Efficacy and safety of distal radial approach for cardiac catheterization: A systematic review and meta-analysis

doi:10.4330/wjc.v13.i5.144

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May 26, 2021 (publication date) through Mar 3, 2026

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World Journal of Cardiology

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1949-8462

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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.

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

ARTICLE HIGHLIGHTS

Research background

While the traditional radial approach (RA) is the gold standard method for cardiac catheterization, a distal RA (DRA) has been recently introduced.

Research motivation

The DRA may have some advantages compared to RA; however, it is not fully understood as to which technique for coronary angiography—DRA or RA—is more beneficial to the patients.

Research objectives

Via the systematic review and meta-analysis, we compared clinical data using the DRA and RA.

Research methods

The databases MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, the World Health Organization International Clinical Trials Platform Search Portal and ClinicalTrials.gov were searched. All randomized-controlled trials for adult patients undergoing cardiac catheterization until December 2020 were included. The primary outcomes were the successful cannulation rate and the incidence of radial artery spasm (RAS) and radial artery occlusion (RAO). The statistical analysis was performed on a random-effect model to pool the relative risk ratios (RRs) and 95% confidence intervals (CIs) for the binary variables, such as cannulation success, RAS, and RAO.

Research results

Three randomized-control trials including 519 participants and 13 registered trials were identified. The two approaches showed similar successful cannulation rates (RR 0.90, 95%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). The evidence of certainty was low.

Research conclusions

The present study indicated the DRA to be safer than the RA, with comparable procedure rates. Importantly, there are limitations, including the limited study numbers and no studies with standard protocols, that prevent definitive conclusions.

Research perspectives

Further research, including studies with standard protocols, is required to establish clinical practice using the DRA.