Distal Radial Access Scientific Foundations and Applied Techniques

This is the first book devoted entirely to distal radial access, a novel vascular access technique that has become a major topic of interest in interventional cardiology, interventional radiology and neurointervention. The rapid spread of distal radial access through social media has been remarkable, reflecting the wide curiosity surrounding this approach. While almost every interventionalist is aware of it, many have yet to fully grasp its clinical significance and the nuances of its proper implementation. Given its growing importance, this topic warrants a more structured, rigorous and comprehensive discussion.

This volume aims to elucidate the scientific basis of distal radial access and provide a thorough critical review of the existing literature. Each chapter focuses on a different aspect of the technique and is written by leading experts from different institutions, ensuring a diverse perspective that enriches the content.

With its commitment to scientific excellence, this book serves as the most comprehensive and up-to-date reference on distal radial access, written by the very pioneers who have contributed to its development and evaluation. It is intended primarily for interventional cardiologists, interventional radiologists, and neurointerventionalists who wish to improve their understanding and clinical practice in this evolving field.

Historical development.- Current status of distal radial access.- Anatomic basis.- Physiological rational.- Relevant anatomic variants.- Patient selection and preparation.- Conventional puncture.- Ultrasound-guided puncture.- Advanced distal radial access.- Troubleshooting transradial issues.- Hemostasis methods.- Prevention and management of complications.- Hand function following distal radial access.- Radiation exposure.- Evidence from clinical registries.- Evidence from randomized-clinical trials.- Slender approach.- Sheathless methods.- Complex coronary procedures.- Structural heart interventions.- Peripheral vascular procedures.- Ancillary distal radial access.- Learning curve for distal radial access.- Starting a distal radial access program.- Future Directions.

Dr. Gregory A. Sgueglia is an interventional cardiologist at Sant’Eugenio Hospital in Rome, Italy, where he is actively involved in the development and recruitment for a number of multicenter clinical trials. His research focuses on complex coronary lesions, minimally invasive percutaneous coronary interventions and, in particular, distal radial access.

In this field, he is the first author of several influential and original publications and has collaborated extensively with international experts. Notable contributions include a seminal position statement rigorously outlining the rationale for distal radial access; the only in-human pathophysiologic study of transradial access providing empirical support for the previously theorized major advantage of distal radial access; the first and only international expert consensus document on distal radial access; the RATATOUILLE study, a unique prospective multicenter study evaluating hand function for up to 12 months in a large cohort of patients undergoing distal radial access for coronary procedures; and the DISCO RADIAL trial, the only international randomized clinical trial comparing distal radial access with conventional transradial access in a large real-world population.

Through his extensive research, prolific publications, and active presence at international conferences, Dr. Sgueglia continues to contribute to the advancement of vascular access techniques, shaping both clinical practice and future research.