Distal Radial Access for Radial Artery Recanalization: Multicenter Outcomes and Stepwise Strategies to Maximize...

Area of Science:

• Cardiovascular Interventions
• Vascular Access Management
• Interventional Cardiology

Background:

• Radial artery occlusion is a complication of transradial access, potentially limiting future procedures.
• Distal radial access (DRA) provides a novel approach for retrograde recanalization of occluded radial arteries.

Purpose of the Study:

• To evaluate multicenter outcomes of radial artery recanalization via DRA.
• To assess the safety, efficacy, and reproducibility of DRA for radial artery recanalization.
• To identify procedural strategies that optimize radial artery patency.

Main Methods:

• An international registry of 110 patients with radial artery occlusion across 7 centers was analyzed.
• Experienced operators performed retrograde recanalization using DRA in the anatomical snuffbox.
• Techniques included drilling or knuckling to cross occlusions, followed by dotter dilation or balloon angioplasty.

Main Results:

• Procedural success was achieved in 94% of cases, with complications managed conservatively.
• Radial artery patency at 30 days was 80%.
• A sheathless approach was the only significant predictor of improved patency (OR: 3.07), while larger sheaths (>6-F) or balloons (>2.25 mm) were associated with decreased patency.

Conclusions:

• Recanalization of occluded radial arteries through DRA is safe, effective, and reproducible.
• DRA preserves the radial artery, maintaining a crucial vascular access option.
• Preferring a dotterization technique with sheaths ≤6-F or a sheathless approach is recommended to enhance 30-day patency.