title: Transulnar compared with transradial artery approach as a default strategy for coronary procedures: a randomized trial. The Transulnar or Transradial Instead of Coronary Transfemoral Angiographies Study (the AURA of ARTEMIS Study).
abstract: BACKGROUND
  The ulnar artery is rarely selected for coronary angiography or percutaneous coronary intervention despite the expanding use of the transradial approach. We aimed to establish noninferiority of a default transulnar relative to transradial approach in terms of feasibility and safety.
  
  
  RESULTS
  This was a prospective, randomized, multicenter, parallel-group study involving 902 patients at 5 sites eligible to undergo diagnostic coronary angiography and percutaneous coronary intervention. Patients were randomized in a 1:1 ratio to either transradial approach (reference intervention) or transulnar approach (experimental intervention) regardless of the Allen test results. The primary end point was a composite of cross-over to another arterial access, major adverse cardiovascular events, and major vascular events of the arm at 60 days. The study was prematurely terminated after the first interim analysis because of inferiority of the transulnar approach. Although the difference in the primary end point became inconclusive after adjustment for operator clustering (24.30%; 99.99% confidence interval [CI], -7.98% to 56.58%; P=0.03 at α=0.0001), need for cross-over in the transulnar group remained inferior to transradial access site with a difference of 26.34% (95% CI, 11.96%-40.69%; P=0.004).
  
  
  CONCLUSIONS
  As a result of higher cross-over rates, a first-line transulnar strategy was proven inferior to the transradial approach for coronary procedures. At present, the transulnar route should not be regarded as an acceptable alternative to the transradial access site.
authors.affiliation: Department of Cardiology, Patras University Hospital, Patras, Greece. hahalisg@yahoo.com
authors.forename: George
authors.initials: G
authors.lastname: Hahalis
authors.forename: Grigorios
authors.initials: G
authors.lastname: Tsigkas
authors.forename: Ioanna
authors.initials: I
authors.lastname: Xanthopoulou
authors.forename: Spyridon
authors.initials: S
authors.lastname: Deftereos
authors.forename: Antonios
authors.initials: A
authors.lastname: Ziakas
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Raisakis
authors.forename: Christos
authors.initials: C
authors.lastname: Pappas
authors.forename: Aggelos
authors.initials: A
authors.lastname: Sourgounis
authors.forename: Nikos
authors.initials: N
authors.lastname: Grapsas
authors.forename: Periklis
authors.initials: P
authors.lastname: Davlouros
authors.forename: Anastasia
authors.initials: A
authors.lastname: Galati
authors.forename: Theodora-Eleni
authors.initials: TE
authors.lastname: Plakomyti
authors.forename: Panagiota
authors.initials: P
authors.lastname: Mylona
authors.forename: Ioannis
authors.initials: I
authors.lastname: Styliadis
authors.forename: Vlassis
authors.initials: V
authors.lastname: Pyrgakis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Alexopoulos
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D057239:Early Termination of Clinical Trials; D005240:Feasibility Studies; D005260:Female; D006115:Greece; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D017534:Radial Artery; D013997:Time Factors; D017535:Ulnar Artery
keywords: catheterization; percutaneous coronary intervention; transradial approach; transulnar approach