Anatomical Snuffbox Versus Dorsum of the Hand for Optimal Access Site in Distal Radial Access: Insight From the KODRA Registry

Background and Objectives: Distal radial access (DRA) has been recognized as an alternative to conventional radial access, with potential puncture sites at the anatomical snuffbox and on the dorsum of the hand. However, the optimal puncture site remains unknown. This study aims to evaluate the efficacy and safety of DRA at these two sites. Methods: This analysis was performed using the KODRA (Korean Prospective Registry for Evaluating the Safety and Efficacy of Distal Radial Approach) registry. The primary efficacy endpoint was defined as successful puncture and completion of the coronary procedure without access-site crossover, while the primary safety endpoint was the DRA-related bleeding. Results: A total of 4,977 and 4,644 patients were included in efficacy and safety analyses, respectively. DRA via the anatomical snuffbox improved the primary efficacy endpoint (odds ratio [OR], 2.358; 95% confidence interval [CI], 1.800–3.090; p<0.001), but did not differ from the dorsum of the hand approach in the primary safety endpoint (OR, 1.305; 95% CI, 0.792–2.150; p=0.296). The anatomical snuffbox approach was also associated with higher puncture success rates (OR, 2.244; 95% CI, 1.672–3.010; p<0.001), but with an increased rate of prolonged hemostasis >180 minutes (OR, 15.002; 95% CI, 7.708–29.197; p<0.001). Conclusions: Compared to the dorsum of the hand approach, DRA via the anatomical snuffbox demonstrated higher procedural efficacy, but was associated with prolonged hemostasis, without an increase in DRA-related bleeding. Further research is needed to determine the optimal site for DRA.