Comparison of puncture outcome between prolonged occlusion flow mediated dilatation method and conventional method during distal radial artery cannulation in coronary intervention

Background: Distal transradial access is increasingly used for coronary angiography (CAG) and percutaneous coronary intervention (PCI), but radial artery cannulation can be technically demanding due to a steeper learning curve and smaller vessel caliber. Prolonged occlusion flow-mediated dilatation (PO-FMD) is a novel technique that may enhance distal radial artery (DRA) access by promoting vasodilatation. Aim was to compare the efficacy and vascular access-site complications of PO-FMD versus the conventional technique during distal transradial artery cannulation. Methods: This cross-sectional analytic study was conducted at the department of cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, from March 2021 to February 2022. A total of 200 purposively selected patients with coronary artery disease (CAD) undergoing CAG with or without PCI via distal radial access were enrolled. Participants divided into 2 groups: Group I (PO-FMD, n=100) and II (conventional method, n=100). Efficacy outcomes included access time, procedural time, number of attempts, 1st-attempt success rate, and crossover rate. Vascular access-site complications such as hematoma, radial artery spasm, and radial artery occlusion were also assessed. Results: Crossover to another access site was significantly lower in group I compared to group II (5% vs. 15%, p=0.030). Access time was shorter with PO-FMD (58.8±10.1 seconds vs. 78.9±7.9 seconds; p=0.006). Group I demonstrated fewer attempts and a higher first-attempt success rate (p=0.015 and p=0.021, respectively). Radial artery spasm and occlusion were significantly reduced in the PO-FMD group (p=0.048 and p=0.039). No significant differences were observed in hematoma formation or total procedural time. Conclusions: PO-FMD-mediated radial artery dilatation appears to be a safer and more effective technique than the conventional method for DRA cannulation.