Retrograde Recanalization of Occluded Radial Artery: A Single-Centre Experience and Literature Review

Abstract

Purpose: Radial artery occlusion (RAO) is one of the common complications after coronary intervention via the conventional radial artery approach. The purpose of the study was to explore the safety and feasibility of retrograde recanalization of the occluded radial artery via a distal radial artery (DRA) approach. Methods: Combined with the practice of our centre and a literature review, we summarized the procedure of retrograde recanalization of RAO, success rate, and complications. Results: A total of 14 of 15 patients with 15 pieces of occluded radial arteries were successfully recanalized via the DRA in our centre. In the 15 occluded vessels, 11 vessels (73.3%) had total occlusion and 4 vessels (26.7%) had functional occlusion. Four of 15 occluded vessels were acute occlusions. Two acute RAOs were only treated with aspiration via sheath, 11 RAOs with balloon angioplasty, and 2 RAOs with both, respectively. In 6 patients, cardiac catheterization was carried out via the DRA after recanalizing the RAO. A total of 10 studies reporting the results of recanalization of RAO via the DRA were systematically retrieved in the present study. In 3 case series, the number of cases was more than 5, and the success rate of recanalization was more than 85.7%. Two studies reported complications, including dissection in one case, hematoma in 2 cases, and pain in the forearm during angioplasty. Conclusions: Recanalization of the occluded radial artery via the DRA was safe and effective. When repeat cardiac catheterization was required, recanalization of the RAO and subsequent coronary angiography or intervention through the ipsilateral radial artery approach was feasible.

Retrograde recanalization of radial artery occlusion via the distal transradial artery: A single-center experience

“…Li et al (12) presented a case of RAO after emergency CAG and PCI in which recanalization was successfully performed through dTRA access. Additionally, case series have suggested that dTRA was safe and convenient for retrograde recanalization of RAO, with success rates of 88 to 93% (4,5). In the present study, the success rate was similar at 88.6%.…”

“…If there is no pulsatile blood flow gushing out of the cannula, we should realize that the sheath may be inserted too deep with the occluded segment or thrombus, instead of vascular dissection. Finally, balloonassisted tracking technology can be applied to navigate the guidewire through the occlusion (5).…”

“…In 2018, Balaban and Elevli (4) showed with 25 patients that it was safe and convenient to perform CAG after retrograde recanalization of RAO via the dTRA. In 2021, Shi et al (5) also found in a 15-case series that recanalization of RAO through the dTRA was safe and effective. However, the lack of large sample populations and long-term follow-up data have limited these studies.…”

Application of ultrasound in cardiovascular intervention via the distal radial artery approach: New wine in old bottles?

“…Nevertheless, Tsigkas G et al emphasized that although ultrasound guidance could improve the success rate of puncture, it might increase the procedure time and cost, and it was not advocated as a routine operation ( 3 ). Moreover, ultrasound guidance has a high value in the reverse recanalization of the proximal RAO via the DRA ( 50 ). In RAO patients, the radial artery in the AS circulates through the reverse lateral branch of the palmar arch.…”

“…The palpation becomes weak or disappears, but blood flow signals are still visible under high-frequency ultrasound. Ultrasound guidance may significantly increase the puncture success rate ( 50 , 51 ).…”