Feasibility of Distal Radial Artery Interventions and Impact of Radial Artery Diameter on Puncture Failure

BACKGROUND: The widespread adoption of distal radial artery (DRA) interventions has been limited by the relatively higher puncture difficulty compared to conventional radial artery access. AIMS: Evaluate the feasibility of DRA access and explore relationship between radial artery diameter and puncture failure. METHODS: A total of 733 patients proposed for DRA access were enrolled at the Department of Cardiology, Fuwai Hospital, between 2021 and 2024. All patients underwent preoperative ultrasound evaluation to measure the radial artery diameter at the snuffbox, and at 5 cm, 10 cm, and 15 cm proximal to the styloid process of the radius. The primary outcome was DRA puncture failure. RESULTS: The overall DRA puncture success rate among these patients was 96.6%. PCI was performed in 74.0% of cases, with a procedural success rate of 92.7%. Multivariate logistic regression analysis showed that DRA diameter at the snuffbox was significantly associated with puncture failure (OR = 0.24; 95% CI: 0.09-0.61). Restricted cubic spline analysis (RCS) demonstrated a nonlinear association between DRA diameter at the snuffbox and puncture failure, with an increased risk observed as DRA diameter decreased below approximately 2.40 mm. Notably, segmented logistic regression identified an inflection point at 1.67 mm, below which the risk of puncture failure increased significantly. CONCLUSION: The feasibility of DRA access was demonstrated in our study. DRA diameter was identified as an important predictor of puncture success. These findings provide an anatomical consideration for patient selection and may assist clinicians in optimizing the use of DRA access in future interventions.