Radial artery thrombus remodeling after transradial access: from fresh components to recanalized channels on OCT

Background: phenotyping remains limited. Aims: This study aims to characterize RAT using optical coherence tomography (OCT), propose an OCT-based phenotyping scheme, and describe interval-stratified patterns after TRA. Methods: We retrospectively analyzed a prospectively maintained, single-center registry of consecutive radial artery OCT (RA-OCT) performed after OCT-guided coronary intervention (April 2019-September 2025). RAT was adjudicated by blinded readers using prespecified criteria: Type 1 (fresh), Type 2a/2b (non-recanalized without/with intrathrombus cavities), and Type 3 (recanalized with communicating channels). Phenotypes were compared across proximal, mid, and distal segments as well as across strata defined by time since the most recent ipsilateral TRA. Results: for trend = 0.014), with Type 3 predominating at ≥181 days. Conclusions: RAT phenotyping and supports a pragmatic OCT-based classification, demonstrating interval-dependent evolution toward a recanalized architecture after TRA.