A Retrospective Analysis of Radial Artery Occlusion Rates in ACS Patients Undergoing Transradial PCI: A Single-Center Experience

Background: Transradial access (TRA) has become the preferred approach for percutaneous coronary intervention (PCI) due to reduced vascular complications. However, radial artery occlusion (RAO) remains a recognized complication. We evaluated RAO rates in acute coronary syndrome (ACS) patients undergoing transradial PCI at a high-volume center and compared outcomes between those receiving ticagrelor versus clopidogrel. Methods: We retrospectively analyzed 240 ACS patients who underwent transradial PCI from June 1, 2022 to June 1, 2024 at Konya City Hospital. All patients received standard heparin (weight-based), immediate sheath removal, and radial compression with Terumo or Shunmei close pads. Barbeau Test results at follow-up (1 month) were used to detect RAO (Type D waveform). Clinical and laboratory characteristics, including echocardiographic ejection fraction (EF), were compared between ticagrelor and clopidogrel groups. Results: Mean age was 60.4±11.2 years, and 71.7% were male. Overall, 66.7% presented with ST-elevation myocardial infarction (STEMI) and 33.3% with non-STEMI (NSTEMI). Laboratory profiles and EF (~48%) did not differ between ticagrelor (n=140) and clopidogrel (n=100) groups. Radial artery patency was high: only 5 patients (2.1% ) had RAO (Barbeau Type D). No significant difference in RAO rates was observed between ticagrelor (2.1%) and clopidogrel (2.0%) groups (p=0.96). Conclusions: In this retrospective analysis, standardized transradial PCI procedures achieved low RAO rates (~2%) with no significant difference between ticagrelor and clopidogrel. These findings underscore the safety and efficacy of radial interventions when performed by experienced operators using best practices, and confirm that RAO should be viewed as a manageable complication.