Feasibility of Transradial Access Through Chronically Occluded Radial Arteries

Background Radial artery occlusion (RAO) often precludes the use of transradial access (TRA) for coronary procedures. This study examines the feasibility and outcomes of TRA through chronically occluded radial arteries. Methods Access was obtained in the proximal or distal radial artery using ultrasound guidance by angiocath needle. Navigation through the occlusion was done using a GlideAdvantage 0.018″ wire. A 6Fr 16‐cm Glidesheath Slender was advanced once the occlusion was crossed. The 5Fr catheters were utilized for coronary angiograms, and 6Fr guides were utilized for percutaneous coronary intervention (PCI). Aspirations were performed through the sheath and catheters up to the brachial artery. Outcomes were assessed predischarge and at 30‐day follow‐up. Results Thirteen patients with chronic RAO were included. The median age was 59 (53, 65) years, with 69% ( n = 9) being male. The last known radial patency was 17.5 (11.5–21.3) months prior to intervention. Proximal radial artery was utilized in 77% ( n = 10) of the patients. Duration for TRA was 8 (6, 10) minutes, with a success rate of 100%. A total of 69% ( n = 9) of the patients had a diagnostic coronary angiogram, while 31% ( n = 4) of the patients underwent additional PCI. The intended procedure was successful in 12 out of 13 patients with no periprocedural complications. Severe pain and spasm occurred in 38% of the patients ( n = 5). Duplex ultrasound revealed RAO in 12 patients predischarge and RAO in all patients at 30‐day follow‐up. Conclusions TRA through chronically occluded radial arteries for coronary procedures was a feasible option in this cohort. This technique can offer an alternative for patients with no viable alternative access sites.