Thrombotic Occlusion of the Radial Artery as a Complication of the Transradial Coronary Intervention

Kim, Kyu Seop; Park, Hyung Seo; Jang, Won Il; Park, Jae‐Hyeong

doi:10.4250/jcu.2010.18.1.31

Cited by 21 publications

(19 citation statements)

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“…Radial artery stenosis has been shown to occur in 31% of patients within 2 days after TRA and in 28% late after the procedure (23). Imaging studies, such as vascular ultrasound (27), angiography (28), optical coherence tomography (24) and histopathological examination of materials aspirated after mechanical recanalization of occluded radial arteries (29) support this thrombus formation theory.…”

Section: Radial Artery Occlusion (Rao)mentioning

confidence: 99%

Radial artery occlusion after transradial coronary catheterization

Avdikos

Karatasakis

Tsoumeleas

et al. 2017

Cardiovasc. Diagn. Ther.

115

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The transradial approach (TRA) for coronary angiography and interventions is increasingly utilized around the world. Radial artery occlusion (RAO) is the most common significant complication after transradial catheterization, with incidence varying between 1% and 10%. Although RAO is rarely accompanied by hand ischemia, it is an important complication because it prohibits future transradial access and radial artery utilization as a conduit for coronary artery bypass grafting or arteriovenous fistula formation. In this review, we discuss factors predicting the occurrence of RAO, aspects of accurate and prompt recognition, methods that contribute to its prevention and possible treatment options.

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Section: Radial Artery Occlusion (Rao)mentioning

confidence: 99%

Radial artery occlusion after transradial coronary catheterization

Avdikos

Karatasakis

Tsoumeleas

et al. 2017

Cardiovasc. Diagn. Ther.

115

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“…10,12 Furthermore, rates of RAO are higher with prolonged cannulation times, 20 -22 whereas RAO is reduced with anticoagulation 23 and nonocclusive hemostasis. 11,24,25 Direct support for the thrombotic hypothesis has come from recent studies that have confirmed the presence of radial artery thrombus on vascular ultrasound, 26 angiography, 27 and pathology. 28 Transradial catheterization can also negatively affect radial artery structure and function.…”

Section: Pathophysiologymentioning

confidence: 99%

Radial Artery Patency After Transradial Catheterization

Kotowycz

Džavík

2012

Circ: Cardiovascular Interventions

180

133

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T he transradial approach to cardiac catheterization has many advantages over the transfemoral approach and is increasingly being used for both diagnostic coronary angiography and percutaneous coronary intervention (PCI). The technique is associated with fewer vascular access complications [1][2][3] and has been shown to reduce major bleeding when compared with the femoral approach. 4 Patients prefer the radial approach and score higher on quality-of-life questionnaires after transradial catheterization. 3,5 Radial access allows for earlier patient ambulation and same-day hospital discharge in PCI patients 4 -6 and is associated with decreased cost. 5,7,8 Radial artery occlusion (RAO) is a complication of transradial catheterization that can lead to permanent occlusion of the radial artery. Estimated to occur in 1-10% of cases, 9 -14 it has been described as the "Achilles' heel" of the transradial technique. 15 RAO is usually clinically silent because of the dual blood supply to the hand, and for this reason it is often overlooked. In fact, more than 50% of transradial operators do not routinely assess radial artery patency before hospital discharge. 16 However, the complication is not benign, as hand ischemia resulting from RAO has been reported. [17][18][19] Furthermore, once the artery is occluded, it cannot be used as an access site for future catheterization or as an arterial conduit for bypass surgery. RAO renders the ipsilateral ulnar artery unusable as well, because instrumenting and cannulating the ulnar would put the patient's hand at risk of ischemia. In this report, we review the pathophysiology, clinical presentation, and risk factors for RAO, discuss prevention and treatment options, and suggest directions for future research aimed at minimizing this complication. PathophysiologyAcute loss of radial artery patency after cardiac catheterization is thought to be due to a thrombotic process. Sheath insertion leads to local endothelial injury and cessation of blood flow in the radial artery, creating an environment conducive to thrombosis. Many observations about RAO provide indirect evidence to support this hypothesis. RAO tends to occur early after transradial catheterization, and roughly 50% of patients have spontaneous recanalization of the artery within 1-3 months. 10,12 Furthermore, rates of RAO are higher with prolonged cannulation times, 20 -22 whereas RAO is reduced with anticoagulation 23 and nonocclusive hemostasis. 11,24,25 Direct support for the thrombotic hypothesis has come from recent studies that have confirmed the presence of radial artery thrombus on vascular ultrasound, 26 angiography, 27 and pathology. 28 Transradial catheterization can also negatively affect radial artery structure and function. A study using optical coherence tomography found that 67% of radial arteries had intimal tears and 36% had medial dissections immediately after transradial PCI. 29 Other studies have found that minimal lumen diameter and minimal lumen area are smaller in repeat transradial patients than i...

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“…Based on the pathophysiologic principle of RAO with endothelial injury involving thrombotic occlusions and the positive peri-procedural effect of heparin, different studies showed a positive effect of heparin on radial artery recanalization [ 5 , 8 , 14 , 18 , 20 – 23 ]. Our study confirms the positive effect of anticoagulation on RAP with higher patency probability of 79.5% and higher patency rate.…”

Section: Discussionmentioning

confidence: 99%

Impact of anticoagulation and vasoactive medication on regained radial artery patency after catheterization: a case–control study

et al. 2018

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BackgroundRadial artery access is the primary approach for coronary interventions due to higher safety profile in comparison to femoral access. Radial artery occlusion (RAO) is the main complication of transradial catheterization that can lead to severe symptoms and a permanent artery occlusion. The incidence of RAO after transradial access ranges from 5 to 38% and data regarding treatment is scarce. Whether anticoagulation and vasoactive medication provides an additional benefit in recovery of radial artery patency (RAP) after catheterization has not been investigated in detail.AimThe objective was to investigate the impact of anticoagulation and vasoactive medication on regained patency after documented RAO following transradial catheterization.Patients and methodsOverall 2635 patients were screened. 2215 (84%) catheterizations were performed by femoral and 420 (16%) by radial access. In 30 patients RAO was observed. In case of RAO patients were classified in three groups: Anticoagulation, anticoagulation added with alprostadil and controls. Follow-up was conducted after 3 months with ultrasound and clinical examination.ResultsEight patients received anticoagulation and 11 patients anticoagulation together with alprostadil. Eleven patients served as controls. Recovery of RAP after catheterization was higher following either treatment (79.5%) compared to controls (0%, p = 0.006). Subgroup analysis yielded a higher RAP recovery in patients treated with anticoagulation (62.5%) as compared to controls (0%, p = 0.002). No effect on regained RAP was found with additional alprostadil therapy (33.3%) compared to anticoagulation therapy (62.5%, p = 0.229).ConclusionRAO should be treated with anticoagulation to regain patency. Addition of vasoactive medication does not lead to further beneficial effects. Further research is needed regarding preventive and therapeutic strategies following RAO.

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Thrombotic Occlusion of the Radial Artery as a Complication of the Transradial Coronary Intervention

Cited by 21 publications

References 0 publications

Radial artery occlusion after transradial coronary catheterization

Radial artery occlusion after transradial coronary catheterization

Radial Artery Patency After Transradial Catheterization

Impact of anticoagulation and vasoactive medication on regained radial artery patency after catheterization: a case–control study

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