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Real-world experience of the left distal transradial approach for coronary angiography and percutaneous coronary intervention: a prospective observational study (LeDRA).

AIMS
This study aimed to evaluate the feasibility and safety of the left distal transradial approach (ldTRA) as a default route for coronary angiography (CAG) and percutaneous coronary intervention (PCI).


METHODS AND RESULTS
Between October 2017 and January 2018, 200 consecutive patients were enrolled in a single centre. The left distal radial artery was punctured with a 20-gauge venipuncture catheter needle by three expert left radial approach operators. The success rates of arterial puncture, CAG, and PCI were 95.5% (191/200), 100% (187/187), and 98.9% (86/87), respectively. Four patients scheduled for staged PCI skipped the routine diagnostic CAG. Puncture time and fluoroscopic time were 3.0±2.8 minutes and 11.3±18.4 minutes, respectively. Haemostasis time was 151.8±39.9 minutes. A total of 15 (7.9%) puncture site complications occurred, including 14 (7.4%) minor haematomas and one (0.5%) arterial dissection, in which the artery was patent at one-month follow-up. Two patients complained of left thumb numbness at one-month follow-up. No distal radial artery occlusion, perforation, pseudoaneurysm, or arteriovenous fistula occurred.


CONCLUSIONS
The success and complication rates of ldTRA support the feasibility and safety of this procedure. Larger randomised comparison studies are needed to support this preliminary evidence.