Prevention of Radial Artery Occlusions Following Coronary Procedures: Forward and Backward Steps in Improving Radial Artery Patency Rates

Abstract

Radial artery (RA) occlusion (RAO) remains the Achilles heel of transradial coronary procedures. Although of silent nature, RAO is relatively frequent, results in graft shortage for future coronary artery bypass surgery, and may occur even after short-lasting, 5F coronary angiography (CAG). The most frequent predictors of RAO are RA size, body size, female gender, and periprocedural anticoagulation intensity. Methods to detect RAO are variable, of which the Barbeau test and ultrasonography have similar diagnostic accuracy. Data indicate that late RAO recanalization may occur. Meticulous handling of RA and the use of appropriate hemostatic devices and techniques along with sufficient heparin dose appear important measures to reduce RAO rates. Recent contradictory studies indicate that the decreasing incidence of RAO overtime is not as uniform as previously thought. In 2 meta-analyses, the benefit of higher over lower anticoagulation intensity became evident. As "it may all be appropriate anticoagulation" for a simplified approach against RAO, the results of an ongoing trial comparing 100 with 50 IU/kg body weight in transradial CAG are eagerly awaited.

Pre–Liver Transplant Cardiac Catheterization Is Associated With Low Rate of Myocardial Infarction and Cardiac Mortality

“…Our center's technique did not result in any major bleeding events and in a minor bleeding incidence of only 2.5%. Another point is that with radial access, in addition to using vasodilating agents, 2500-5000 units of intra-arterial heparin or up to 100 IU/Kg is used to prevent thrombus formation after the wire is inserted that may lead to radial artery occlusion (38). Heparin is not needed in the femoral approach unless PCI is required.…”

Slender Sheath/Guiding Catheter Combination vs. Sheathless Guiding Catheter for Acute Coronary Syndrome: A Propensity-Matched Analysis of the Two Devices

“…For alleviating potential selection bias between the two groups, a propensity score was estimated using a multivariate logistic regression model. The co-variables included in the model were selected based on the results of the univariate analysis/clinical perspective including age, sex, body mass index, diabetes mellitus, hypertension, dyslipidemia, current smoking, peripheral artery disease, history of previous bleeding requiring hospitalization or transfusion, history of stroke and myocardial infarction, previous PCI, previous coronary artery bypass grafting, use of oral anticoagulants, Killip class on admission, estimated glomerular filtration rate, arterial access site (left or right radial artery approach), and the number of previous ipsilateral transradial coronary angiography or intervention attempts [ 2 , 14 ]. Notably, these co-variables only included those that would be known at the time of the point of catheter selection.…”

Simple Techniques That Can Facilitate Radial Artery Access

“…The lower rate of vascular complications makes the transradial route recommended choice of access for coronary procedures. 1 Radial artery spasm (RAS) and radial artery occlusion (RAO) are the main disadvantages for transradial procedures. 1 In a well-presented article, Hahalis et al 1 figured out the risk factors for RAO and stated that careful handling of the radial artery and appropriate heparin dose are the main measures to reduce RAO.…”

“…1 Radial artery spasm (RAS) and radial artery occlusion (RAO) are the main disadvantages for transradial procedures. 1 In a well-presented article, Hahalis et al 1 figured out the risk factors for RAO and stated that careful handling of the radial artery and appropriate heparin dose are the main measures to reduce RAO. As mentioned in the article, higher number of puncture attempts and access site pain are also among the reasons of RAS and RAO.…”