Near-Styloid puncture improves first-attempt success and reduces access-site complications in coronary angiographyNear-Styloid Puncture May Improve Success in Heart Procedures

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions Published September 7, 2026 Study authors: Aslan Vedat, Sural Sefa, Yeral Nurettin, Gorgulu Şevket, Brilakis Emmanouil S PubMed ↗ NCT07060820 ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Consider near-styloid puncture to improve first-attempt success and reduce access-site complications in coronary angiography.

This randomized controlled trial enrolled 380 patients undergoing diagnostic coronary angiography or percutaneous coronary intervention via a transradial approach. The study compared a near-styloid puncture (0-20 mm from the radial styloid process) to a far-styloid puncture (21-40 mm from the radial styloid process).

The primary outcome, clinical radial artery spasm (RAS), showed no statistically significant difference between groups (14.7% for near-styloid vs. 17.9% for far-styloid; p=0.488). However, several secondary outcomes favored the near-styloid approach. First-attempt puncture success was significantly higher in the near-styloid group (74.2% vs. 58.4%; p=0.002). Additionally, the median puncture time was shorter for near-styloid (20 s) compared to far-styloid (30 s; p<0.001), and there were fewer puncture attempts (p=0.003).

Safety outcomes also favored the near-styloid technique. Rates of persistent forearm pain were lower (3.2% vs. 8.4%; p=0.048). Complications at the access site were also lower in the near-styloid group, including radial artery occlusion (1.6% vs. 6.8%; p=0.019) and hematoma (1.1% vs. 5.8%; p=0.020).

Limitations include the single-center design and the exploratory nature of the secondary endpoints. While the near-styloid approach is associated with better efficiency and lower complication rates, the primary outcome of RAS did not differ significantly. Results for secondary outcomes require confirmation in multicenter studies.

How this fits prior evidence

How this fits prior evidence: This study addresses a gap in procedural technique for radial access in coronary artery disease. While previous coverage focused on pharmacological management of coronary artery disease, such as clopidogrel monotherapy to reduce bleeding risk to 2.1% versus 3.2% and the impact of PCI complexity on P2Y12 inhibitor monotherapy, this study focuses on the technical nuances of the radial access site. It provides specific data on puncture site selection to improve procedural efficiency and safety.

Researchers conducted a study involving 380 patients undergoing heart procedures through the radial artery. The study compared two different puncture locations: a "near-styloid" site (closer to the bone) and a "far-styloid" site (further from the bone). The goal was to see which location worked better for the medical team and the patient.

The results showed that the near-styloid approach led to a higher success rate on the first attempt and a faster procedure time. It also showed lower rates of complications, such as blood pooling (hematoma) and artery blockage. However, the study did not find a significant difference between the two locations regarding the specific occurrence of artery spasms.

Because this was a single-center study and the findings on efficiency are exploratory, these results are not yet definitive. While the near-styloid approach showed several benefits in this specific group, more research across multiple hospitals is needed to confirm these findings before they can change standard medical practices.

What this means for you:

Near-styloid puncture showed better success rates and fewer complications, but more multi-center research is needed.

Common questions

What are the benefits of a near-styloid puncture?

The study found that a near-styloid puncture had a higher first-attempt success rate of 74.2% compared to 58.4% for far-styloid. It also resulted in shorter procedure times, with a median of 20 seconds compared to 30 seconds. Additionally, it was linked to lower rates of artery blockage and bruising at the site.

Are there any risks or side effects to the puncture site?

Both sites can lead to complications. However, the near-styloid group had lower rates of artery occlusion (1.6% vs 6.8%) and fewer cases of hematoma (1.1% vs 5.8%). There was also a lower rate of persistent forearm pain in the near-styloid group, which was 3.2% compared to 8.4% in the far-styloid group.

Is this a proven way to treat heart conditions?

This study was a single-center trial with 380 patients. While the results for puncture efficiency and complications were positive, the primary outcome of artery spasm showed no significant difference between the two sites. Because the findings are exploratory, you should talk to your doctor about the best approach for your specific procedure.

Study Details

Study typeRct

Sample sizen = 380

EvidenceLevel 2

PublishedSep 2026

PMID42460683

TrialNCT07060820

View Original Abstract ↓

BACKGROUND: Radial artery spasm (RAS) remains a clinically relevant limitation of the transradial approach (TRA). AIMS: This study aimed to evaluate the influence of the distance between the radial artery puncture site and the radial styloid process on RAS and access-site complications. METHODS: This prospective, single-center, randomized, single-blind trial enrolled 380 patients undergoing diagnostic coronary angiography or percutaneous coronary intervention via TRA. Using fluoroscopic identification of the radial styloid process as a fixed anatomical reference, patients were randomized 1:1 to Near-Styloid (0-20 mm) or Far-Styloid (21-40 mm) puncture. The primary endpoint was clinical RAS. Secondary endpoints included puncture efficiency, pain scores, crossover, and access-site complications, including radial artery occlusion (RAO) and hematoma. RESULTS: Clinical RAS occurred in 14.7% of the Near-Styloid group and 17.9% of the Far-Styloid group (p = 0.488). First-attempt puncture success was significantly higher with Near-Styloid access (74.2% vs. 58.4%, p = 0.002), with shorter puncture time (median 20 vs. 30 s, p < 0.001) and fewer puncture attempts (p = 0.003). Procedural characteristics and fluoroscopy parameters were similar between groups. Persistent forearm pain (3.2% vs. 8.4%, p = 0.048), RAO (1.6% vs. 6.8%, p = 0.019), and access-site hematoma (1.1% vs. 5.8%, p = 0.020) were less frequent in the Near-Styloid group. CONCLUSIONS: No statistically significant difference in clinical RAS was detected between puncture sites located closer to or farther from the radial styloid process. Near-Styloid access was associated with improved puncture efficiency and lower rates of RAO and access-site hematoma. As these findings were derived from secondary endpoint analyses, they should be considered exploratory and warrant confirmation in future multicenter studies. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT07060820.

Near-Styloid puncture improves first-attempt success and reduces access-site complications in coronary angiographyNear-Styloid Puncture May Improve Success in Heart Procedures

How this fits prior evidence

Common questions

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