Distal Radial Artery Approach to Prevent Radial Artery Occlusion (DAPRAO) (DAPRAO)

The main complication of transradial intervention is radial artery occlusion (RAO). This is relevant because it limits the radial approach for future interventions and disables this conduit for coronary bypass grafts and arteriovenous fistula. Observational studies suggest that distal radial access could reduce RAO incidence. The primary endpoint of our study is to compare the efficacy of the distal and proximal transradial approaches in terms of RAO incidence. The safety endpoint is the incidence of complications between these two methods.

Two randomized groups, one receiving traditional radial access and the other receiven distal radial access

Puncture in the snuff box area of the arm with through and through technique, advancement of a wire and placement of an hydrophilic sheath introducer.

Puncture in the ventral side of the arm (2 cm proximal to the styloid apophysis) with through and through technique, advancement of a wire and placement of an hydrophilic sheath introducer.

The primary endpoint of our study is to compare the efficacy of the distal and proximal transradial approaches in terms of RAO incidence.

The primary endpoint of our study is to compare the efficacy of the distal and proximal transradial approaches in terms of RAO incidence.

The RAO will be evaluated 24 hours after the procedure by ultrasound examination and was defined as the absence of both color pattern and pulsed wave registry.

Inclusion Criteria: Perceptible radial artery pulse Diagnostic or interventional procedure feasible to be performed with radial access. Exclusion Criteria: Myocardial infarction with ST segment elevation in time for primary angioplasty. Cardiogenic shock or hemodynamic instability. Clinical, plethysmography or ultrasound suggestive of occlusion of the radial artery Prior recent radial artery access (1 month)