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Incidence and Predictors of Early and Late Radial Artery Occlusion after Percutaneous Coronary Intervention and
Aisha Khalid1, Hans Mautong2, Kayode Ahmed3
1Department of Postgraduate Medical Education, Harvard University, Cambridge, MA 02138, USA.
Insights
Trans-radial access for coronary procedures can lead to radial artery occlusion (RAO). This meta-analysis found early RAO incidence at 14% and late RAO at 10%, with female sex and age as potential risk factors.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Trans-radial access is increasingly preferred for coronary angiography and percutaneous coronary intervention (PCI).
- Radial artery occlusion (RAO) is a recognized complication of trans-radial procedures.
- Understanding RAO incidence and risk factors is crucial for patient safety and procedural optimization.
Purpose of the Study:
- To systematically review and meta-analyze the incidence of early and late radial artery occlusion (RAO) after trans-radial coronary procedures.
- To identify potential risk factors associated with RAO.
- To evaluate the impact of procedural elements on RAO rates.
Main Methods:
- A comprehensive systematic review and meta-analysis of six major databases (Medline, Cochrane, Embase, Scopus, etc.).
- Adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Inclusion of 41 studies comprising 30,020 patients, utilizing random-effect models for analysis.
Main Results:
- The overall incidence of RAO was 13%, with early RAO (within 24h) at 14% and late RAO (after 24h) at 10%.
- Female gender (effect size 0.22) and age were identified as potential predictors of RAO.
- Catheter size >6 Fr and hemostatic compression <90 minutes significantly reduced RAO incidence.
Conclusions:
- This meta-analysis quantifies the incidence of early (14%) and late (10%) RAO following trans-radial angiographic procedures.
- Female sex and older age are suggested predictors of RAO.
- Utilizing larger catheters (≥6 Fr) and shorter compression times (<90 min) can mitigate RAO risk.
Abstract:
Introduction: Trans-radial access for coronary angiography and percutaneous coronary intervention (PCI) has gained popularity due to its advantages over the traditional transfemoral approach. However, radial artery occlusion (RAO) remains a common complication following trans-radial procedures. This study aimed to investigate the incidence of early and late RAO along with their risk factors. Methods: Six databases, Medline (Ovid), National Library of Medicine (MeSH), Cochrane Database of Systematic Reviews (Wiley), Embase, Scopus, and Global Index Medicus, were searched. The systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted and analyzed. Using a random-effect model, the primary endpoint was the overall incidence of RAO after invasive coronary procedures. Subgroup analysis and meta-regression were also performed to identify possible predictors of RAO. Results: A total of 41 studies with 30,020 patients were included. The overall incidence of RAO was 13% (95% CI = 0.09-0.16). The incidence of early RAO (within 24 h) was 14% (95% CI = 0.10-0.18) in 26 studies, while the incidence of late RAO (after 24 h) was 10% (95% CI = 0.04-0.16) in 22 studies. The average incidence rates of early RAO in studies with catheter sizes of <6 Fr, 6 Fr, and >6 Fr were 9.8%, 9.4%, and 8.8%. The overall effect size of female gender as a predictor was 0.22 with a 95% CI of 0.00-0.44. Age was a potential predictor of early RAO (B = 0.000357; 95% CI = -0.015-0.0027, p: 0.006). Conclusions: This meta-analysis provides essential information on the incidence of early (14%) and late (10%) RAO following angiographic procedures. Additionally, our findings suggest that female sex and age are possible predictors of RAO. A larger catheter, especially (6 Fr) and hemostatic compression time <90 min post-procedure, substantially reduced the incidence of RAO. The use of oral anticoagulation and the appropriate dosage of low-molecular-weight heparin (LMWH) does reduce RAO, but a comparison between them showed no statistical significance.
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