Influence of Puncture Site on Radial Artery Occlusion After Transradial Coronary Intervention

Abstract

Background:The risk of radial artery occlusion (RAO) needs particular attention in transradial intervention (TRI). Therefore, reducing vascular occlusion has an important clinical significance. The aim of this study was to determine the appropriate puncture site during TRI through comparing the occurrence of RAO between the different puncture sites to reduce the occurrence of RAO after TRI.Methods:We prospectively assessed the occurrence of RAO in 606 consecutive patients undergoing TRI. Artery occlusion was evaluated with Doppler ultrasound in 2 days and 1 year after the intervention. Risk factors for RAO were evaluated using a multivariate model analysis.Results:Of the 606 patients, the RAO occurred in 56 patients. Compared with TRI at 2–5 cm away from the radius styloid process, the odds ratio (OR) for occlusion risk at 0 cm and 1 cm were 9.65 (P = 0.033) and 8.90 (P = 0.040), respectively. The RAO occurred in the ratio of the arterial diameter to the sheath diameter ≤1 (OR = 2.45, P = 0.004).Conclusion:Distal puncture sites (0–1 cm away from the radius styloid process) can lead to a higher rate of RAO.Trial Registration:ClinicalTrials.gov, NCT01979627; https://clinicaltrials.gov/ct2/show/NCT01979627?term = NCT01979627 and rank = 1.

Radial Artery and Ulnar Artery Occlusions Following Coronary Procedures and the Impact of Anticoagulation: ARTEMIS (Radial and Ulnar ARTE ry Occlusion M eta‐Analys IS ) Systematic Review and Meta‐Analysis

“…Notably, the upper 95% CI for early RAO on low‐heparin dose was 10.6% in the current meta‐analysis, revealing that every tenth patient may be at risk for forearm artery occlusion if not appropriately anticoaggulated during and after a transradial coronary procedure. Recent publications confirm the difficult challenge encountered by the transradial interventionalists to maintain postprocedural forearm artery patency with ranging frequencies between 9.24% of ultrasonography‐detected late RAOs using the patent hemostasis technique (56 of 606 patients) and 25% of clinically detected RAOs with low‐dose heparin . Analysis of observational studies showed a benefit of higher heparin dose in terms of forearm artery patency, which was also confirmed after analyzing 5 small randomized, controlled trials specifically designed to address this issue.…”

“…Of those, 28 articles were excluded because either no RAO/UAO rates were reported or they were reviews/editorials or meta‐analyses not reporting original data on RAO/UAO rates, whereas 5 studies were excluded because they were duplicate reports (Figure ). Finally, 112 original articles assessing RAO and/or UAO were deemed eligible for our meta‐analysis, of which 99 cohorts from 92 studies publishing RAO…”

“…Ultrasonography demonstrated clear superiority over clinical evaluation with respect to RAO and UAO detection rates. Absence of flow on Doppler ultrasonography along with the simultaneously obtained anatomic information (eg, thrombus delineation) appears as a straightforward detection technique of RAOs and UAOs. In this regard, the predictive accuracy of solely anatomic stenosis or partial flow remains to be established.…”

A Randomized Trial Comparing Short versus Prolonged Hemostasis with Rescue Recanalization by Ipsilateral Ulnar Artery Compression: Impact on Radial Artery Occlusion—The RESCUE-RAO Trial

“…The incidence of bleeding (0.8%) and local hematoma (2.2%) in both groups was comparable. The reduction of the duration of hemostasis did not lead to an increase in bleeding complications and hematomas, compared with the other studies [ 4 , 6 , 9 , 16 , 18 , 21 ].…”

“…Overall, our results regarding RAO are compared well with other studies published on this topic. The incidence of RAO varies greatly from 1.1 to 33% [ 7 , 9 , 17 , 21 ]. Whereas Uhlemann et al reported a relatively high incidence of RAO with 33.1% using 6 F introducers [ 9 ], RAO occurred in 5.8% of our patients.…”