Incidence, classification, healing patterns, and vascular remodeling of radial artery dissection assessed by OCT

The incidence and natural history of radial artery dissection (RAD) after transradial or distal transradial coronary intervention (TDRI) remain unclear.

To determine the incidence, classification, healing patterns, vascular remodeling, and factors associated with RAD identified by optical coherence tomography (OCT).

This retrospective single-center study included 1,995 patients who underwent radial artery OCT during TDRI with a uniform 6 Fr introducer sheath between 2016 and 2024. RAD incidence was assessed on a patient basis (≥1 RAD/patient). RAD lesions were classified per lesion as Type I (flap) or Type II (cavity), stratified by external elastic membrane (EEM) depth (E1 within media; E2 at EEM; E3 beyond EEM). Healing and remodeling were analyzed per lesion in a repeat-OCT cohort defined as patients who underwent repeat radial artery OCT during subsequent TDRI; a remodeling index <1 defined negative remodeling. Exploratory logistic regression was performed to identify factors associated with RAD.

RAD occurred in 266/1,995 patients (13.3%). Overall, 325 RAD lesions were identified (mean 1.22 per patient); the most frequent baseline subtype was Type I-E1 (33.8%). In exploratory multivariable analysis, older age, female sex, longer procedure duration, clinically relevant radial artery spasm, and smaller OCT-derived reference radial artery diameter remained associated with RAD. In the repeat-OCT cohort (22 patients; 28 lesions), repeat OCT at day 9 in one patient (3 lesions) showed partial healing, whereas repeat radial artery OCT performed ≥30 days in the remaining 21 patients (25 lesions) demonstrated complete healing, predominantly through intimal hyperplasia (60%) or fibrous plaque (40%). The mean remodeling index was 0.94 ± 0.11.

In this 6 Fr sheath-based TDRI cohort,RAD was frequently detected by OCT and was usually limited in depth. Older age, female sex, radial artery spasm, longer procedure duration, and smaller radial artery diameter were associated with RAD. lesions reassessed ≥30 days healed completely with mild negative remodeling.