Feasibility of primary percutaneous coronary intervention via the distal radial approach in patients with st-elevation myocardial infarction

Background/Aims: Recently, distal radial approach (DRA), called as snuff box ap-proach, has gained the interest of interventional cardiologists, but there is a lack of data about the feasibility of DRA as an alternative route for primary percutaneous coronary intervention (PCI). Methods: A total of 138 patients presenting with ST-elevation myocardial infarction (STEMI) in whom primary PCI via the DRA was attempted at three hospitals from October 2017 to September 2019 were analyzed. Results: The success rate of snuff box puncture in the setting of STEMI was 92.8% (128/138). Successful primary PCI via the DRA was achieved in all 128 patients. The snuff box puncture time, defined as the time interval from local anesthesia induction to successful sheath cannulation, was 2.7 ± 1.6 minutes, and snuff box puncture was performed within 5 minutes in 95.3% of patients. Moreover, the per-centage of the puncture time in the door-to-balloon time was 3.3%. The left DRA was selected in 103 patients (80.5%), and primary PCI via the DRA was performed using a 6-Fr guiding catheter in 125 patients (97.7%). There was no major bleeding; however, there were four cases (3.1%) of access-site complications, including three cases of local hematoma (≤ 5 cm diameter) and one case of local numbness, which improved 3 months later. Conclusions: In the setting of STEMI, the DRA could be a feasible alternative access route for primary PCI.