Incidence and predictors of radial artery occlusion following transradial coronary procedures

Abstract Background Transradial access for percutaneous coronary procedures has grown in popularity because of its advantages over the femoral approach. However, the benefit is overshadowed by an increased rate of radial artery occlusion (RAO). We aim to assess incidence and predictors of RAO after transradial catheterization. The anatomic variations of the radial artery (RA) were also studied. Methods This prospective study enrolled 427 patients who underwent coronary angiography or angioplasty via transradial access. An ultrasound evaluation of forearm arteries was performed. In case of RAO, another ultrasound check-up was performed after 1 month and 3 months of the procedure. Results Our study population includes 288 patients (32.6% female). The mean age was 61.9 ± 11.1 years. RAO occured in 48 patients (11.24%), among whom spontaneous recanalization was observed within 3 months in 15 patients (32.6%). On multivariate analysis, a younger age (OR 0.642 [CI 95%: 0.480 – 0.858], P = 0.031), low periprocedural systolic blood pressure, (OR 0.598 [CI 95%: 0.415 – 0.862], P = 0.007), a small radial diameter (OR 0.371 [CI 95%: 0.323 – 0.618], P = 0.031), insufficient anticoagulation (OR 0.287 [CI 95%: 0.163 – 0.505], P < 0.001), occlusive hemostasis (OR 0.128 [CI 95%: 0.047 – 0.353], P < 0.001), and a long duration of hemostasis emerged as independent predictors of radial occlusion. The overall incidence of radial artery anatomic variations was 14,8% (n=63). Among these patients, 40 (63.5%) had a high radial origin, 18 (28.6%) had extreme radial artery tortuosity, and 5 (7.9%) had a full radioulnar loop. Conclusion The incidence and prevalence of radial artery occlusion is expected to increase. Insufficient heparinization and occlusive hemostasis are the main modifiable predictors. The preventive strategy should focus primarily on these 2 predictive factors.