Both conventional transradial access (TRA) and distal radial access (DRA) showed “surprisingly low” rates of radial artery occlusion (RAO), but DRA failed to demonstrate superiority over TRA, according to the DISCO RADIAL trial. Adel Aminian, MD, of Centre Hospitalier Universitaire de Charleroi, Belgium, presented these findings Tuesday at EuroPCR 2022 in Paris, and they were reported in a manuscript simultaneously published online in JACC: Cardiovascular Interventions. DISCO RADIAL (Distal vs Conventional Radial Access) was an international, multicenter, randomized controlled trial that randomized 1,309 patients with an indication for percutaneous coronary procedures with a 6-French Glidesheath Slender (Terumo) to undergo those procedures with either DRA (n= 657) or TRA (n=650) at 15 centers across Europe and Japan, with systematic implementation of best practices to reduce RAO. The intention-to-treat population was 1,307 patients after two were excluded (one withdrew consent and one failed screening after randomization). The study’s RAO preventive measures included adequate anticoagulation, effective spasmolytic treatment, use of the 6-French Slender sheath, achieving patient hemostasis, and extensive transradial expertise for patients in both the DRA and TRA arms, according to the slide presentation. The trial was designed to demonstrate the superiority of DRA to TRA. The primary endpoint was the incidence of forearm RAO assessed by ultrasound Doppler at discharge. Key secondary endpoints included crossover rates, time to hemostasis, spasm and access-site complications. At baseline, the patients were well-matched. Their overall mean age was 68.1 years, 72.5% were men, 29.5% had diabetes mellitus and 78.2% had arterial hypertension. A higher percentage of TRA patients were taking aspirin (69.3% vs. 63.7%; p=0.033) and antihypertensive medication (82.7% vs. 77.7%, p=0.025). Forearm RAO was low in both groups, with no significant difference between treatment strategies (TRA 0.91% vs. DRA 0.31%; p=0.29). A higher percentage of DRA patients experienced radial artery spasm (TRA 2.7% vs. DRA 5.4%; p=0.015). Time to hemostasis was shorter in the DRA group (TRA 180 minutes vs. DRA 153 minutes; p<0.0001), and hemostasis was achieved in 94.4% of TRA patients. Both groups showed similar rates of bleeding (TRA 5.5% vs. DRA 6.8%; p=0.33) and vascular complications (TRA 1.2% vs. DRA 1.1%; p=0.81). In an editorial accompanying the manuscript, Grigorios Tsigkas, MD, PhD, and colleagues, of the University Hospital of Patras, Greece, remarked that forearm RAO “was surprisingly low in both arms, but especially in the TRA arm.” “To the best of our knowledge, it is the lowest RAO incidence in [such a] large-scale trial in the existing literature, showing that the systematic implementation of best practices for RAO prevention could drive to amazing results,” the editorialists wrote. Yet, Tsigkas and colleagues added, the RAO rate could have been even lower had the anticoagulation matched that of an international consensus paper. They concluded that DRA “could be considered as another step closer to RAO prevention.” “The [DRA] for coronary procedures in combination with the systematic implementation of best practices for RAO prevention may be the final solution against RAO,” the editorialists wrote. The DISCO RADIAL study was sponsored by Terumo Europe. Sources: Aminian A, Sgueglia GA, Wiemer M, et al. Distal Versus Conventional Radial Access for Coronary Angiography and Intervention (DISCO RADIAL). JACC Cardiovasc Interv 2022 May 17 (Article in press). Tsigkas G, Apostolos A, Davlouros P. Less is More, But Not Always; Distal Transradial Access for Radial Artery Occlusion Prevention. JACC Cardiovasc Interv 2022 May 17 (Article in press).