Feasibility of Distal Radial Access in the Use of a Large-Bore Sheath for Percutaneous Coronary Intervention: Real-World Evidence From the Nationwide Cohort

초록

Background and Objectives Despite the established benefits of distal radial access (DRA) in reducing access-site complications compared to conventional radial access, evidence regarding the feasibility of using large-bore sheaths via DRA remains limited. This study aimed to evaluate the feasibility of using a 7 Fr sheath via DRA in patients who underwent percutaneous coronary intervention (PCI). Methods Among 4,977 patients enrolled in the Korean Prospective Registry for Evaluating the Safety and Efficacy of Distal Radial Approach registry, a total of 1,599 patients who underwent PCI were selected. Patients were classified according to the use of a 7 Fr sheath. The primary endpoint was overall access-site complication before discharge and at 1-month follow-up. Results Of 1,599 patients, 115 patients underwent PCI via DRA using a 7 Fr sheath. There was no significant difference in overall access-site complications between the 7 Fr sheath group and the smaller sheaths group (12.2% vs. 9.5%, adjusted odds ratio [OR], 1.66; 95% confidence interval [CI], 0.88–2.92; p=0.111). However, patients in the 7 Fr sheath group had a significantly higher rate of access-site crossover compared to the smaller sheath group (10.4% vs. 1.4%, adjusted OR, 7.87; 95% CI, 3.58–16.52; p<0.001). Conclusions In patients undergoing PCI via DRA, the use of a 7 Fr sheath did not significantly increase access-site complications compared to smaller sheath. These findings suggest that DRA can be considered as a feasible and safe route for a 7 Fr sheath, provided that it is coupled with meticulous patient selection and pre-procedural vascular assessment. Trial Registration ClinicalTrials.gov Identifier: NCT04080700

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