Left Distal Radial Artery Access Site in Primary Percutaneous Coronary Intervention: Is It Safe?

Background: Left distal radial artery access site has emerged as anew technique for coronary angiography procedures.Aims: We aimed at assessing its applicability as an alternative wayfor primary percutaneous coronary interventions in ST-elevationmyocardial infarction.Study Design: Retrospective observational cohort study.Methods: Left distal radial artery was used as an access site in 30consecutive ST-elevation myocardial infarction patients for primarycoronary intervention. It was used by experienced operators who wereunaware of the study. All patients had a prominent pulse in their leftforearm and distal radial artery. Each patient’s left arm was gentlybent into his/her right groin with comfortable position of the hand.The operator/s stood at the right side of the patient where both couldmake the arterial puncture. Demographic features and complicationswere recorded during the hospital stay.Results: Mean age of patients was 58 years with a male genderpredominance of 87%. Fifteen patients were diagnosed of Inferiorelevation myocardial infarction, 14 patients of Anterior, and one ofLateral elevation myocardial infarction. The most common culpritartery was the left anterior descending coronary artery (14 patients).Six patients were in KILLIP class II on admission and only one withAnterior elevation myocardial infarction was in severe pulmonaryedema (KILLIP III) during intervention. All the procedures weresuccessfully contemplated with 6 French Judkins catheters. Brachialspasm occurred in one patient which was resolved with intra-arterialnitrate. Transfemoral approach was changed to left distal radial accessin 4 patients due to severe bilateral iliac artery disease. Mean puncturetime was 37.36 seconds. There was no radial occlusion, hematoma,hand neurologic deficit or bleeding. Patients were discharged on anaverage duration of 4.2 days.Conclusion: Left distal radial artery can be used as an alternative safeand feasible access site for successful primary coronary interventionsprovided that it is performed by experienced operators.

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