Structural radial artery modifications following transradial access: Mechanisms, clinical implications, and...

Transradial access (TRA) has emerged as the preferred vascular access route for coronary angiography and percutaneous coronary interventions due to its superior safety profile compared to transfemoral access. However, its widespread adoption raises concerns regarding structural alterations in the radial artery, which may impact long-term vascular health and future procedural feasibility. TRA is associated with histopathologic changes in the arterial wall, such as intimal injury and hyperplasia, medial remodeling and adventitial inflammation, collectively contributing to radial artery remodeling. Moreover, TRA can induce changes in radial artery lumen diameter driven by an inflammatory response due to arterial puncture and mechanical friction during the procedure. Nonetheless, a more clinically significant consequence is radial artery occlusion, which is influenced by various procedural and patient-related factors. Strategies to minimize remodeling include meticulous pre-procedural ultrasound assessment to ensure appropriate sheath-to-artery size matching, periprocedural pharmacological interventions and implementation of patent hemostasis techniques. This review synthesizes current knowledge regarding the mechanisms, clinical implications, and preventive strategies related to radial artery remodeling following TRA. Further research is needed to elucidate the long-term consequences of radial artery remodeling and to refine preventive strategies for preserving radial artery patency and its suitability for future interventions.