The Rotterdam Radial Access Research

Abstract

Background-Radial artery wall might be damaged after cannulation for cardiac catheterization. We investigated structural changes of the radial artery wall after catheterization to understand whether these might predict radial pulsation loss or occlusion and local pain or functional impairment of the upper extremity. Methods and Results-Ninety patients underwent transradial coronary angiography or intervention and were scanned with a high-resolution 40-MHz ultrasound before cannulation and at 3 hours and 30 days after procedure. Acute injuries of the radial artery occurred in all patients: dissection and intramural hematoma were the most common. However, these phenomena did not predict loss of radial pulsation or occlusion, local pain, or functional impairment at 30 days. Overall, the radial artery lumen was significantly reduced distal to the puncture site. Radial artery intima and total wall thickness increased 3 hours after puncture and persisted at 30 days. Radial occlusion and pulsation loss were observed in 3.9% and 9.2% of patients, respectively, at 30 days. Smaller radial artery lumen at baseline increased the risk of radial pulsation loss at 30 days (odds ratio, 1.23; P=0.049). The number of radial puncture attempts predicted pulsation loss (odds ratio, 2.64; P=0.027), occlusion (odds ratio, 3.49; P=0.022), and symptoms (odds ratio, 2.24; P=0.05) at 30-day follow-up. Conclusions-After catheterization, radial artery puncture site is associated with increased intima and total wall thickness and with modest decrease of inner lumen diameter. Acute injuries of the vessel wall were ubiquitous, but contrary to repeated puncture attempts, did not seem to affect postprocedural radial occlusion or loss of pulsation.(Circ Cardiovasc Interv. 2016;9:e003129.

Hemostasis pad combined with compression device after transradial coronary procedures: A randomized controlled trial

“…[21] Current guidelines prefer radial access over femoral access if performed by experienced operators. [22, 23] However, the transradial approach is still not free from access site complications although they are low [3]. Major bleeding is an independent predictive factor of adverse clinical outcomes regardless of the access site.…”

“…[1, 2] However, radial access is still associated with significant complications such as access site bleeding and vessel occlusion. [3]…”

The ACRA Anatomy Study (Assessment of Disability After Coronary Procedures Using Radial Access)

“…3 Arterial wall trauma with thromboembolic phenomena to the digital arteries or palmar arch circulation is probably the main underlying mechanism of acute hand ischemia after transradial access. 3,24,25 Therefore, optimal anticoagulant therapy and meticulous access techniques remain paramount to prevent ischemic complications.…”

Thrombotic complications after radial arterial line placement in systemic sclerosis: A case series

“…However, with every procedure, there are potential adverse effects. In fact, temporary occlusion of the artery has ranged from 1.5% to 35% (mean 19.7%) [8,9], and recently, it has been described that transradial coronary angiogram or intervention is highly associated with artery dissection and hematoma even at 30 days post procedure [5]. Furthermore, digital embolization following cannulation can potentially lead to irreversible digital ischemia.…”