Efficacy and Safety of the Distal Radial Approach

NCT ID: NCT05311111

Last Updated: 2022-04-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

250 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-02-01

Study Completion Date

2022-06-30

Brief Summary

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The aim of this non-inferiority trial is to determine if the distal radial access (DRA) during percutaneous coronary intervention (PCI) has an acceptable efficacy compared to the reference access through the conventional radial artery (TRA) with a lower rate of radial artery occlusion (RAO) in real life practice.

Detailed Description

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The conventional radial approach is the recommended vascular access for percutaneous coronary interventions. It is effective, feasible, but associated with a risk of occlusion of the radial artery.

The distal radial approach is proposed as a new approach to reduce complications and preserve the radial artery. However, few clinical trials in real life were conducted in North African patients.

This trial aims to evaluate the efficacy and safety of the distal radial approach versus the conventional radial approach.

This trial is a non-inferiority, randomized controlled trial with two parallel arms: distal radial approach and conventional radial approach. Two hundred and fifty patients scheduled for percutaneous coronary intervention will be included. The two main endpoints are the puncture success rate with a non-inferiority margin of 10% and the rate of 30-day occlusion of the punctured radial artery.

Secondary endpoints: catheterization success, crossover rate, procedure time, radial artery spasm, bleeding complications, QuickDASH score, pain score and operator satisfaction A single blind analysis will be led according to the per-protocol and intention-to-treat methods.

Avoiding occlusion of the puncture site allows to preserve the radial artery for subsequent coronary or cerebral percutaneous interventions as well as for coronary bypasses and hemodialysis fistulas. The results will provide the parameters related to the efficacy and safety of the distal radial approach, so improving clinical practice.

Conditions

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Vascular Access Complication Coronary Artery Disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Prospective, single-center, single-blind, randomized controlled trial
Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors
single blind during the analyze

Study Groups

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distal radial artery approach

Elective percutaneous coronary intervention by forearm radial artery through the distal radial artery in the dorsum of the hand or the anatomical snuff-box

Group Type EXPERIMENTAL

distal radial artery approach

Intervention Type PROCEDURE

Procedure: Use of radial artery for access for a coronary angiography or intervention After preparation and local anesthesia, the operator will puncture the distal radial artery in the dorsum of the hand or the anatomical snuff-box. Then a sheath will be placed. A cocktail combining Risordan®, Loxen® and unfractionated heparin will be injected through the sheath. a wire will be introduced. At the end of the procedure, the sheath will be removed immediately and hemostasis by compression will be carried out with an elastic band for 12 hours. The choice of limb side, sheath, catheters will be chosen according to the operator's discretion.

conventional radial artery approach

Elective percutaneous coronary intervention through conventional radial artery access

Group Type ACTIVE_COMPARATOR

conventional radial artery approach

Intervention Type PROCEDURE

Procedure: conventional radial access for a percutaneous coronary intervention After preparation and local anesthesia, the operator will puncture the proximal radial artery at the conventional site in distal forearm. Then a sheath will be placed. A cocktail combining Risordan®, Loxen® and unfractionated heparin will be injected through the sheath. a wire will be introduced. At the end of the procedure, the sheath will be removed immediately and hemostasis by compression will be carried out with an elastic band for 12 hours. The choice of limb side, sheath, catheters will be chosen according to the operator's discretion.

Interventions

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distal radial artery approach

Procedure: Use of radial artery for access for a coronary angiography or intervention After preparation and local anesthesia, the operator will puncture the distal radial artery in the dorsum of the hand or the anatomical snuff-box. Then a sheath will be placed. A cocktail combining Risordan®, Loxen® and unfractionated heparin will be injected through the sheath. a wire will be introduced. At the end of the procedure, the sheath will be removed immediately and hemostasis by compression will be carried out with an elastic band for 12 hours. The choice of limb side, sheath, catheters will be chosen according to the operator's discretion.

Intervention Type PROCEDURE

conventional radial artery approach

Procedure: conventional radial access for a percutaneous coronary intervention After preparation and local anesthesia, the operator will puncture the proximal radial artery at the conventional site in distal forearm. Then a sheath will be placed. A cocktail combining Risordan®, Loxen® and unfractionated heparin will be injected through the sheath. a wire will be introduced. At the end of the procedure, the sheath will be removed immediately and hemostasis by compression will be carried out with an elastic band for 12 hours. The choice of limb side, sheath, catheters will be chosen according to the operator's discretion.

Intervention Type PROCEDURE

Other Intervention Names

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DRA TRA

Eligibility Criteria

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Inclusion Criteria

* Over 18 years old.
* Hospitalized in the cardiology department of the military hospital of Tunis.
* elective Percutaneous coronary intervention performed by experienced operators or fellows trained in the proximal and distal radial approach


* not provided written informed consent
* both radial arteries were used for prior catheterization
* Under oral anticoagulation
* Having coronary bypass surgery
* Hemodynamic instability
* contra-indication to the radial approach:

* Orthopedic surgery: amputation
* Severe burns of both upper limbs.
* Radial artery pulse not palpable, negative modified Allen test or Barbeau classification type D
* Identified radial vascular anomaly: stenosis, fistula, tortuosity not allowing passage of the catheter

Exclusion Criteria

* death within a short period of time after admission
* PCI by the same puncture site will be performed within 30 days after the first puncture
* lost to follow-up
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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General Administration of Military Health, Tunisia

NETWORK

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Aymen Noamen, MD

Role: PRINCIPAL_INVESTIGATOR

military hospital of Tunis , Tunis EL manar University, Faculty of medicine of Tunis

Nadhem Hajlaoui, Pr

Role: STUDY_DIRECTOR

military hospital of Tunis , Tunis EL manar University, Faculty of medicine of Tunis

Wafa Fehri, Pr

Role: STUDY_CHAIR

military hospital of Tunis , Tunis EL manar University, Faculty of medicine of Tunis

Locations

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Military hospital of Tunis

Tunis, , Tunisia

Site Status RECRUITING

Countries

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Tunisia

Central Contacts

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Aymen Noamen, MD

Role: CONTACT

0021620215773

Ahmed Ben Amara, fellow

Role: CONTACT

0021654430166

Facility Contacts

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Stambouli Nejla

Role: primary

0021655104234

References

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Ben Amara A, Noamen A, Anouar Y, Chenik S, Hajlaoui N, Fehri W. Evaluation of the Distal Radial Approach in percutaneous coronary interventions. Controlled, randomized non-inferiority trial. Tunis Med. 2022 mars;100(3):192-202.

Reference Type DERIVED
PMID: 36005910 (View on PubMed)

Other Identifiers

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santemilitaire7

Identifier Type: -

Identifier Source: org_study_id

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