Radial Artery Cannulation for Diagnostic Coronary Angiography and Interventions: Historic Perspective, Overview, and State of the Art

Abstract

Due to its superior safety and virtual elimination of access site complications, trans-radial access to cardiac catheterization and interventions is gaining popularity worldwide. Several types of puncture equipment and introducer sheaths are available for radial puncture, and their use depends on availability and local practice patterns. Pharmacological agents are routinely used in conjunction with this approach to minimize radial spasm, thrombosis, and subsequent occlusion. Today, practically any coronary intervention can be performed safely and effectively via trans-radial route. Radial artery occlusion following trans-radial cardiac catheterization is relatively uncommon, and although usually silent, it should be avoided at all cost as it limits future radial access. Its pathophysiology is multifactorial and involves interaction of several factors such as local trauma, associated with local thrombus formation, and leading to occlusion over a variable time scale, with a percentage of spontaneous re-canalization. Patients with diabetes, vascular disease, low body weight, and those undergoing repeat procedures are at risk. It can be avoided by appropriately selecting patients suitable for this technique, use of heparin anticoagulation, and appropriately sized sheaths. Of crucial importance is the prompt removal of the radial arterial sheath following the procedure and implementation of patent hemostasis technique.