Research Article
Volume 7 Issue 5 - 2020
Comparative Assessment of DOrsal Radial Artery Access with Classical Radial Artery Access for Percutaneous Coronary Angiography-A Randomized Control Trial (DORA Trial)
Awadhesh kumar Sharma1*, Sameer Sarraf2, MM Razi1, Akhil Sharma3, Santosh Sinha4, Umeshwar Pandey5 and Neeraj Prakash6
1Assistant Professor, Department of Cardiology, LPS Institute of Cardiology, Kanpur,UP, India
2Assistant Professor, Department of Cardiology, Uttar Pradesh University of Medical Science, Saifai, Etawah, UP, India
3Associate Professor, Department of Cardiology, King George Medical University, Lucknow, UP, India
4Associate Professor, Department of Cardiology, LPS Institute of Cardiology, Kanpur, UP, India
5Professor, Department of Cardiology, LPS Institute of Cardiology, Kanpur, UP, India
6Assistant Professor, Department of Cardiothoracic surgury, LPS Institute of Cardiology, Kanpur, UP, India
*Corresponding Author: Awadhesh Kumar Sharma, Department of Cardiology, LPS Institute of Cardiology, Kanpur, UP, India.
Received: March 19, 2020; Published: April 14, 2020


In percutaneous cardiac catheterization both for diagnostic and intervention purposes, vascular access site is a controversial field from the start of this technique. Percutaneous radial artery approach for coronary angiography was invented by Lucien Campeau at Montreal Heart Institute (Canada) in 1986 with publication of the first 100 cases in 1989. And thereafter, this technique advocated for percutaneous coronary intervention (PCI) by Kiemeneij. In spite of frequent use of dorsal radial artery access for percutaneous interventions, there was no head to head trial comparing dorsal radial access with classical radial artery access. This is first open label randomized control trial with parallel assignment with single masking comparing patients undergoing coronary angiography via dorsal radial and classical radial assess. Study done at three tertiary cardiac care centers between January 2019 to January 2020. Total of 985 patients were recruited for the study, out of which fifteen patients were found to be unsuitable and five patients denied for procedure. So, the total of 970 patients were finally recruited for the study. Patients were randomly selected for dorsal radial artery access Group A (485 patients) and classical radial artery access Group B (485 patients) assess without any bias for age and sex. First time on comparative assessment of dorsal versus classical radial artery vascular access it is found equal in terms of procedural success rate and complication in the form of incidences of radial artery hematoma. While dorsal access was superior in terms of less incidences of radial artery occlusion, radial artery spasm. Post procedure persistence of pain and hand clumsiness is also less in dorsal radial artery access. In comparison to this, number of puncture attempts and time to achieve post procedure haemostasis is less in classical radial access. So, both techniques have pros and coins and it is the discretion of interventionist to adopt which technique.

Keywords: Percutaneous Angiography; Radial Angiography; Dorsal Radial Artery; Snuff Box; Radial Artery Occlusion; Radial Artery Spasm


  1. Yader Sandoval., et al. “Transradial Artery Access Complications MN”. Circulation: Cardiovascular Interventions (2019): 12.
  2. Kaledin AL., et al. “Distal radial artery in endovascular interventions”. Interventional Cardiology Clinics 2 (2019): 111.
  3. Koutouzis M., et al. “Distal Versus Traditional Radial Approach for Coronary Angiography”. Cardiovascular Revascularization Medicine 20 (2019): 678-680.
  4. Lee JW., et al. “Real-world experience of the left distal transradial approach for coronary angiography and percutaneous coronary intervention: a prospective observational study (LeDRA)”. EuroIntervention 14 (2018): e995-e1003.
  5. Valsecchi O., et al. “Early Clinical Experience with Right and Left Distal Transradial Access in the Anatomical Snuffbox in 52 Consecutive Patients”. Journal of Invasive Cardiology 30 (2018): 218-223.
  6. Ziakas A., et al. “Right arm distal transradial (snuffbox) access for coronary catheterization: Initial experience”. The Hellenic Journal of Cardiology (2018).
  7. Sgueglia GA., et al. “Anatomic Basis and Physiological Rationale of Distal Radial Artery Access for Percutaneous Coronary and Endovascular Procedures”. JACC: Cardiovascular Interventions 11 (2018): 2113-2119.
  8. Andrade PB., et al. “Initial experience with left distal transradial access for invasive coronary procedures”. Journal of Transcatheter Interventions 26 (2018): eA0002.
  9. Davies RE and Gilchrist IC. “Dorsal (Distal) Transradial Access for Coronary Angiography and Intervention”. Korean Circulation Journal 12 (2018): 1131-1134.
  10. Avdikos G., et al. “Radial artery occlusion after transradial coronary catheterization”. Cardiovascular Diagnosis and Therapy 7 (2017): 305-316.
  11. Kim Y., et al. “Feasibility of coronary angiography and percutaneous coronary intervention via left snuffbox approach”. Korean Circulation Journal 48 (2018): 1120-1130.
  12. Kiemeneij F. “Left distal transradial access in the anatomical snuffbox for coronary angiography and interventions”. Euro Intervention 20 (2017): 851‐857.
  13. Valgimigli M., et al. “MATRIX Investigators. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial”. Lancet 385 (2015): 2465-2476.
  14. Babunashvili A and Dundua D. “Recanalization and reuse of early occluded radial artery within 6 days after previous transradial diagnostic procedure”. Catheterization and Cardiovascular Interventions 77 (2011): 530‐ 536.
  15. Jolly SS., et al. “Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials”. The American Heart Journal 1 (2009): 132-140.
  16. Agostoni P., et al. “Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; systematic overview and meta-analysis of randomized trials”. Journal of the American College of Cardiology 44 (2004): 349-356.
  17. Sones FM Jr and Shirey EK. “Cine coronary arteriography”. Modern Concepts of Cardiovascular Disease 31 (1962): 735-738.
  18. Campeau L. “Percutaneous radial artery approach for coronary angiography”. Catheterization and Cardiovascular Diagnosis 16 (1989): 3-7.
  19. Radner S. “Thoracal aortography by catheterization from the radial artery; preliminary report of a new technique”. Acta Radiologica 29 (1948): 178-180.
Citation: Awadhesh Kumar Sharma., et al. “Comparative Assessment of DOrsal Radial Artery Access with Classical Radial Artery Access for Percutaneous Coronary Angiography-A Randomized Control Trial (DORA Trial)”. EC Cardiology 7.5 (2020): 41-52.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

November Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 13, 2022.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.