Predictors Of Radial Artery Occlusion Research Articles

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

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

Our aim was to establish the long term incidence of radial artery occlusion and investigate its predictors.

Incidence and Predictors of Radial Artery Occlusion Associated Transradial Catheterization

In this study, we sought to assess the incidence and predictors of radial artery occlusion (RAO), which is a significant complication of transradial cardiac catheterization. We prospectively evaluated the results of 106 patients who underwent coronary angiography and percutaneous coronary intervention (PCI) via the transradial approach (TRA). At the 3rd h of intervention, the radial artery was checked by palpation; color doppler ultrasonography was performed at the 24th h. Fluoroscopy duration, procedure success, and complications of the radial artery were recorded. The procedure was successfully completed in all patients. RAO was detected in eight female and two male patients. In terms of RAO, there was a statistically significant difference between males and females (p=0.019). Other parameters did not show a significant correlation with RAO. Altough did not have any effect on procedural success, eight patients developed transient radial artery spasm. Gender was not associated with radial arterial spasms (p=0.19). TRA in the diagnosis and treatment of coronary artery disease has shown high procedural success and low complication rates; it addition, it presents a low economic burden. It should be used widely and be involved in the routine cardiology residency program.

Effect of duration of hemostatic compression on radial artery occlusion after transradial access

To evaluate the effect of duration of hemostatic compression on the incidence of radial artery occlusion (RAO) after transradial coronary intervention. RAO occurs in 2-10% of patients after transradial access. The effect of duration of hemostatic compression on occurrence of RAO is unknown. Four hundred consecutive patients undergoing transradial coronary intervention were retrospectively analyzed. Group I (n = 200) patients received hemostatic compression for 6 hr after completion of the procedure, and group II (n = 200) patients for 2 hr after completion of the procedure. TR band was used for hemostasis. Demographic and procedural variables as well as early (24 hr) and chronic (30 days) RAO as well as bleeding events were recorded. Demographic as well as procedural variables were similar between group I and group II. Early radial artery occlusion (ERAO) occurred in 12% of patients in group I and 5.5% of patients in group II, the difference was statistically significant (P = 0.025). Chronic radial artery occlusion (CRAO) occurred in 8.5% of patients in group I and 3.5% of patients in group II, the difference was statistically significant (P = 0.035). Occlusive compression was the only independent predictor of radial artery occlusion [Odds ratio = 13.1, P = 0.001]. Two patients in group I and one in group II developed small hematoma (P = 0.161). Shorter duration of hemostatic compression is associated with a lower incidence of early and chronic RAO, without increase in bleeding complications, although maintaining radial patency during hemostatic compression, eliminates the adverse effect of duration of compression.

Interruption of blood flow during compression and radial artery occlusion after transradial catheterization

To analyze the possible relationship between compression after transradial catheterization and radial artery occlusion. Radial artery occlusion is an important concern of transradial catheterization. Interruption of radial artery flow during compression might influence the rate of radial artery occlusion at follow-up. A prospective study including 275 consecutive patients undergoing transradial catheterization was conducted. Arterial sheaths were removed immediately after procedures and conventional compressive dressings were left in place for 2 hr. The pulse oximeter signal in the index finger during ipsilateral ulnar compression was used for the assessment of radial artery flow. Radial artery flow was absent in 174 cases (62%) immediately after entry-site compression. After 2 hr of conventional hemostasis, radial artery flow was absent in 162 cases (58%) before bandage removal. At 7-day follow-up, 12 patients (4.4%) had absent pulsations and radial artery flow was absent in 29 cases (10.5%). Patients with an occluded radial artery at follow-up had significantly smaller arterial diameters at baseline (2.23+/-0.4 mm vs. 2.40+/-0.5 mm; P=0.032) and more frequently had absent flow during hemostasis (90% vs. 54%, P<0.001). Stepwise logistic regression analysis revealed that absent flow before compressive bandages removal was the only independent predictor of radial artery occlusion at follow-up (OR=6.7; IC 95%: 1.95-22.9; P=0.002). Flow-limiting compression is a frequent finding during conventional hemostasis after transradial catheterization. Absence of radial artery flow during compression represents a strong predictor of radial artery occlusion.