Early radial artery occlusion following the use of a transradial 7‐French sheath for complex coronary interventions in Chinese patients

Abstract

Objectives: We aimed to explore the impact of 7-Fr sheaths on the incidence of early radial artery occlusion (RAO) after transradial coronary intervention (TRI) in Chinese patients.Background: RAO precludes future use of the vessel for vascular access. Transradial catheterization is usually performed via 5-Fr or 6-Fr catheters; 7-Fr sheath insertion enables complex coronary interventions but may increase the RAO risk.Methods: We prospectively enrolled 130 consecutive patients undergoing complex TRI using 7-Fr sheaths. Radial artery ultrasound assessment was performed before and after TRI. Early RAO was defined as the absence of flow on ultrasound within 6-24 hr after TRI. Multivariate logistic regression was used to determine the factors related to early RAO after TRI.Results: 7-Fr sheaths were mainly used for chronic total occlusion (44.6%), bifurcation (30.0%), and tortuous calcification (25.4%) lesions. All patients were successfully sheathed. Percutaneous coronary intervention (PCI) procedural success was 96.2%; 119 patients (91.5%) had preserved radial artery patency after TRI. All 11 RAO cases (8.5%) were asymptomatic. The radial artery diameter was significantly larger postoperatively (3.1 ± 0.4 mm) than preoperatively (2.6 ± 0.5 mm) (p < .001). No parameters significantly differed between patients with and without RAO. TRI history was the only independent risk factor of early RAO (odds ratio: 6.047, 95% confidence interval: 1.100-33.253, p = .039).Conclusions: 7-Fr sheath use after transradial access for complex PCI is feasible and safe. Evaluating the radial artery within 24 hr after TRI allows timely RAO recognition, important for taking measures to maintain radial artery patency and preserve access for future TRIs.

Preventing and Managing Radial Artery Occlusion following Transradial Procedures: Strategies and Considerations

“…Among these factors, cardiovascular risk factors could be modified over the years through lifestyle changes and pharmacological interventions, whereas previous radial artery cannulation is an unmodifiable risk factor that does not constitute a generic characteristic. Unfortunately, repeated radial cannulation leads to intimal hyperplasia and intima-media thickening, resulting in reduced lumen diameter [18].…”

“…Post-procedural pain at the cannulation site and hematoma formation are both considered to be contributing factors to thrombotic radial artery occlusion. Paradoxically, the formation of a hematoma after removal of the hemostatic device is thought to increase the risk of thrombus formation, as the operator may need to manipulate the access site in order to minimize its extent [18,20].…”

Retrograde Recanalization of Occluded Radial Artery: A Single-Centre Experience and Literature Review

“…1 Generally, RAO is regarded as a “benign complication,” because most patients with RAO do not have obvious symptoms. 2 However, the occluded radial artery will limit the application of the radial artery approach in cardiovascular interventions, which has gradually attracted the attention of interventionalists. With the increase in the incidence of coronary heart disease and the trend of ageing, an increasing number of patients need multiple coronary diagnoses and interventions.…”

Comparison of long-term radial artery occlusion via distal vs. conventional transradial access (CONDITION): a randomized controlled trial

“…However, the rate of dRAO was 1.4% in the present study. The distal radial artery was relatively small, and the mismatch between the sheath and the vessel was an independent risk factor for RAO and/or dRAO [29,30]. To determine whether a slender sheath is superior to a conventional artery sheath in terms of reducing the incidence of dRAO, the ongoing SMART trial (NCT05501925) might provide an answer.…”