Ultrasound-Guided Distal Radial Artery Recanalization (RETRY Study): Initial Case Series and Early Experience

Radial artery occlusion (RAO) is the most common complication of transradial access. Existing revascularization protocols are not yet standardized, and different revascularization techniques may be employed across centers.

An innovative protocol named RETRY, which targets the recanalization of the proximal radial artery via distal radial access using specific wire techniques and drug-coated balloons, could be feasible and safe.

We prospectively collected and analyzed data from 12 consecutive patients undergoing attempted recanalization of RAO via distal radial access between January 2024 and July 2025. Demographic, clinical, and procedural variables were recorded. The primary endpoint was technical success, defined as successful recanalization with restoration of antegrade radial flow on angiography. Secondary outcomes included complications and radial patency at follow-up.

Mean patient age was 61.5 ± 12.1 years; mean body mass index was 29.1 ± 3.3 kg/m². Retrograde guidewire passage was achieved in all 12 patients (100%), with no crossover. Percutaneous coronary intervention was performed in 3 cases (25%). Mean procedural time was 50.0 ± 15.6 min, with fluoroscopy time 12.6 ± 6.5 min, and contrast volume 106.7 ± 47.2 mL. No complications were recorded. Patency was confirmed in 91.7% at 48 hours and 83.3% at 1 month.

The RETRY protocol for RAO recanalization, based on ultrasound-guided distal radial access and drug-coated balloon angioplasty, is feasible, safe, and associated with excellent technical success and favorable short-term patency. As a prospective feasibility study, these findings warrant validation in larger, comparative trials with longer follow-up.