Right versus left distal radial access for coronary procedures in a large prospective multicenter registry: Insight from the KODRA registry

Abstract

Background: Distal radial access (DRA) can be performed from either the right or left distal radial artery. However, comparative data between these two access routes remain limited. Methods: Using data from the KODRA registry, we compared procedural outcomes between right (RDRA) and left DRA (LDRA). The primary endpoint was access-site crossover after successful puncture. Secondary endpoints included successful coronary angiography (CAG) via the initial access site, puncture success, overall access-site crossover, DRA-related bleeding, and procedure-related times. Results: Among 4977 patients, RDRA showed a higher rate of access-site crossover (1.7% vs. 0.7%, p < 0.001). Rates of successful CAG (92.5% vs. 93.8%, p = 0.087), puncture success (94.2% vs. 94.5%, p = 0.670), overall access-site crossover (7.5% vs. 6.2%, p = 0.068), and DRA-related bleeding (3.0% vs. 3.4%, p = 0.446) were comparable between groups. The times for arterial puncture and CAG were significantly shorter with RDRA than with LDRA (88.2 +/- 115.4 s vs. 107.9 +/- 123.2 s; 8.6 +/- 6.7 min vs. 10.9 +/- 8.3 min; both p < 0.001), although procedural times were shorter when procedures were performed on the operators&apos; preferred access side. In multivariable analysis, RDRA independently predicted access-site crossover after successful puncture (OR 2.156, 95% CI 1.184-3.926). Conclusions: Compared with LDRA, RDRA was associated with a higher risk of access-site crossover, whereas success rates of CAG and puncture, overall access-site crossover, and DRA-related bleeding were comparable. The shorter procedural times with RDRA were largely influenced by the operator&apos;s access-side preference.