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Research Article | DOI: https://doi.org/10.31579/2641-0419/512
Department of Cardiology, Nizam’s Institute of Medical Sciences, Hyderabad, India.
*Corresponding Author: Nuthalapati Rama Kumari, Department of Cardiology, Nizam’s Institute of Medical Sciences, Hyderabad, India.
Citation: Ankur Sabherwal, Reddy Matli RK, Sunitha Arumulla, Uma D. Karuru, Neusha Doddi, et al, (2025), Distal Trans Radial Approach for Cardiac Catheterization – An Early Clinical Experience and Future Directions: An Observational Study, J Clinical Cardiology and Cardiovascular Interventions, 8(14); DOI:10.31579/2641-0419/512
Copyright: © 2025, Nuthalapati Rama Kumari. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 28 August 2025 | Accepted: 24 September 2025 | Published: 06 October 2025
Keywords: distal access; trans radial approach; cardiac catheterization; snuff box; coronary angiogram
Background:
The trans radial approach (TRA) is the preferred access for coronary angiography (CAG) and percutaneous coronary intervention (PCI) due to its lower complication rates and quicker recovery compared to transfemoral access. The distal trans radial approach (dTRA), accessed via the anatomical snuffbox, has recently emerged as a viable alternative, potentially reducing radial artery occlusion (RAO), shortening hemostasis time, and improving patient comfort. The study aims to evaluate the real-world feasibility, safety, and effectiveness of distal transradial access (DRA) as the default access site for routine coronary angiography (CAG) and percutaneous coronary intervention (PCI), and to compare it with traditional transradial access (TRA).
Materials and Methods:
We conducted a prospective observational study from January 2020 to December 2021, enrolling 100 patients undergoing CAG or PCI. Patients were assigned to either the dTRA or conventional TRAgroup. Baseline characteristics, procedural data, and access-related complications were collected. All procedures were performed by experienced radial operators using manual palpation method without ultrasound guidance.
Results:
Baseline demographics were similar between groups. Procedural success rates were high, with only two crossovers in the dTRA group. Minor vascular complications occurred in two dTRA patients; no major complications or surgical interventions were required. The dTRA group showed faster haemostasis. The left anterior descending artery was the most frequently stented vessel in both groups. Complex interventions were successfully performed using dTRA with acceptable safety.
Conclusions:
The distal trans radial approach is a safe and effective alternative to traditional TRA for CAG and PCI. It provides additional benefits such as reduced RAO risk, quicker recovery, and enhanced patient comfort. Larger, randomized studies are needed to validate these findings and potentially support dTRA as the default access method in interventional cardiology.
The radial artery (RA) has emerged as a valuable vascular access site for coronary interventions, with the trans radial approach (TRA) becoming the preferred technique since its introduction in 1993 [1- 4]. A novel variation of the trans radial approach involves accessing the distal RA through the anatomical snuffbox (radial fossa) on the dorsal aspect of the hand. The anatomical snuffbox is a concave area located on the radial side of the wrist when the thumb is extended, bordered posteriorly by the tendon of the extensor pollicis longus and anteriorly by the tendons of the extensor pollicis brevis and abductor pollicis longus. The RA traverses the floor, formed by the scaphoid and trapezium bones [5]. First described by Babunashvili et al. [6] for retrograde recanalization of occluded ipsilateral radial arteries, the left distal trans radial access (ldTRA) in the anatomical snuffbox was later detailed by Kiemeneij [7] as a potential default approach. As an advancement of the conventional proximal transradial access (pTRA), this technique offers advantages in terms of patient comfort, operator ease, and reduced risk of proximal RA occlusion. The distal RA can accommodate 4, 5, and 6 Fr sheaths and catheters [8]. One notable feature of this approach is the puncture site, located proximal to the pollicis brevis artery and distal to the branch supplying the superficial palmar arch. Occlusion at this site preserves antegrade flow through the superficial palmar arch, reducing the risk of retrograde thrombus formation in the proximal RA—a common complication associated with puncture trauma or hemostasis failure at traditional RA access sites. Importantly, this ensures continued blood flow to the thumb via the superficial palmar arch, preventing ischemia and hand dysfunction. RA preservation is particularly critical for patients requiring future hemodialysis access, coronary artery bypass grafting (CABG), or repeat trans radial access (TRA) procedures [9]
Despite these benefits, the distal trans radial approach (dTRA) does have limitations. The smaller
artery size and increased angulation at this access point contribute to a steeper learning curve and a higher failure rate when advancing the wire or cannulating the distal RA (10). To evaluate the feasibility and safety of using distal trans radial access (dTRA) as the default approach for routine coronary angiography (CAG) and percutaneous coronary intervention (PCI), we conducted a prospective observational registry. At our institution, traditional trans radial access (TRA) has been the standard technique for coronary interventions. However, the distal radial access (DRA) approach has been increasingly adopted in recent practice. The study aims to evaluate the real-world feasibility, safety, and effectiveness of distal transradial access (DRA) as the default access site for routine coronary angiography (CAG) and percutaneous coronary intervention (PCI), and to compare it with traditional transradial access (TRA).
This observational study was conducted on consecutive patients admitted for Percutaneous Transluminal Coronary Angioplasty (PTCA) at our department from January 2020 to December 2021. Details of the study were explained to the patients in a language they understood, and an information sheet along with a consent form was provided. Consent was obtained from patients who voluntarily agreed to participate in the study. All enrolled patients underwent reperfusion therapy via Percutaneous Coronary Intervention (PCI), with the access route determined at the discretion of the attending clinician.
Inclusion Criteria
Patients aged 18-80 years Undergoing PTCA at the cardiac catheterization laboratory
Exclusion Criteria :
Patients with Raynaud’s disease or upper limb vascular disorders
Patients with neural disorders affecting the radial nerve innervation area (specifically for the trans- snuffbox approach)
Patients with chronic tenosynovitis or osteomyelitis
Patients with significant deformities of the hand
Patients with a recent fracture of the scaphoid bone
Technique:
The presence of an appropriate pulse in the anatomical snuffbox was first verified by manual palpation. To minimize patient discomfort and arterial spasm, intravenous (IV) midazolam (1-2 mg) and/or sublingual trinitroglycerin (TNG) (0.4 mg) was administered, as needed. The forearm was positioned on a soft surface, with the wrist in ulnar deviation and semi-flexion for optimal palpation and access to the snuffbox artery. Local anesthesia was administered using 2-5 ml of 2% lidocaine subcutaneously in the snuffbox cavity. A 20 G or 21G needle was then used to puncture the artery at a 35–45-degree angle, directed towards the site of the strongest pulse [7,8]. Following successful arterial puncture, a 0.018-inch guide wire was gently passed while the wrist was held in a semi abducted and extended position, minimizing pressure from the abductor pollicis longus and extensor pollicis brevis tendons (Figure 01).
Figure 1: Illustration showing the anatomical landmarks and structures relevant for puncture at the anatomical snuff box.
If resistance was encountered, fluoroscopic guidance and dye injection were used to verify the cause of the resistance. In cases where the 0.018-inch guide wire failed, a 0.014-inch coronary guide wire was used. To prevent damage to the artery and introducer sheath tip, a small skin incision was made before introducing a 4, 5, or 6 Fr sheath, as needed. Unfractionated heparin (2500-5000 IU) was administered as an anticoagulant. For arterial hemostasis, the sheath was removed immediately, and local compression was applied using the contralateral thumb over the puncture site, while the other four fingers were placed
under the patient’s wrist for 10-15 minutes. Additional pressure was applied using bandage packs to complete hemostasis within 1-2 hours [3,5,7,8].
Statistical Analysis
Data was analyzed with SPSS 23 software. Descriptive statistics were used to summarize the dat and the chi-square test was employed for comparisons of categorical variables. Odds ratios (OR) and confidence intervals (CI) were calculated. Continuous variables were analyzed using the student’s t- test and Analysis of Variance (ANOVA). A p-value <0>
A total of 100 patients participated in the study, with 48 undergoing distal trans-radial access (dTRA, snuffbox approach) and 52 receiving traditional radial access (TRA). The mean age was 57.44 ± 9.8 years in the dTRA group and 56.36 ± 10.54 years in the TRA group. Most patients were male: 41 (85.4%) in the dTRA group and 43 (82.7%) in the TRA group. Hypertension was the most common coronary artery disease (CAD) risk factor in both groups: 30 62.5%) in dTRA and 29 (55.8%) in TRA. Diabetes was present in 19 (39.6%) of dTRA patients and 22 (42.3%) of TRA patients. Smoking was reported by 14 (29.2%) in the dTRA group and 12 (23.1%) in the TRA group (p > 0.05). A family history of CAD was noted in 6 (12.5%) dTRA patients and 5 (9.6%) TRA patients. The most common clinical presentations in both groups were ST-elevation myocardial infarction (STEMI) and chronic stable angina (CSA). Patients were categorized based on their presentation as either acute coronary syndrome (ACS) or chronic coronary artery disease (CAD). STEMI was observed in 23 patients (47.9%) in the distal trans-radial access (dTRA) group and 23 patients (44.2%) in the traditional radial access (TRA) group (Figure 02).
Figure 2: Chart showing clinical presentation of patients in distal trans-radial access (snuff box) and traditional radial (radial) access route
A history of CAD was reported in 21 patients (43.8%) in the dTRA group and 21 (40.4%) in the TRA group. Previous myocardial infarction (MI) was present in 14 patients (29.2%) in dTRA and 14(26.9%) in TRA. Prior PCI was noted in 12 (25.0%) and 9 (17.3%) patients in the dTRA and TRA groups, respectively. A history of coronary artery bypass grafting (CABG) was recorded in 2 patients (4.2%) in dTRA and 2 (3.8%) in TRA. No statistically significant differences were found between the groups regarding baseline characteristics, cardiovascular risk factors, or overall clinical presentation. Baseline characteristics are summarized in Table 1.
| Characteristics | Distal transradial Access | Traditional radial Access | P Value |
| Age (In years) (Mean + SD) | 57.44 + 9.800 | 56.36 +10.54 | 0.600 |
| Gender n (%) | |||
| 1. Male | 41(85.4%) | 43(82.7%) | 0.710 |
| 2. Female | 7 (14.6%) | 9 (17.3%) | |
| CAD risk factorsn (%) | |||
| 1. Hypertension | 30 (62.5%) | 29 (55.8%) | 0.49 |
| 2. Diabetes mellitus | 19 (39.6%) | 22 (42.3%) | 0.78 |
| 3. Smoking | 14 (29.2%) | 12 (23.1%) | 0.48 |
| 4. Family history of CAD | 06 (12.5%) | 05 (9.6%) | 0.64 |
| Clinical diagnosis n (%) | |||
| STEMI | 23(47.9%) | 23(44.2%) | 0.866 |
| NSTEMI | 1 (2.1%) | 4 (7.7%) | 0.41 |
| USA | 4 (8.3%) | 5 (9.6%) | 0.90 |
| CSA | 12 (25%) | 15 (28.8%) | 0.83 |
| ISR | 2 (4.2%) | 1 (1.9%) | 0.94 |
| Heart Failure after stabilization | 6 (12.5%) | 4 (7.7%) | 0.64 |
Table 1: Baseline Characteristics of the study population
However, some clinical features varied between groups. The dTRA group had a higher incidence of post-heart failure recovery (6 patients, 12.5%
vs. 4 patients, 7.7%) and in-stent restenosis (ISR) (2 patients, 4.2% vs. 1 patient, 1.9%). In contrast, non-ST-elevation myocardial infarction (NSTEMI) was more common in the TRA group (1 patient, 2.1% in dTRA vs. 4 patients, 7.7% in TRA). Unstable angina (USA) was reported in 4 patients (8.3%) in the dTRA group and 5 (9.6%) in the TRA group. CSA was observed in 12 patients (25.0%) in dTRA and 15 (28.8%) in TRA. most frequently stented vessel in both groups was the left anterior descending artery (LAD). The left main coronary artery (LMCA) and obtuse marginal 1 (OM1) were exclusively stented via dTRA, while the ramus and OM2 were stented only through TRA. The left circumflex artery (LCX) was more often stented via TRA. In dTRA patients, multivessel stenting involving combinations such as RCA–PLVB, RCA–OM1, and LCX–OM2 was more common, whereas LAD–OM1 and LCX–PDA combinations were more frequent in the TRA group. These differences were not statistically significant. A significantly higher proportion of dTRA patients received two stents, whereas single- stent usage was more common in TRA. The mean haemostasis duration was significantly shorter in the dTRA group (154 minutes) compared to the TRA group (185 minutes).
Complications:
Arterial dissection occurred in 2.1% of patients in the distal trans-radial access (dTRA) group and 1.9% in the traditional radial access (TRA) group. Arterial perforation was reported in 2.1% of dTRA patients and none in the TRA group. Hematoma was observed in 2.1% of dTRA patients and 1.9% in TRA. Conversion to right femoral access due to radial artery spasm was required in 4.2% of dTRA cases, whereas 1.9% of TRA patients required femoral access due to dissection. These differences were not statistically significant (p > 0.05). A summary of vascular complications is provided in Table 2.
| Characteristics | Distal trans radial Access | Traditional radial Access | P Value |
| Dissection n (%) | 1 (2.1%) | 1 (1.9%) | 0.954 |
| Perforation (Acute marginal branch of the right coronary artery) | 1 (2.1%) | 0 (0%) | 0.296 |
| Hematoma | 1 (2.1%) | 1 (1.9%) | 0.954 |
Alternate accessused due to Arterial spasm Arterial dissection |
2 (4.2%) 0 (0%) |
0 (0%) 1 (1.9%) |
0.511 |
Table 02: Complications between the distal and traditional radial access
Distal trans-radial access (dTRA) via the anatomical snuffbox has emerged as a viable alternative to conventional trans-radial access (TRA) for coronary angiography and percutaneous coronary intervention (PCI). Its growing adoption is primarily attributed to its potential to reduce radial artery occlusion (RAO), a key concern for patients requiring repeated vascular access. Despite promising early data, evidence remains limited to a few randomized and observational studies (Table 03).
| Studyauthor (Year) | Study design | Sample size | Successful dTRA (Distaltrans radial access) Cannulation(%) | dTRA Access site | Hematomas (%) | Radial artery occlusion |
| Kiemenej et al. 2017(7) | Non-Randomised | 70 | 89 | Left | 3.2 | Left distal radial artery occlusion (2%) |
| Soydan et al. 2017 (11) | Prospective | 54 | 96.3 | Left | None | None |
| Ali Azizi Km et al. 2018 (08) | Prospective | 22 | 100 | Left | None | None |
| Azizi Km et al. 2018 (8) | Retrospective | 61 | 98.4 | Left | None | None |
| Kim et al. 201 (12) | Retrospective | 150 | 88 | Left | 1.33 | None |
| Coughlan et al. 2018 (13) | Prospective non-randomised | 94 | 100 | Left | None | None |
| Ziakas et al. 2018 (14) | Prospective | 49 | 89.8 | Right | 15 (No Major) | None |
| Adel Aminian et al. 2022 (15) | Randomised controlled | 1307 | 80.8 | Right | None | Seen in 5.4% patients |
Table 03: Summary of Studies on Distal Transradial Artery Access – Success Rates and Complications
The first randomized comparison by Koutouzis et al. [10] showed that while dTRA facilitated faster hemostasis, it required more puncture attempts and longer cannulation time. Importantly, rates of spasm, hematoma, and RAO were comparable between groups. In our study, dTRA showed a high procedural success rate (95.8%), even with exclusive use of right-sided access and 6 Fr sheaths. These results align with success rates reported by Kiemeneij (89%) and Zikas et al. (89.8%) [7, 14], possibly reflecting increasing operator proficiency and careful patient selection. The 6 Fr sheath, thoug technically challenging in smaller vessels, proved safe and effective—supporting its use in coronary interventions including FFR, imaging-guided, and multivessel PCI [8, 11, 15, 16]. RAO remains critical factor in access selection. The DISCO RADIAL trial [15], involving over 1,300 patients, reported no significant difference in RAO rates between dTRA and TRA (0.31% vs 0.91%, P = 0.29). However, dTRA was associated with shorter hemostasis time (153
vs 180 minutes), higher crossover (7.4% vs 3.5%), and increased spasm (5.4% vs 2.7%). Our findings mirror these outcomes: while procedural success was high, puncture difficulty and wire manipulation were more frequent, particularly with right-sided access.
Feasibility and Safety
In our cohort, dTRA was performed without major complications requiring surgical intervention o transfusion. Complex interventions were completed successfully, with only two cases requiring crossover (4.17%), a rate lower than that reported by Tsigkas et al. (9%) [17]. Minor complications included two cases of radial spasm (2.1%) and one forearm hematoma, consistent with prior literature [7, 11]. The smaller vessel caliber—especially in female patients—remains a limitation, though anatomical landmarks generally suffice for successful puncture, even in hypotensive patients. The distal radial artery’s location beyond the superficial palmar arch also preserves hand perfusion in the event of RAO, reducing ischemic risk. Since its introduction by Kiemeneij in 1993 [7], TRA has become the preferred access site due to its favorable safety profile over femoral access. However, TRA is still prone to RAO (2.8%–11.7%), which, while often asymptomatic, can preclude future procedures such as CABG or AV fistula creation [18–21]. Anatomic variations, prior surgeries, and vessel occlusions may further limit TRA applicability. Transulnar access offers an alternative but has not demonstrated clear advantages [21– 25]. dTRA—first described by Roghani et al. in 2016 [25–29]—has been increasingly recognized for its advantages: lower RAO risk, quicker hemostasis, and reduced risk of hand ischemia. Accessing the artery distal to the superficial palmar branch enhances safety and preserves future access sites.
Key Advantages of dTRA
Faster Hemostasis: The anatomical snuffbox offers stable bony support, allowing quicker compression and reduced bleeding risk. Lower RAO Risk: Distal puncture preserves forearm radial nflow and reduces long-term access loss. Improved Ergonomics: Natural hand positioning improves comfort for both patient and operator, and may reduce radiation exposure. Minimal Ischemic Risk: Dual hand perfusion via the ulnar artery minimizes complications in case of distal RAO. Enhanced
Workflow: Faster hemostasis enables earlier ambulation and potential same-day discharge. Challenges and Limitations Despite its benefits, dTRA poses technical challenges. Smaller vessel diameter increases cannulation difficulty and may limit the use of larger sheaths or guide catheters in complex interventions (e.g., CTO). The puncture site—
located in the snuffbox or first intermetacarpal space—can be harder to access, particularly in patients with small or tortuous vessels. Ultrasound guidance may enhance accuracy and safety but were not used in this study. Standard catheters designed for wrist access may be insufficient for dTRA, necessitating longer equipment. Additionally, a learning curve exists, requiring dedicated training and experience.
Further large-scale, multicenter randomized trials are needed to validate the safety, procedural outcomes, and long-term efficacy of dTRA compared to TRA. Future research should also focus on optimizing sheath/catheter design, puncture techniques, and hemostasis protocols. As operator experience grows and device technology evolves, dTRA may become a standard access strategy— particularly in patients at high risk of RAO or those requiring repeated vascular access.
Distal trans-radial access using a 6 Fr sheath is a safe, effective, and increasingly viable alternative for coronary interventions. While procedural complexity may be higher, the benefits—including shorter hemostasis, lower RAO risk, and long-term vascular preservation—support its broader adoption. Our findings, consistent with those of the DISCO RADIAL trial, underscore its potential role in contemporary interventional cardiology.
This was a single-center, observational feasibility study with a modest sample size and short follow- up. Ultrasound guidance was not used for arterial puncture, possibly affecting success rates. All dTRA cases were performed by a single experienced operator. Vascular complications were only assessed during hospitalization, and no post-procedural ultrasound was conducted to evaluate RAO. Pain at the access site was not formally recorded. The study period coincided with the COVID-19 pandemic, limiting evaluation of early discharge feasibility.
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The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Grace Pierce, International Journal of Clinical Case Reports and Reviews I appreciate the opportunity to review for Auctore Journal, as the overall editorial process was smooth, transparent and professionally managed. This journal maintains high scientific standards and ensures timely communications with authors, which is truly commendable. I would like to express my special thanks to editor Grace Pierce for his constant guidance, promt responses, and supportive coordination throughout the review process. I am also greatful to Eleanor Bailey from the finance department for her clear communication and efficient handling of all administrative matters. Overall, my experience with Auctore Journal has been highly positive and rewarding. Best regards, Sabita sinha
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
