Radial access during percutaneous interventions in patients with acute coronary syndromes: should we routinely monitor radial artery patency by ultrasonography promptly after the procedure and in long-term observation?

Abstract

Access-site vascular complications in patients undergoing transradial coronary procedures are rare but may have relevant clinical consequences. The aim of the study was to evaluate: (1) radial artery’s (RA) patency immediately after the procedure and in long-term observation, (2) factors influencing the frequency of radial artery’s occlusion (RAO) after percutaneous coronary intervention (PCI) procedures performed via transradial access in the group of 220 patients with acute coronary syndromes (ACS). RA ultrasound was performed 48–72 h after the procedure and in those who were diagnosed with RAO-again after 6–12 months. According to the ultrasonographic findings, the patients were divided into two sub-groups: 187 pts (85 %) with patent RA after PCI and 33 pts (15 %) with RAO. Both sub-groups significantly statistically differed with regard to the frequency of local hematomas—15 versus 27.3 % (p = 0.02), the frequency of applying IIbIIIa inhibitors in PCI—6.4 versus 15.1 % (p = 0.015) and procedure duration—0.59 ± 0.37 versus 0.77 ± 0.38 (p = 0.014), respectively. In a multifactorial analysis the only factor influencing RA patency promptly after the procedure was PCI duration (p < 0.05, r = −0.22). In the follow-up, right RA remained still obstructed in 28 patients (12.7 %) whereas in five patients (2.3 %) the regular flow in RA was resumed. The chronic RAO was clinically silent. Due to insignificant frequency of the occurrence of RAO after PCI procedure in patients with ACS as well as practically lack of clinical consequences of this artery’s occlusion in long-term observation, we do not see any implications to routine ultrasound periprocedural RA evaluation.

Radial Artery Occlusion After Transradial Interventions: A Systematic Review and Meta‐Analysis

“…Several studies evaluated significant predictors of RAO (Table ). Age was reported to be a significant predictor of RAO in 3 studies, while sex was significant in 6 studies . Body weight was reported as a significant predictor in 3 studies .…”

“…Age was reported to be a significant predictor of RAO in 3 studies, 47,77,78 while sex was significant in 6 studies. 29,49,69,73,77,78 Body weight was reported as a significant predictor in 3 studies. 17,65,75 In terms of procedural variables, use of a smaller introducer sheath has been shown to be predictive of lower RAO 71 and use of larger diameter of sheath 42,78,81 and duration of compression 61,81 was associated with higher occlusion rates.…”

“…17,65,75 In terms of procedural variables, use of a smaller introducer sheath has been shown to be predictive of lower RAO 71 and use of larger diameter of sheath 42,78,81 and duration of compression 61,81 was associated with higher occlusion rates. Other predictors included baseline radial artery diameter, 19,84,85 peripheral artery disease, 79 statin use, 42 procedural success, 47 serum creatinine, 49 and heparin use. 66 Two studies evaluated the effectiveness of the TR band compared to other TRA hemostatic devices in reducing radial occlusion.…”

Cardiovascular imaging 2015 in the International Journal of Cardiovascular Imaging

“…Transradial coronary procedures are increasingly being used. lisowska et al [16] studied 220 patients with acute coronary syndromes who underwent percutaneous coronary intervention performed via transradial access and studied radial artery's patency immediately after the procedure and in long-term observation using ultrasound technology. radial artery's occlusion was found in 15 % of the patients immediately after the procedure.…”

Pedal access: Put the “pedal to the metal” or drive with caution?

“…Lisowka et al found that when ultrasound was used to evaluate radial artery patency 6-12 month following radial access, a not insignificant 15% had asymptomatic radial artery occlusion, and multivariable analysis demonstrated duration of the procedure as the main variable associated with arterial occlusion. 3 Levin et al reported a vessel closure in one of five patients treated with a radial artery 7-french sheath with a mean follow up of 507 days. 4 Performing peripheral PAD procedures from the radial artery has demonstrated an unflattering 31% occlusion rate in one published series.…”