Factors influencing radial artery occlusion after transradial coronary intervention in the Indian population

Abstract

Transfemoral vascular access is the most common approach for both diagnostic as well as therapeutic coronary interventions; however, higher rate of vascular complications and bleeding have been reported especially in women and older patients than with radial access (1). Transradial approach (TRA) is now being increasingly used and is the preferred vascular access for cardiac interventions (2). TRA offers advantages such as minimal invasion, ease of performance of diagnostic and therapeutic coronary interventions, minimum patient discomfort, early ambulation, shorter hospital stay, and lower hospital costs (3-7). In addition, there are lower local site complications, morbidity, and mortality in patients who specifically present with acute coronary syndromes (6, 7). Radial artery occlusion (RAO) is one of the most frequent complications of TRA that affects a sizeable proportion of patients (8, 9). Post transradial coronary intervention (TCI), early RAO may occur because of radial artery spasm and thrombosis, which may be precipitated by combined effects of catheter-induced endothelial injury and decrease in blood flow after sheath and catheter insertion (8). The incidence of RAO varies in different studies ranging from 1% to 42%, and has been determined by the timing of evaluation and the method used for the diagnosis of RAO. Various patient-specific and procedure-related factors influence the occurrence and consequences of . However, the predictors of RAO after TCI are not clearly defined. In this study, we determine the incidence and patient-specific and procedure-related predictors of RAO among patients undergoing TCI.

Incidence and Prognostic Factors of Radial Artery Occlusion in Transradial Coronary Catheterization

“…The reported RAO incidence of 9.5% at 24 h is lower than that in all other studies (11.3-17.4%), except for that of Schlosser et al (4.6%) [48,[51][52][53]. In accordance with these studies, the RAO predictors found in the present study are the female gender [48,52,53] and the presence of forearm hematomas [51].…”

“…In the PCI group, the RAO incidence was 6.2%, higher again than the mean range of 4.0–4.5% reported in the meta-analyses by Rashid et al and Hahalis et al but much lower than the extreme values of 11.3–32.9% reported in more recent studies [ 16 , 18 , 47 , 48 , 50 , 51 , 52 ] ( Figure 1 ). We state again that this was an unselected population with no specialized equipment used (like slender guiding catheters), and all peri-procedural parameters were decided by the operator.…”

“…Our study is one of the largest multicenter studies dealing with RAO incidence and predictors in transradial angiography and PCI and in sample sizes of more than 1000 patients [ 48 , 51 , 52 , 53 ]. The reported RAO incidence of 9.5% at 24 h is lower than that in all other studies (11.3–17.4%), except for that of Schlosser et al (4.6%) [ 48 , 51 , 52 , 53 ]. In accordance with these studies, the RAO predictors found in the present study are the female gender [ 48 , 52 , 53 ] and the presence of forearm hematomas [ 51 ].…”

Effectiveness and Safety of Left Distal Transradial Access in Coronary Procedures in the Caribbean

“…Radial artery diameter was a predictive factor for DTRAO [28]. In Indian populations, RAO was encountered in approximately 12-18% of patients undergoing coronary procedures, attributed to a smaller body surface area and radial artery diameter [29]. As a result of the adoption of RAO mitigation strategies, rates were reduced to <3% in landmark trials performed at highly experienced radial centers [30][31].…”

Frequency of radial artery occlusion in patients with diabetes mellitus 24.hr and one month after coronary intervention

“…Reduced infiltrative radial artery exposure led to a considerable improvement in patient convenience and a decrease in punctured site problems when matched to the femoral artery method (Roffi et al, 2016;Wang et al, 2022). Because of radial artery spasms and occlusion during transradial CI, which can be triggered by the cumulative effects of catheterinduced endothelial damage and a reduction in blood circulation following membrane and catheters placement (Dwivedi et al, 2022).…”