an emerging puncture route,the distal transradial access(d TRA)in anatomical snuffbox has received much attention since its introduction for its potential benefits in terms of local complications.However,compared with the conventional transradial access(cTRA),the safety and efficacy of dTRA for coronary angiography and/or intervention are still unknown.Therefore,we performed a meta-analysis to evaluate the effectiveness of d TRA vs c TRA in CAG and/or PCI.Methods:China National Knowledge Infrastructure,Wanfang Medical Online,VIP,Pubmed,Embase,and Cochrane Library databases were searched for studies on c TRA vs d TRA in CAG and/or PCI up to October 2021 to evaluate the differences in radial artery puncture success rate,hematoma,radial artery spasm,radial artery occlusion,puncture time,fluoroscopy time,radiation dose area product,total procedure time,and hemostasis time.Results:A total of 5,779 patients from 26 studies were included in the meta-analysis.The results showed that the risk of hematoma(OR=0.80,95%CI: 0.56～1.13,P=0.209)and radial artery spasm(OR=1.04,95%CI: 0.76～1.42,P=0.798)were similar.d TRA was associated with a lower risk of radial artery occlusion(OR=0.35,95%CI: 0.24～0.51,P<0.001).Although d TRA had a lower puncture success rate(OR=0.29,95%CI: 0.16～0.53,P<0.001)and longer puncture time(WMD=1.03,95%CI: 0.68～1.38,P<0.001),d TRA had a shorter hemostasis time(WMD=-83.76,95%CI:-120.02～-47.50,P<0.001),and no significant differences were found in fluoroscopy time(WMD=0.11,95%CI:-0.05～0.26,P=0.191),radiation dose area product(SMD=-0.18,95%CI:-0.79～0.42,P=0.550)and total procedure time(WMD=0.25,95%CI:-1.89～2.40,P=0.816).Conclusion:Compared with cTRA,dTRA had a lower puncture success rate and longer puncture time,but did not affect the total procedure time.In terms of surgical complications,d TRA has a lower risk of radial artery occlusion and a shorter hemostasis time,which is worthy of further evaluation in clinical practice.