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Predictors of radial artery size in patients undergoing cardiac catheterization: insights from the Good Radial Artery
Mark A Kotowycz1, K Wayne Johnston1, Joan Ivanov1
1Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
Insights
Radial artery diameter, a key factor in preventing occlusion after cardiac procedures, can be predicted using bedside measurements. Wrist circumference, male sex, and ancestry are significant predictors, enabling identification of patients at risk for smaller arteries.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Interventional Cardiology
Background:
- Radial artery occlusion is a complication following transradial cardiac catheterization and percutaneous coronary intervention.
- Using a sheath larger than the radial artery diameter is a known risk factor for occlusion.
- Routine measurement of radial artery size is not standard practice, despite its importance.
Purpose of the Study:
- To identify easily measurable, bedside predictors of radial artery diameter.
- To develop a tool for assessing the risk of radial artery occlusion before procedures.
Main Methods:
- Prospective ultrasound measurement of radial, ulnar, and brachial artery diameters in 130 patients.
- Patients were undergoing elective percutaneous coronary intervention or diagnostic angiography.
- Multivariable linear regression analysis was used to identify predictors of radial artery diameter.
Main Results:
- Mean radial artery diameter was 2.44 mm; it was larger in men (2.59 mm) than women (1.91 mm) and smaller in South Asian patients (2.00 mm).
- Independent predictors of larger radial artery diameter included wrist circumference (r²=0.26), male sex (r²=0.06), and non-South Asian ancestry (r²=0.05).
- A risk score incorporating these factors demonstrated predictive value for radial artery diameter (c-statistic=0.71).
Conclusions:
- Wrist circumference, male sex, and non-South Asian ancestry are significant independent predictors of radial artery diameter.
- A developed risk score effectively identifies patients with smaller radial arteries, potentially preventing complications.
- These bedside predictors can aid in procedural planning and reduce the incidence of radial artery occlusion.
Background:
Radial artery occlusion occurs after transradial cardiac catheterization or percutaneous coronary intervention. Although use of a sheath larger than the artery is a risk factor for radial artery occlusion, radial artery size is not routinely measured. We aimed to identify bedside predictors of radial artery diameter.
Methods:
Using ultrasound, we prospectively measured radial, ulnar, and brachial artery diameters of 130 patients who presented for elective percutaneous coronary intervention or diagnostic angiography. Using prespecified candidate variables we used multivariable linear regression to identify predictors of radial artery diameter.
Results:
Mean internal diameters of the right radial, ulnar, and brachial arteries were 2.44 ± 0.60, 2.14 ± 0.53, and 4.50 ± 0.88 mm, respectively. Results for the left arm were similar. The right radial artery was larger in men than in women (2.59 vs 1.91 mm; P < 0.001) and smaller in patients of South Asian descent (2.00 vs 2.52 mm; P < 0.001). Radial artery diameter correlated with wrist circumference (r(2) = 0.26; P < 0.001) and shoe size (r(2) = 0.25; P < 0.001) and weakly correlated with height (r(2) = 0.14; P < 0.001), weight (r(2) = 0.18; P < 0.001), body mass index (r(2) = 0.07; P = 0.002), and body surface area (r(2) = 0.22; P < 0.001). The independent predictors of a larger radial artery were wrist circumference (r(2) = 0.26; P < 0.001), male sex (r(2) = 0.06; P < 0.001), and non-South Asian ancestry (r(2) = 0.05; P = 0.006; final model r(2) = 0.37; P < 0.001). A risk score using these variables predicted radial artery diameter (c-statistic, 0.71).
Conclusions:
Wrist circumference, male sex, and non-South Asian ancestry are independent predictors of increased radial artery diameter. A risk score using these variables can identify patients with small radial arteries.
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