Predictors Of Radial Artery Occlusion Research Articles

Outcomes of a Modified Technique for Deflation of Distal Radial Artery Occlusion Device on Radial Artery Patency After Percutaneous Coronary Intervention.

This study aimed to compare two protocols of deflation with increased intervals versus late deflation with smaller intervals for distal radial artery occlusion device (DROAD) removal to assess for radial artery occlusion (RAO). All patients who underwent PCI with distal radial access were enrolled in the study. The DROAD was applied using an occlusive hemostasis method. Patients were assigned to either protocol 1 or protocol 2 at the primary physician's discretion. Protocol 1 involved the removal of 2 ml of air starting 1 h after the sheath removal and then the removal of 2 ml every 30 min until the band came off. Protocol 2 involved the removal of 4 ml of air 2 h after the sheath removal and then a further 4 ml of air every 15 min until the band came off. A total of 446 patients were enrolled in this study (mean age; 61 ± 6 (Group 1) and 60 ± 5 (Group 2); females 45.83% (Group 1) and 46.34% (Group 2)). The baseline characteristics were the same, including mean hemostasis time (256 ± 25 min (Group 1) and 254 ± 28 min (Group 2), P-value = 0.611). Primary and secondary endpoints did not reach significance in either group (RAO; 21 (8.71) Group 1 and 18 (8.78) Group 2 (P-value = 0.932)). Age (OR (95%CI): 1.07 (0.57-1.45); P-value = 0.031), female gender (OR (95%CI): 1.42 (0.93-1.74); P-value = 0.012), distal artery diameter (OR (95%CI): 0.57 (0.21-0.93); P-value = 0.005), procedure time (OR (95%CI): 2.64 (0.95-4.32); P-value = 0.001), and sheath size (OR (95%CI): 2.47 (1.43-3.76); P-value = 0.044) were predictors of RAO in our cohort. This investigation shows no difference in the incidence of RAO with the standard versus accelerated deflation protocol after PCI. However, local vascular complications, including hematoma were increased with the accelerated protocol.

Predictive value of CHA2DS2-VASc score in radial artery occlusion after transradial coronary angiography.

Radial artery occlusion is the most common complication of transradial catheterization. RAO is characterized by thrombus formation due to catheterization and endothelial damage. CHA2DS2-VASc scores are the current scoring systems used to determine the risk of thromboembolism in patients with atrial fibrillation. The aim of this study was to investigate the relationship of CHA2DS2-VASc score with radial artery occlusion. This prospectively designed study was included 500 consecutive patients who underwent coronary artery transradial catheterization for diagnostic or interventional procedures. The diagnosis of radial artery occlusion was made by palpation examination and Doppler ultrasound at the twenty-fourth hour after the procedure. Independent predictors of radial artery occlusion were determined by logistic regression analysis. Radial artery occlusion was observed at a rate of 9%. The CHA2DS2-VASc score was higher in the group of the patients who developed radial artery occlusion (p < 0.001). Arterial spasm (OR: 2.76, 95% CI 1.18-6.45, p: 0.01), catheterization time (OR: 1.03, 95% CI 1.005-1.057, p: 0.01) and CHA2DS2-VASc score ≥ 3 (OR: 1.44, 95% CI 1.17-1.78, p: 0.00) as significant independent predictors of radial artery occlusion. A high CHA2DS2-VASc score was associated with the continuity of the occlusion after the treatment (OR:1.37, 95% CI 1.01-1.85, p: 0.03). An easily applicable CHA2DS2-VASc score of ≥3 has a predictive value for radial artery occlusion.

Radial Artery Occlusion Following Cardiac Catheterization by Conventional Radial Approach versus Distal Radial Approach: Incidence and Predictors

Purpose: In comparison to transfemoral approach, transradial access (TRA) has developed to be the conventional entry site and is quickly expanding. Radial artery occlusion (RAO) which can occur during transradial intervention, impairs radial artery (RA) to be the future access site, and prohibits the artery from being used as an arterial conduit. Aim of this research was comparing incidence and predictors of RAO among individuals receiving elective cardiac catheterization by conventional radial access vs distal radial access.&#x0D; Methodology: This prospective study enrolled 120 patients from June 2022 to January 2023 (84 males, 36 females; mean age 68.5 (10.4) years with 62 patients had elective cardiac catheterization via conventional radial approach (CRA) and others via distal radial approach (DRA). Clinical follow up at 24 hours and 30 days was recorded with analysis of the incidence and predictors of RAO among all included participants.&#x0D; Findings: This study reported no substantial difference among groups in terms of socio-demographic and clinical characteristics. Time to sheath insertion and Procedure time were long among patients who had Distal radial approach with statistically significant difference (P &lt;0.01). Moreover, RAO at 24 hours and 30 days follow up was higher among patients had CRA than those had DRA with no significant difference (P &gt;0.05). This research demonstrated that RAO incidence was significantly high among younger patients, smoker, DM and those with previous CAD. Also, time to sheath insertion and hemostasis were long in patients with RAO with statistically significant difference (P &lt;0.05). Smoking, DM, long Procedure time and increased time to hemostasis with diminished blood supply in wrist throughout hemostasis were strong predictors for radial artery occlusion.&#x0D; Recommendations: Maintaining radial patency must be done with all procedures using the radial approach. DRA may be useful to lower RAO incidence through shortening hemostasis time and sustaining radial artery flow during hemostasis. Encouraging the interventional cardiologists for more practicing about utilizing DRA was recommended due to its advantages like safety with less vascular complications.

Incidence and predictors of radial artery occlusion following transradial coronary angiography: the proRadial trial

ObjectivesThis study investigated the contemporary incidence and predictors of radial artery occlusion as well as the effectiveness of antithrombotic treatment for radial artery occlusion following transradial coronary angiography.BackgroundThe radial artery is the standard access for coronary angiography and even complex interventions. Postprocedural radial artery occlusion is still a common and significant complication.MethodsThis prospective study enrolled 2004 patients following transradial coronary angiography. After sheath removal, hemostasis was obtained in a standardized fashion. Radial artery patency was evaluated by duplex ultrasonography in all patients. In case of occlusion, oral anticoagulation was recommended and patients were scheduled for a 30-day follow-up including Doppler ultrasonography.ResultsA new-diagnosed radial occlusion was found in 4.6% of patients. The strongest independent predictors of radial occlusion were female sex and active smoking status. In the subgroup of patients with percutaneous coronary interventions, female sex followed by sheath size > 6 French were the strongest predictors of radial occlusion. 76 of 93 patients with radial occlusion received an oral anticoagulation for 30 days. However, reperfusion at 30 days was found in 32% of patients on oral anticoagulation.ConclusionThe incidence of radial artery occlusion following coronary angiography in contemporary practice appears with 4.6% to be lower as compared to previous cohorts. Female sex and smoking status are the strongest independent predictors of radial occlusion followed by procedural variables. The limited effectiveness of oral anticoagulation for treatment of radial artery occlusion suggests a primarily traumatic than thrombotic mechanism of this complication.Graphical abstract

Study on Influencing Factors of Radial Artery Occlusion after Repeated Right Radial Artery Coronary Intervention.

Objective To investigate the risk factors of radial artery obstruction after repeated right radial coronary interventions. Methods 497 patients who underwent repeated coronary intervention via the right radial artery in our hospital from January 2017 to January 2021 were selected and followed up for 28.07 ± 6.07 months. According to whether the right radial artery was obstructed or not, they were divided into radial artery occlusion group (n = 48) and nonradial artery occlusion group (n = 449). Results The proportion of patients with diabetes mellitus, elevated D-dimer, and elevated LDL cholesterol was higher in the radial artery occlusion group than in the nonradial artery occlusion group (p < 0.05). The radial artery occlusion group had more passage through the right radial artery often and had a longer cumulative sheath retention time than the radial artery occlusion group (p < 0.05). Cumulative sheath retention time (hours) had a high predictive value for radial artery occlusion. The optimal diagnostic limit for radial artery occlusion was 2.75 h, with a sensitivity of 77.1% and a specificity of 79.5% (p < 0.05). Conclusion Diabetes mellitus, elevated D-dimer, elevated LDL cholesterol, and long retention sheath time predispose to radial artery occlusion. Cumulative duration of sheath retention is a predictor of radial artery occlusion.

Frequency and Predictors of Radial Artery Occlusion in Patients Undergoing Percutaneous Coronary Intervention.

Background and objectiveTransradial access (TRA) has become the preferred route for percutaneous coronary interventions (PCI), and this site is often a chink in the armor for staged PCI. In this study, we aimed to evaluate the incidence and predictors of radial artery occlusion (RAO) after TRA.MethodsWe conducted a retrospective study involving 1,307 patients who underwent PCI at the Tabba Heart Institute (THI) in Karachi, Pakistan from August 2018 to June 2019. TR band was used for hemostasis after PCI.ResultsThe primary outcome of our study was RAO, which was observed in 11.3% of the study subjects. On multivariate analysis, female gender [odds ratio (OR): 1.79, 95% CI: 1.21-2.64], cardiovascular instability (OR: 2.5, 95% CI: 1.22-5.11), dyslipidemia (OR: 0.61, 95% CI: 0.4-0.92), and a higher number of diseased vessels were found to be predictors of RAO (p=0.004).ConclusionRAO is often an asymptomatic complication of TRA. To ensure radial artery patency, a carefully thought-out management plan and follow-up must be devised for high-risk patients.

Analysis of radial artery occlusion causes and methods of its prevention after interventions using radial access. Results of the APRIORI study

Aim. To study predictors of radial artery occlusion (RAO) and ways to prevent it after interventions using radial access.Material and methods. The study consisted of prospective and retrospective parts. The total number of included patients was 2284. Patients undergoing interventions by radial access in various medical organizations were retrospectively considered. The prospective study included 1284 patients who were subject to interventional treatment. Patients were randomized into two groups as follows: in group 1, hemostasis was performed within 4 hours, in group 2 — &gt;6 hours. All patients underwent a bedside Barbeau test with a pulse oximeter and an ultrasound of access arteries to determine the radial artery patency/occlusion.Results. The RAO rate in the retrospective part was 21,8%, while in the prospective one — 10,1% with long-term hemostasis and 1,4% with short-term hemostasis (p&lt;0,001). Predictors of RAO were type 2 diabetes (odds ratio (OR), 1,9, 95% confidence interval (CI), 1,1-3,4, p=0,03) and an increase in hemostasis duration by 1 hour (OR, 1,2, 95% CI, 1,1-1,3, p&lt;0,001). When analyzing the retrospective part, the predictors of RAO were body mass index (OR, 1,06, 95% CI, 1,02-1,09, p=0,002), female sex (OR, 0,6, 95% CI, 0,4-0,9, p=0,02), smoking (OR, 1,38, 95% CI, 1-1,91, p=0,047). The administration of statins in different dosages, as well as antihypertensive and anti-ischemic agents, did not have a significant effect on the RAO rate.Conclusion. The main predictors of RAO were type 2 diabetes, an increase in hemostasis duration, female sex, smoking, and the artery-to-introducer diameter ratio. Taking statins, anti-ischemic and antihypertensive agents does not have a protective effect on RAO rate.

Safety and efficacy of different arterial pressure bandages following percutaneous coronary interventions from radial access: preliminary data of the RAD-PRESS trial

Abstract Background The overwhelming majority of diagnostic coronary angiographies and percutaneous coronary interventions (PCIs) are performed via radial access as recommended by the current European revascularization guidelines. Using dedicated pressure bandages for the radial access site in high-volume centres can be a significant part of the budget of catheterization laboratories, therefore we developed a cost-effective pressure bandage utilizing wrapped empty glass vials of intravenous medications. Furthermore, compression time of the radial puncture site following PCI is a predictor of radial artery occlusion, therefore shortening the period of compression to as short as possible is feasible. Purpose Our aim was to validate efficacy and safety of our cost-effective pressure bandage by comparing it to two dedicated devices, as well as reducing length of compression to as short as possible. Methods We designed the RAD-PRESS trial, major inclusion criteria of which were first puncture of a radial artery with a diameter greater than 1.8mm, PCI performed as per guidelines utilizing a 6 French guiding catheter and age below 80 years. Patients were then randomized to receive one of three pressure bandages: the glass vial, Seal-One or the gold standard TR-band. Release of pressure was performed as fast as possible in 10-minute steps, and guided by pulse oximetry. Hematoma formation was thoroughly checked for all patients and categorized using the Easy scale. Radial artery patency was investigated by ultrasound 24 hours after final removal of the bandage. The data of 40 patients of every group was analysed. Results Population characteristics were similar among the groups. Length of compression time (126±10, 142±11 and 144±11 mins for Vial, Seal-One and TR-band, respectively, p&amp;gt;0.05), hematoma formation (Easy Grade 1 in 17.5%, 15.0% and 10.0%, Easy Grade 2 in 5.0%, 7.5% and 7.5% for Vial, Seal-One and TR-band, respectively, all p&amp;gt;0.05) were not significantly different among the groups. Radial artery occlusion occurred in only 2 patients (Vial and TR-Band groups), accounting for 1.7% of the cases. Conclusions The cost-effective wrapped vial strategy to compress the radial puncture site was comparable to both Seal-One and the gold standard TR-band regarding safety and efficacy. Furthermore, compression time could be safely shortened to approximately 2.5 hours. Funding Acknowledgement Type of funding source: None

Predictors of patent and occlusive hemostasis after transradial coronary procedures

To assess the independent predictors of patent and occlusive hemostasis (PH and OH, respectively) during radial hemostasis after coronary procedures. Radial artery occlusion (RAO) is a thrombotic complication of transradial catheterization that can lead to permanent occlusion of the radial artery. Sheath-vessel diameter ratio, postprocedure compression time, occlusive hemostasis, inadequate, and excessive anticoagulation are all predictors of RAO. As a part of a previously published study investigating the relationship between residual anticoagulation and risk of RAO, 837 patients undergoing transradial diagnostic coronary angiography or percutaneous coronary interventions were enrolled. Cumulative heparin dose used during the procedure and ACT measured before sheath removal were recorded. PH with reverse Barbeau test was attempted in all patients (NCT02762344). PH was less frequently obtained for increasing cumulative heparin dose and ACT values (p < .0001 and p=.0034, respectively). At logistic regression analysis both cumulative heparin dose and ACT values were independent predictors of OH (OR 1.017, 95% IC 1.011-1.023 p < .0001 and OR 1.004, 95% IC 1.001-1.006, p=.0004) while adjusted probability for RAO showed exponential relationship with both parameters. The level of anticoagulation is strongly related to the incidence of RAO, and should be taken into account when choosing hemostasis protocol.

Nursing-led ultrasound to aid in trans-radial access in cardiac catheterisation: a feasibility study.

Trans-radial access is increasingly common for cardiac catheterisation. Benefits include reduced bleeding complications, length of hospital stay and costs. To determine the feasibility of implementing a nurse-led ultrasound programme to measure radial artery diameter before and after cardiac catheterisation; to determine radial artery occlusion (RAO) rates, risk factors for RAO and predictors of radial artery (RA) diameter. A prospective observational cohort study design for 100 consecutive patients undergoing cardiac catheterisation, using RA access. Pre- and post-procedural RA diameter were measured using ultrasound, by specialist nurses trained to do so. Logistic regression analyses were performed to determine risk factors for RAO and predictors of RA diameter with results reported as odds ratios (OR) and 95% confidence intervals (CI). There were no adverse events, supporting the feasibility of nurse led ultrasound programmes. A 4% (n = 4) rate of occlusion was observed. Haemostasis device application time of greater than 190 min was a predictor of RAO (OR 3.12, 95% CI 0.31-31). Male gender and height were predictors for a RA diameter of >2.2 mm. Nurses can lead the assessment of RA occlusion using ultrasound to enhance planning and care, including monitoring compression times to reduce RAO.

Frequency and Predictors of Radial Artery Occlusion after Coronary Procedure through Transradial Approach: A Vascular Doppler-guided Study

Background: Although transradial approach (TRA) has better outcome and reduced vascular complications, radial artery occlusion (RAO) is now a major concern as it limits future radial artery use for further TRA, for use as a conduit during CABG, for invasive hemodynamic monitoring and for creation of arteriovenous fistula for hemodialysis in CKD patients. Vascular doppler study is the most accurate method for evaluation of RAO and yet this is not practiced in our population.&#x0D; Objectives: To detect the frequency and identify the predictors of RAO after coronary procedure through TRA. Methods: This cross-sectional analytical study was done in the department of cardiology, NICVD from July-2015 to June- 2016 by including a total 125 patients undergoing coronary procedures (CAG and/or PCI) through TRA. Vascular doppler study of the radial artery were performed before and one day after the procedure. RAO was defined as an absence of antegrade flow and monophasic flow on doppler study. Univariate and multivariate logistic regression analysis were done to evaluate the predictors of RAO.&#x0D; Results: On the day after the procedure, radial artery vascular doppler examination revealed RAO in 12 (09.6%) patients. On univariate analysis female gender (p= 0.038), diabetes mellitus (p= 0.024), prolonged hemostatic compression for more than 02 hours after sheath removal (p= 0.003) were identified as predictors of RAO. Interestingly hypertension, low BMI, smaller radial artery diameter and use of reprocessed sheath were not identified as predictors of RAO. On multivariate analysis diabetes mellitus (p= 0.016), prolonged hemostatic compression for more than 02 hours after sheath removal (p= 0.004) were found as independent predictors for RAO.&#x0D; Conclusion: Frequency of RAO was 09.6% after coronary procedure through TRA. Diabetes mellitus and hemostatic compression after sheath removal for more than two hours were identified as independent predictors of RAO. Strategies should be taken from patient selection for TRA to end of hemostatic compression removal to prevent RAO.&#x0D; Bangladesh Heart Journal 2019; 34(2) : 111-117

P6523Radial artery occlusion: predictors, methods for reducing the frequency of complications-a single center study

Abstract Radial access has great advantages in terms of the frequency of complications, but it has one specific complication - radial artery occlusion (RAO). This complication often does not manifest itself in any way; however, it limits the use of access for the future interventions. Aim To compare methods of short and traditional hemostasis and to identify the main predictors of RAO after radial access. Materials and methods During the period from 2012 to 2018, 2000 patients were included in the study, which consisted of two parts: prospective - 1000 patients who underwent coronary angiography and percutaneous coronary intervention (PCI) with stable coronary artery disease, and retrospective part of the study, which included 1000 patients admitted for PCI from other clinics. In a prospective study, patients were divided into two groups: after coronary angiography and PCI, respectively (n=500 in the coronary angiography group and n=500 in the PCI group), and then randomized. Hemostatic bandages in the first group of patients (n=250) were removed after 12–24 hours, in the second group (n=250) - after 4±1 hours. When the occlusion of the radial artery was detected, all patients underwent an hour-long compression of the ipsilateral ulnar artery to recanalize acute RAO. Results The frequency of RAO in the retrospective part of the study was 21.8%. The frequency of RAO in the prospective part of the study was 10.2% with a traditional time hemostasis and 1.4% with a short-time compression (P&lt;0.001). Predictors of the RAO are illustrated in table 1. Predictors of bleeding were PCI (OR 0.12, 95% CI 0.01–0.67, P=0.05) and weight (OR 1.09, 95% CI 1.02–1.18, P=0.01). Table 1. Predictors of RAO Variables Odds ratio 95% Confidential interval Significance, P Traditional-time hemostasis 8.78 4.2–21.5 &lt;0.001 Diabetes mellitus+smoking 18.1 12.7–26.7 &lt;0.001 Diabetes mellitus 0.45 0.25–0.83 0.009 Body mass index 0.95 0.91–0.99 0.02 Male 1.75 1.01–3.18 0.05 Protein C 0,86 0,75–0,96 0,01 Conclusion Careful examination of the patient for detecting RAO before and after interventions is essential. Short hemostasis with compression of the ipsilateral ulnar artery reduce the frequency of RAO. For short-time hemostasis, special attention should be paid to patients after PCI and with low BMI, as far as these factors are associated with a greater risk of bleeding after removal of the compression bandage.

Incidence and predictors of radial artery occlusion after transradial coronary catheterization

BackgroundRadial artery occlusion (RAO) is considered the most common and devastating complication of transradial approach (TRA). It has been described as the “Achilles’ heel” of the transradial technique. Our aim was to assess the incidence and predictors of radial artery occlusion after transradial coronary catheterization.ResultsThis was a prospective study enrolling 164 patients undergoing percutaneous coronary interventions (PCI) via the transradial approach (TRA) using 6-F catheters. Doppler ultrasonography assessment of the radial artery (RA) was conducted on day 1 and 6 months following the procedure. The studied group included 104 male (63.4%) and 60 female (36.6%) patients with a mean age of 57.7 ± 8.8 years and a mean RA diameter of 2.8 ± 0.5 mm. On day 1, Doppler examination revealed RAO in 54 patients (32.9%). After 6 months, RAO was detected in 49 patients (29.9%). Interestingly, only 1 new case (0.9%) of RAO was noted, and 6 patients (11.1%) had regained their RA patency. On multivariate analysis, female gender, age, manual compression, and RA diameter emerged as independent predictors of RAO. Using TR band for hemostasis for only 2 h was recognized as a potent independent predictor of RA patency on day 1 and 6 months after the procedure (n = 2, 3.7% in the RAO group, vs. n = 23, 20.9% in the non-RAO group, p = 0.004).ConclusionRAO, although clinically a silent issue, has been the main complication following TRA. In patients with high predictors of RAO, careful management and close follow-up are required to ensure radial artery long-term patency.

Influence of remote ischemic conditioning on radial artery occlusion.

This study aimed to explore the influence of remote ischemic conditioning (RIC) on radial artery occlusion (RAO) and distinguish the risk factors for RAO. A total of 640 consecutive patients who prospectively underwent transradial artery coronary angiography (TRACA) (322 patients received RIC before TRACA) were enrolled. RIC was not performed in 318 patients. RAO was estimated using Doppler ultrasonography after the procedure. Patients were divided into two groups according to the protocol of RIC: RIC and non-RIC. The rate of RAO was significantly lower in the RIC group than in the non-RIC group. Patients were divided into two groups according to the patency of radial artery: radial artery patency (RAP) and RAO. The radial artery diameter was significantly narrower in the RAO group (2.31 ± 0.53) than in the RAP group (2.59 ± 0.47). The rate of applying β-blocker was significantly higher in the RAP group (69%) than in the RAO group (41%). The rate of applying trimetazidine was significantly higher in the RAP group (49.1%) than in the RAO group (17.6%). The multiple logistic regression analysis using radial artery diameter, RIC, β-blocker, and trimetazidine treatments revealed that small radial artery diameter, lack of β-blockers, and RIC were independent predictors of RAO. RIC might help in improving the rate of RAO. The multiple logistic regression analysis showed that the lack of β-blockers, RIC, and small radial artery diameter were independent predictors of RAO.

Radial Artery Occlusion – Incidence, Predictors and Long-term outcome after TRAnsradial Catheterization: clinico-Doppler ultrasound-based study (RAIL-TRAC study)

Background and aim The purpose of this study was to assess incidence, predictors and outcome of radial artery occlusion (RAO) after transradial catheterization (TRC) based on clinical and Doppler ultrasound study.Methods A total of 1,945 consecutive patients undergoing transradial catheterization for diagnostic evaluation or intervention were included. Radial artery examination was based on palpation and colour Doppler study on the day before, 1 day (D1), 1 month (D30) and 6 months (D180) following the procedure. RAO was defined as absence of pulse on palpation and forward flow on Doppler study. Predictors of RAO were found by logistic regression analysis.Results Baseline demographic and procedural data were recorded. The mean radial arterial diameter was 2.56 ± 0.29 mm. On D1, radial artery Doppler examination revealed RAO in 339 patients (17.4%) but pulse was still palpable in 115 (34%) of them. At D30, these were 221 (11.4%) and 114 (52%), respectively, as no new RAO were noted. Interestingly, 118 (34.8%) patients had spontaneous recanalization of their radial artery as shown by catch-up in patency rate. At D180, these were 99 (5.1%) and 68 (69%), respectively, meaning further new catch-up implying further recanalization. Patients with persistent RAO remained asymptomatic. On multivariate analysis, female sex, diabetes, lower BMI, radial artery diameter ≤2.2 mm and radial artery-to-sheath ratio (AS ratio) < 1 were predictors of RAO.Conclusion TRC for coronary angiography, ad hoc and staged angioplasty can be performed with similar efficacy and safety though RAO occurs more frequently in patients with prior radial artery cannulation and with larger sheath size. Persistent RAO remains asymptomatic.

Randomized Comparison of 3 Hemostasis Techniques After Transradial Coronary Intervention.

The transradial route for coronary intervention has proven to be a safe and feasible method, and several techniques have been shown to be effective in achieving hemostasis. The aim of this study is to evaluate the efficacy of 3 hemostasis techniques on radial artery outcomes after transradial catheterization. A total of 1650 patients were randomly assigned to 1 of the 3 hemostasis techniques after the procedure. The outcome measures were local vascular complications, tolerance to the device, and the time taken to achieve hemostasis. Time taken to achieve hemostasis was significantly longer in the pressure dressing (PD) group than in the pneumatic compression device (PCD) group and rotary compression pad device (RCD) group (306 ± 65 vs 263 ± 62 and 237 ± 58 minutes; P < .0001). There were also significant differences between PD, PCD, and RCD groups with respect to the incidence of oozing (8.2% vs 5.1% and 5.1%; P = .047) and discomfort level (1.68 vs 1.43 and 1.40; P < .0001). The incidence of early (24 hours after the procedure) radial artery occlusion was significantly higher in the PD group than in the PCD and RCD groups (15.6% vs 5.8% and 4.5%; P < .0001). Logistic regression analysis showed that independent predictors of radial artery occlusion at 30-day follow-up visit were diabetes (hazard ratio, 2.39), larger radial artery diameter (hazard ratio, 0.52), the use of the PCD (hazard ratio, 0.51, compared with PD) and the RCD (hazard ratio, 0.52, compared with PD), and radial artery patency during compression (hazard ratio, 0.016). Hemostasis devices have comparative advantages over the conventional pressure dressing. The presence of radial artery flow during compression represents a strong predictor of radial artery patency during follow-up periods.

Ultrasound evaluation of forearm arteries in patients undergoing percutaneous coronary intervention via radial artery access: results of one-year follow-up.

A proven advantage of radial over femoral arterial access has led to an increase in the number of interventions performed via radial artery access in patients with acute coronary syndromes. Both assessment of the pulse volume and the Allen's test are subjective and subject to investigator bias. An ultrasound examination of the forearm arteries provides important information about the anatomy of the forearm vessels, and indirectly also about the efficiency of collateral blood supply to the hand. It also enables determination of the relevant vessel diameter before the planned intervention, and may be used to assess local complications. To assess the morphology of forearm blood vessels and measure the diameter of both radial and ulnar arteries at the cannulation site using ultrasound imaging. We also aimed to identify potential vascular anomalies and local complications associated with radial artery puncture. The study included 109 patients with cardiologic indications for coronary angiography or coronary angioplasty. An ultrasound evaluation of forearm arteries was performed prior to the intervention, and the vascular anatomy was later verified by angiography during the procedure. Ultrasound measurements of the vessel diameter were also performed and local complications of the cannulation were assessed. Measurements were performed immediately after the procedure and at 30 days and 12 months. Fifty-nine right and 50 left forearm arteries were evaluated. Women were 29% of the study population. The mean patient age was 59.2 ± 7.9 years. The mean diameter of the right radial artery was 2.17 ± 0.54 mm, and the mean diameter of the left radial artery was 2.25 ± 0.43 mm. The measurements revealed gender-related differences in forearm artery diameter (p = 0.003). Vascular anomalies of the radial artery were identified by ultrasound examination in 10% of subjects. A significant dilatation of the cannulated blood vessel was observed which lasted up to 12 months. An occlusion of the cannulated artery was demonstrated in 6.4% of patients. Ultrasound imaging is a reliable method to evaluate the diameter of forearm arteries and track their course in patients undergoing invasive cardiovascular procedures via radial artery access. The diameter of the radial artery by ultrasound evaluation is larger compared to that of the ulnar artery. The diameter of forearm arteries in women is smaller compared to men. A dilatation of the radial artery which may last up to 12 months develops following its percutaneous cannulation. Ultrasound imaging allows detection and monitoring of local complications such as radial artery occlusion. An unfavourable ratio of blood vessel diameter to the size of the used introducer sheath is a predictor of radial artery occlusion. Ultrasound imaging enables reliable evaluation of vascular anomalies involving the radial artery, especially within the distal forearm.

A novel approach to reduce radial artery occlusion after transradial catheterization: postprocedural/prehemostasis intra-arterial nitroglycerin.

To evaluate whether administration of nitroglycerin through the sheath at the end of a transradial procedure might preserve the patency of the radial artery. Despite the increasing acceptance of transradial approach, radial artery occlusion (RAO) continues to be a vexing problem of transradial access and limits utility of the radial artery as an access site in the future. We conducted a multicenter, prospective, randomized, placebo-controlled, operator-blinded trial and enrolled 1,706 patients who underwent transradial catheterization in three experienced radial centers. Patients were randomized to receive either 500 µg nitroglycerin (n=853) or placebo (n=853), given intra-arterially through the sheath at the end of the radial procedure. The primary outcome was the incidence of RAO as confirmed by absence of antegrade flow at one day after the transradial procedure evaluated by duplex ultrasound of the radial artery. The use of nitroglycerin, as compared with placebo, reduced the risk of the primary outcome [8.3% vs. 11.7%; odds ratio, 0.62; 95% confidence interval (CI), 0.44-0.87; P=0.006]. From a multivariable analysis, duration of hemostasis was a predictor of RAO (odds ratio, (odds ratio, 3.11; 95% CI, 1.66 to 5.82; P<0.001). There were no significant differences between the groups with respect to the sheath size (P=0.311), number of puncture attempts (P=0.941), duration of hemostasis (P=0.379) and procedural time (P=0.095). The administration of nitroglycerin at the end of a transradial catheterization, reduced the incidence of RAO, examined 1 day after the radial procedure by ultrasound. Postprocedural/prehemostasis pharmacologic regimens may represent a novel target for further investigation to reduce RAO.

The long-term incidence and predictors of radial artery occlusion following a transradial coronary procedure

Radial artery occlusion (RAO) is an infrequent complication of transradial coronary procedures (TRA). To our knowledge, there is no satisfactory data regarding the late term incidence and predictors of RAO in the literature. Our aim was to establish the long-term incidence of radial artery occlusion and investigate its predictors. This was a single center prospective study. A total number of 409 consecutive patients undergoing their first TRA were recruited. Clinical and procedural data were all recorded. Doppler ultrasound examination was performed at 6-15 months following the intervention. RAO was detected in 67 patients and 342 patients maintained radial artery patency. The overall RAO incidence was 16.4% at late term. Patients with RAO were younger than the patients with patent radial arteries (55.9 ± 9.7 vs. 59.1 ± 9.4 years, p = 0.014). The incidence of RAO in hypertensive patients (9.8%) was lower (p < 0.001) than the observed incidence (23%) in non-hypertensive patients. RAO group had higher rate (28%, p = 0.027) of post--procedural access site pain. Regression analysis revealed that hypertension was negative while post-procedural access site pain was positive independent predictors for RAO. In addition, the relative risk for RAO also increased significantly (p < 0.001) when the ratio of sheath/artery diameter (S/A) was > 1. The present study reveals that the long-term incidence of RAO is 16.4%. Hypertension, post-procedural access site pain and S/A ratio > 1 are independent predictors of RAO at late term.

The Long Term Incidence and Predictors of Radial Artery Occlusion Following a Transradial Coronary Procedure

OP-008 Our aim was to establish the long term incidence of radial artery occlusion and investigate its predictors. Radial artery occlusion (RAO) is an infrequent complication of transradial coronary procedures (TRA). To our knowledge, there are no studies reporting the incidence and predictors of