Retrograde Recanalization and Catheterization of Occluded Radial Arteries

Transradial access (TRA) is the dominant approach for cardiac catheterization and percutaneous intervention (PCI). Radial artery occlusion (RAO) remains the most common complication of TRA. Though upper extremity perfusion is usually maintained due to collateral circulation, RAO poses a challenge to future catheterization access and has previously been considered a relative contraindication to TRA. More recently, cases of successful recanalization of RAO via a distal approach have been reported with favorable success rates and minimal complications. This review summarizes current literature on re-accessing an occluded radial artery (RA) via a distal RA approach for cardiac catheterization, with a focus on considerations for operators who may attempt this technique.