Incidence and predictors of radial artery occlusion following transradial coronary procedures

The use of transradial access for percutaneous coronary procedures has increased due to its advantages over the femoral approach. However, this benefit comes at the expense of a higher rate of radial artery occlusion (RAO). Our objective was to assess the incidence and predictors of RAO following transradial catheterization. Additionally, we studied anatomic variations of the radial artery (RA).

This prospective study enrolled 427 patients who underwent coronary angiography or angioplasty via transradial access. The forearm arteries were evaluated by ultrasound. If RAO was present, follow-up ultrasound examinations were performed at 1 and 3 months postprocedure.

Our study population included 288 men (67.4%) and 139 women (32.6%). The mean age was 61.9 ± 11.1 years. RAO occurred in 48 patients (11.24%), and spontaneous recanalization was observed within 3 months in 15 patients (32.6%). On multivariate analysis, independent predictors of RAO were younger age (OR, 0.642; 95%CI, 0.480-0.858; P = .031), low periprocedural systolic blood pressure (OR, 0.598; 95%CI, 0.415-0.862; P = .007), a small radial diameter (OR, 0.371; 95%CI, 0.323-0.618; P = .031), insufficient anticoagulation (OR, 0.287; 95%CI, 0.163-0.505; P < .001), occlusive hemostasis (OR, 0.128; 95%CI, 0.047-0.353; P < .001), and long duration of hemostasis. The overall incidence of RA anatomic variations was 14.8% (n = 63). Among these, 40 patients (63.5%) had a high radial origin, 18 (28.6%) had extreme RA tortuosity, and 5 (7.9%) had a complete radioulnar loop.

The main modifiable predictors of RAO are insufficient heparinization and occlusive hemostasis. Preventive strategies should focus primarily on these 2 predictive factors to reduce the risk of RAO.