Distal Radial Artery Access for Recanalization of Radial Artery Occlusion and Repeat Intervention: A Single Center Experience

Abstract

Background: Once occluded, the radial artery becomes unsuitable for repeat interventions and obligates the need for alternative vascular access, such as the femoral approach, which is not encouraged by current guidelines. With the dissemination of distal radial access (DRA), which allows the cannulation of the artery in its distal segment and which remains patent even in the case of radial artery occlusion (RAO), the option to perform angioplasty at this level becomes feasible. Methods: Thirty patients with RAO were enrolled in this pilot study. Recanalization was performed through DRA using hydrophilic guidewires. The feasibility endpoint was procedural success, namely the successful RAO recanalization, the efficacy endpoint was patency of the artery at 30 days, and the safety endpoint was the absence of periprocedural vascular major complications or major adverse cardiac and cerebrovascular events. Results: The mean age of the patients was 63 ± 11 years, and 15 patients (50%) were men. Most patients had asymptomatic RAO (n = 28, 93.3%), and only two (6.6%) reported numbness in their hands. The most common indication for the procedure was PCI (19, 63.2%). Total procedural time was 41 ± 22 min, while the amount of contrast used was 140 ± 28 mL. Procedural success was 100% (n = 30). Moreover, there were no major vascular complications (0%); only two small hematomas were described (10%) and one had an angiographically visible perforation (3%). One case of periprocedural stroke was reported (3%), with onset immediately after the procedure and recovering 24 h later. Twenty-seven radial arteries (90%) remained patent at the one-month follow-up. Conclusions: RAO recanalization is feasible and safe, and by using dedicated hydrophilic guidewires, the success rate is high without significantly increasing procedural time or the amount of used contrast.

The Role of Ultrasound in Accessing the Distal Radial Artery at the Anatomical Snuffbox for Cardiovascular Interventions

“…Hemostasis was achieved with inflatable devices in 80% of cases, and the mean hemostasis duration was 123 ± 75 min, which finally led to remarkably low levels of RAO following DRA, further establishing the safety of this access route [ 30 ]. Another role of US in assisting DRA was demonstrated in a recent pilot study where chronic RAO was recanalized retrogradely in 30 patients, accessing distally the artery with US, in the only segment where it remained permeable (by collateralization) [ 31 ]. Antegrade damped Doppler sign or reverse flow through the palmar arch were positive signs that the puncture could be performed at this level even though the pulse was not palpable [ 31 ].…”

“…Another role of US in assisting DRA was demonstrated in a recent pilot study where chronic RAO was recanalized retrogradely in 30 patients, accessing distally the artery with US, in the only segment where it remained permeable (by collateralization) [ 31 ]. Antegrade damped Doppler sign or reverse flow through the palmar arch were positive signs that the puncture could be performed at this level even though the pulse was not palpable [ 31 ]. It remains to be seen whether the utility of US in DRA will outweigh its practical role and bring benefits on clinical hard endpoints, as it did for femoral access [ 32 ].…”

Safety and Feasibility of Retrograde Recanalization of Radial Artery Occlusion in Patients with Need for Repeated Wrist Procedures

“…A new study published recently explored retrograde recanalization of RAO through distal TRA, which proved to be feasible with a 90% patency rate at 1 month follow-up [27]. In our study, we had a smaller rate of patency at long term follow up to 10 years, which shows that patency rate decreases over time.…”

“…Several techniques have been published in the past dealing with the opening of a chronic total occlusion of the RA and re-using it for the following intervention [24], [25], [26], [27].…”

Special Issue “Coronary Artery Disease Interventions”

“…Achim et al stated the excellent feasibility, safety, and fast learning curve of dRA in their multicenter trial [5]. Furthermore, this access shows promising results through the successful recanalization of radial artery occlusion (RAO) in an additional single-center approach highlighted in this Special Issue [6].…”