Very distal transradial approach (VITRO) for coronary interventions

Introduction
Radial access is a standard approach for coronary interventions. However, it carries some risk of local or long-term complications such as hematoma or radial artery occlusion.

Aim
To assess the feasibility of a very distal left and right transradial approach (VITRO) for coronary interventions.

Material and methods
Three hundred and twenty consecutive patients were submitted to diagnostic or therapeutic coronary interventions. In 102 patients the distal radial artery was not palpable or the pulse was too weak. In 218 selected patients (142 male, 76 female, age: 69 ±11 years) we decided to perform a distal transradial approach.

Results
The VITRO access was suitable in 195 patients with a success rate of 89.4%. In 9 patients arterial puncture failed, while in 14 others despite successful arterial puncture the wire could not be advanced towards the forearm part of the radial artery. Not only elective diagnostic angiographies were performed with VITRO but also urgent ad hoc coronary interventions in subjects with unstable angina or NSTEMI (48 subjects; 24.3%). Moreover, this very distal approach allowed 11 rotablations and 11 FFR/iFR examinations to be performed in 22 patients. No major bleeding, requiring prolonged hospital stay, surgery or transfusion occurred. One patient on oral anticoagulation with DAPT had conservatively managed minor forearm bleeding.

Conclusions
Very distal radial artery access is feasible, safe and comfortable in 60% of patients referred for elective or urgent coronary arteries angiography, or coronary interventions.