Feasibility of Distal Radial Access in the Use of a Large-Bore Sheath for Percutaneous Coronary Intervention: Real-World Evidence From the Nationwide Cohort

BACKGROUND AND OBJECTIVES: Despite the established benefits of distal radial access (DRA) in reducing access-site complications compared to conventional radial access, evidence regarding the feasibility of using large-bore sheaths via DRA remains limited. This study aimed to evaluate the feasibility of using a 7 Fr sheath via DRA in patients who underwent percutaneous coronary intervention (PCI). METHODS: Among 4,977 patients enrolled in the Korean Prospective Registry for Evaluating the Safety and Efficacy of Distal Radial Approach registry, a total of 1,599 patients who underwent PCI were selected. Patients were classified according to the use of a 7 Fr sheath. The primary endpoint was overall access-site complication before discharge and at 1-month follow-up. RESULTS: Of 1,599 patients, 115 patients underwent PCI via DRA using a 7 Fr sheath. There was no significant difference in overall access-site complications between the 7 Fr sheath group and the smaller sheaths group (12.2% vs. 9.5%, adjusted odds ratio [OR], 1.66; 95% confidence interval [CI], 0.88-2.92; p=0.111). However, patients in the 7 Fr sheath group had a significantly higher rate of access-site crossover compared to the smaller sheath group (10.4% vs. 1.4%, adjusted OR, 7.87; 95% CI, 3.58-16.52; p