Optimal radial artery diameter for predicting radial artery occlusion after transradial coronary catheterization

The study aims to investigate how the radial artery diameter (RAD) predicts post-procedural radial artery occlusion (RAO) in patients undergoing transradial coronary catheterization (TRC).

RAO is the most frequent complication of TRC. However, the cut-off value of RAD for predicting RAO remains uncertain.

A total of 2073 patients undergoing TRC were consecutively screened, and 1023 were enrolled. The participants were divided into 6 French (Fr) coronary angiography (CAG), 6 Fr percutaneous coronary intervention (PCI), and 7 Fr PCI groups. Ultrasound examination was performed before and after the procedure to measure RAD and to assess RAO. The primary endpoint was the rate of RAO at 12-24 h post-TRC.

RAO was observed in 11.2% (115/1023) of patients. RAO was significantly lower in the 6 Fr PCI group than in the 6 Fr CAG and 7 Fr PCI groups (6.6% vs. 14.3%, P = 0.003, 6.6% vs. 15.4%, P = 0.001, respectively). The RAD cut-off values for predicting RAO were 2.42 mm in the 6 Fr CAG group, 2.38 mm in the 6 Fr PCI group, and 2.85 mm in the 7 Fr PCI group. The larger pre-procedural RAD was an independent protective factor for preventing RAO (odds ratio [OR]: 0.239, 95% confidence interval [CI]: 0.099-0.561, P < 0.001), while 7 Fr sheath (OR: 4.610, 95% CI: 2.159-9.938, P < 0.001) and local complaints at access site (OR: 4.782, 95% CI: 2.815-8.150, P < 0.001) were associated with an increased risk of RAO post-TRC.

Pre-procedural ultrasound measurements of RAD can help to choose an optimal sheath size to prevent RAO after TRC.