Radial Artery Anomalies Research Articles

Sex differences in transradial access failure in ST segment elevation myocardial infarction.

Transradial access (TRA) is now the default access site for PPCI, but technically is a more challenging approach mostly due to anatomic challenges connected to the RA. To assess the differences according to sex in radial artery (RA) access site characteristics during primary percutaneous coronary intervention (PPCI) for ST segment elevation myocardial infarction (STEMI). All 5092 consecutive STEMI patients from our center in the period from March 2011 until December 2017 were examined. The right proximal radial was the "intention-to-treat" access in all patients. Preprocedural RA angiography was performed in all patients. Clinical and procedure characteristics, type of radial anatomy variants, need to use another arterial access sites (the primary endpoint for this study), and procedure time were analyzed by sex. Using logistic regression, we selected predictors of radial crossover. Access site bleeding complications and vascular complications were also recorded. The STEMI population in this period included 1326 females and 3766 male patients. Females were older (65 ± 11 years) than males (59 ± 11 years, p < 0.0001). Among standard risk factors, hypertension and diabetes mellitus were more common in women and smoking less common. RA anomalies were more frequent in the females (8.8% vs. 6.5%, p < 0.0001), with complex RA loop and tortuous RA twice as frequent in women. Failure of TRA access as the initially chosen site occurred in 4.6% (61) of females versus 2.5% (97) of male STEMI patients (p = 0.0003). The most common subsequent access site was right ulnar access in both groups (57 and 61% respectively). Access site bleeding complications were more common in women 4.4% versus 3.2%, mirrored in hematomas with EASY score III to V. Clinical RA spasm (RAS) was significantly more frequent in females (5.7% vs. 2.2%, p < 0.0001). Multiple regression analysis identified 5 independent predictors for TRA access crossover: previous TRA, anomalous RA, RAS, along with female sex and diabetes. Female sex is a significant predictor of more complex TRA in STEMI. Understanding sex differences and predictors for TRA crossover will strengthen the use of different procedural modalities that can help in preserving a successful wrist access in female STEMI patients.

Microcatheter Crossing of Radial Artery Loops and Tortuosities: New Ideas in Reducing Trans Radial Approach Crossover

BACKGROUND: Transradial access is currently the default access site for percutaneous cardiovascular interventions. Radial artery (RA) anomalies present a significant challenge in radial access success. RA 360-degree loops are an uncommon, but quite challenging vascular anomaly even for the most experienced radial operators. CASE REPORT: We report on two cases of patients with complex RA loops referred for PCI through radial approach in a high-volume radial center. Pre-procedural RA angiography was performed in both cases identifying a 360-degree RA loop in the proximal part of the RA below the entrance into the brachial artery. In both cases, we present a novel “Microcatheter crossing” technique of the complex RA loop as a new strategy in overcoming even the most difficult radial adversary. After identifying the loop a hydrophilic wire 0.014 inch was used to cross the loop and extend it in the upper arm. Then a microcatheter ASAHI corsair (Asahi Intecc USA, Inc.) was advanced through the loop without difficulty. The microcatheter is advanced through the wire until middle of the upper arm. Hydrophilic wire is then exchanged with High Torque Iron man guide wire (Abbott Vascular). Again, the wire is advanced in the upper arm. Microcatheter is then removed and 5F catheter JR 4.0 or similar is advanced gently through the iron man wire with a clockwise rotation through the loop. Then, wire and catheter are pulled back to straighten the loop. The percutaneous angiography procedure was performed successfully in both cases. CONCLUSION: Both patients were discharged without registered bleeding complications from place of puncture. They both reported slight pain during the beginning of the procedure in the arm of puncture, but without additional problems after the procedure.

Republished: Manual reduction of a radial artery loop under direct fluoroscopic visualization

Transradial access has become increasingly used in neurointerventions because it reduces access site complications. However, radial artery anomalies can be difficult to navigate, often necessitating conversion to femoral access. We describe the case of a female patient in her early 70 s who underwent preoperative embolization of a carotid body tumor via right transradial access. Her radial angiogram demonstrated the presence of a radial artery loop which was successfully navigated with a triaxial system but would not spontaneously reduce even after the guide catheter was advanced into the subclavian artery. However, manual manipulation of the catheters in the antecubital fossa under direct fluoroscopic visualization reduced the loop allowing the procedure to continue transradially. Although a majority of radial loops can be traversed and reduced using standard techniques, this case demonstrates that manual reduction can be successful when other measures fail. We recommend attempting this method before converting the access site.

Sex differences in transradial access site characteristics and crossover in STEMI

Abstract Objective To assess the differences according to sex in radial artery access site characteristics and crossover and it's influence on the success of ST segment elevation myocardial infarction (STEMI) procedures with primary chosen transradial access site in a large series of patients. Background Transradial angiography (TRA) is now the default access site for PPCI, but technically is a more challenging approach mostly due to anatomic challenges connected to the radial artery. Methods All 5092 consecutive STEMI patients from our center, in the period from March 2011 until December 2017 were examined. Patient were divided in two groups according to sex. Preprocedural radial artery angiography was performed in all patients. Clinical and procedure characteristics, type of radial anatomy variants, transfer to other access sites, transfer direction and procedure time were analyzed. Access site bleeding complications and in-hospital mortality were also recorded. Primary end-point of the study was the occurrence of TRA failure and need to crossover to another access site to finish the procedure. Results From the STEMI population in this period the female group had 1326 PPCI treated patients and the male group 3766 patients. The female group of patients was older 65±11 than the male group 59±11 (p&amp;lt;0,0001). BMI was 27 vs. 30 in the male group (p=0.0003). Most common risk factors in both groups were hypertension, smoking and diabetes, with the latter being more frequent in the female group p&amp;lt;0,0001. Radial artery anomalies were more frequent in the female group 8,8% vs 6,5% (p&amp;lt;0,0001), with complex RA loop and tortuous RA having double percentage than in their male counterparts. Primary chosen TRA access site failure occurred in 4.6% (61) vs. 3.5% (97) of STEMI patients (p&amp;lt;0.0001). Most common access site crossover site was right ulnar access in both groups with 57 and 61% accordingly. Access site bleeding complications, were more common in the female group with 4.4% vs. 3.2%, also this difference persisted in EASY score hematoma 3 to 5. Clinical radial artery spasm was significantly more frequent in female patients 5,7% vs. 2.2% (p&amp;lt;0.0001). In-hospital mortality rate was similar in the two group of patients. Conclusion Female sex is a significant risk factor for TRA failure in STEMI usually connected to smaller size of RA and the more common finding of radial artery anomalies and spasm. Funding Acknowledgement Type of funding sources: None.

Endovascular management of radial artery loop for neuroangiography: Case series.

Radial loops are rare congenital radial artery anomalies that may pose a significant challenge to successful transradial neuroangiography. In this case series, we describe the anatomy and frequency of radial artery loops and provide a technique for successful navigation of this anatomic anomaly. We reviewed our database of radial diagnostic or interventional neuroangiographic procedures to identify cases in which a radial loop was encountered during the procedure. The loop pattern, the presence of an associated recurrent radial artery branch, navigation technique, and procedure-related complications were recorded. A descriptive analysis was performed. A total of 997 transradial approach procedures were performed over a 9-month period. A radial loop was identified in 10 (1.0%) patients. The average age was 68.6 ± 14.3 years. A microcatheter advanced over a microwire was used to navigate the loop and avoid entry into the recurrent branch. A diagnostic neuroangiographic procedure was performed successfully in 8 cases and an intervention was performed successfully in 1 case. A 360° loop was present in 2 of these cases. In each case, transradial access was performed successfully. In 1 other diagnostic case, transradial access was aborted, and the femoral artery was accessed to perform the procedure. A radial loop was present in 1% of the cases in this series. Our technical results suggest that this anomaly should not be considered a contraindication to transradial neuroangiography because the procedure was successfully performed in most (9 of 10) cases using a microcatheter system to navigate the loop.

Radial anomalies in North Indian patients undergoing TRAns-radial catheterization: A prospective observational study (RAIN-TRAC study)

Background: Radial artery anomalies are relatively common and one of the major causes of transradial procedure failure. Aim: The study was aimed to assess the incidence of radial axis anomalies in patients undergoing transradial cardiac catheterization and their impacts on procedural failure. Materials and Methods: This was a prospective, single-center study, 1870 consecutive patients underwent transradial coronary catheterization. Radial artery anatomy was determined by injecting diluted contrast agent through radial sheath. Results: About 11.4% patients (213/1870) were noted to have abnormal radial artery anatomy which was associated with significantly higher procedural failure rate (odds ratio [OR] [95% confidence interval [CI] = 240.72 [57.98–999.43]) and radial artery spasm (OR [95%CI] = 7.12 [4.06–12.49]) than patients with normal radial artery anatomy. Among all the radial artery anomalies, high bifurcation was the most common anomaly, found in 128 (60%) patients. The high bifurcation was found most commonly at the mid-humerus level (53.12%). Extremely tortuous radial artery was found in 43 (20%) patients. Radial artery loop was found in 22 (10%) patients and was associated with the highest failure rate (54.5%). Other unclassified anomalies were found in 20 patients (10%). In bivariate analysis, the incidence of each of the radial artery anomalies was found to have significant correlation with older age, short stature, female sex, and hypertension. Conclusion: Radial artery anomalies are not uncommon and are related to significant procedural failure. Retrograde radial arteriography helps to identify patients with unfavorable radial artery anatomy, which can be performed with a minimum amount of contrast and should be considered part of a routine transradial procedure.

Correlation Between Radial Artery Anomalies and Procedural Outcomes of Trans-radial Coronary Catheterisation

Correlation Between Radial Artery Anomalies and Procedural Outcomes of Trans-radial Coronary Catheterisation

Anatomic Variation in the Origin and Course of Radial Artery: A Descriptive Cross-Sectional Study

Introduction: The radial artery is commonly originated from the brachial artery in the cubital fossaat the level of the neck of the radius. It is the artery of choice for coronary artery angiography,percutaneous coronary artery intervention, cannulation, and others. Radial artery anomalies likehigh origin, tortuosity, and accessory branches are associated with the failure of such procedures.The main objective of this study is to study the variation in origin and course of the radial artery incadavers.&#x0D; Methods: A descriptive cross-sectional study was conducted in 27 formalin-fixed adult humancadavers in the Department of Anatomy, KIST Medical College and Teaching Hospital, Lalitpur,Nepal, from 2075/4/2 to 2076/4/2. Ethical approval was taken on date 02/04/2075 (IRC No.2074/75/38). Altogether, 53 specimens were enrolled in the study by convenience sampling method.Point estimate at 95% Confidence Interval was done for binary data along with frequency andproportion. The data was analyzed by and Statistical Package for the Social Sciences version 20.&#x0D; Results: Out of of 53 upper limbs, forty-six (86.79%) specimens, the origin of the radial artery wasobserved to be normal in the cubital fossa, 34.5±6.31mm below the level of the intercondylar lineof the humerus with the superficial course. In seven (13.21%) specimens, the radial artery showedvariation in the origin. Among them, variations in origin were found to be from sites like the axilla,upper-middle, and lower part of the arm. One cadaver showed a tortuous radial artery bilaterally.&#x0D; Conclusions: This study concludes that most of the radial artery originates in the cubital fossa fromthe brachial artery with few variations.

PP-163 - Varıatıons Encountered With Increasıng Transradıal Approach for Coronary Interventıon: Accesory Radial Artery

Introduction: Transradial (TR) approach for percutaneous coronary interventions has advantages of entry site complications, early patient mobilization and high patient satisfaction however when compared to transferomal approach specific technical difficulties are encountered. Failed attempts are also increased with the increase in the frequency of TR approach. Radial artery anomalies are seen as an important factor for procedural failure. We present a case in which a TR approach is planned in a patient.

New year, new CRM, new editorial board, new look, and expanding opportunities

To assess the crossover rate from primarily chosen transradial access (TRA) in a high volume transradial center.All consecutive 30,848 patients, that underwent diagnostic angiography and/or intervention in the period from 2010 until 2015 were examined. Preprocedural radial artery angiography was performed in all patients since 2011. Clinical and procedure characteristics, reason for crossover and its direction were analyzed. Primary end-point of the study was the occurrence of TRA failure and need to crossover to another approach to finish the procedure.Procedural success of primarily chosen TRA was 94% (n = 28,988). Crossover to other access sites was 6% (n = 1860). Most common reason for crossover was inability to puncture the right radial artery in 4,1%, presence of radial artery anomalies (0,3%), high grade spasm (0,1%), or radial artery occlusion (1,2%). Crossover direction was primarily through the ipsilateral transulnar access (TUA) 3,8%, left radial access (LRA) 1,5% and in only 0,6% (n = 189) of patients to transfemoral access (TFA). Access site bleeding complications were present in 5,1% (n 1579).Total wrist access is feasible and safe with low rate of access site complications and crossovers, especially when performed in experienced high volume transradial center.

Total wrist access for angiography and interventions: Procedural success and access site crossover in a high volume transradial center.

Abstract Objective To assess the crossover rate from primarily chosen transradial access (TRA) in a high volume transradial center. Methods All consecutive 30,848 patients, that underwent diagnostic angiography and/or intervention in the period from 2010 until 2015 were examined. Preprocedural radial artery angiography was performed in all patients since 2011. Clinical and procedure characteristics, reason for crossover and its direction were analyzed. Primary end-point of the study was the occurrence of TRA failure and need to crossover to another approach to finish the procedure. Results Procedural success of primarily chosen TRA was 94% (n = 28,988). Crossover to other access sites was 6% (n = 1860). Most common reason for crossover was inability to puncture the right radial artery in 4,1%, presence of radial artery anomalies (0,3%), high grade spasm (0,1%), or radial artery occlusion (1,2%). Crossover direction was primarily through the ipsilateral transulnar access (TUA) 3,8%, left radial access (LRA) 1,5% and in only 0,6% (n = 189) of patients to transfemoral access (TFA). Access site bleeding complications were present in 5,1% (n 1579). Conclusion Total wrist access is feasible and safe with low rate of access site complications and crossovers, especially when performed in experienced high volume transradial center.

Radial Artery Anomalies and their Implications to Percutaneous Coronary Interventions

Radial Artery Anomalies and their Implications to Percutaneous Coronary Interventions

Influence of radial anatomy on pain experienced during transradial coronary angiography

BackgroundThe transradial route has become the primary approach for coronary angiography with the presence of radial artery anomalies found to be 10–20%. There has been limited study on the influence of these anomalies on procedural pain. Our aims were to determine local prevalence of the high radial origin (HRO) anatomical variant; to investigate factors influencing transradial procedural pain; and to determine if HRO specifically was associated with increased pain. MethodsRadial artery anatomy was characterized by arteriography in sequential patients undergoing angiography. Patients were asked to mark their perceived procedural pain on a visual analog scale, which was converted to a pain score. Results382 patients were enrolled, 5 were excluded. There were 259 males (68.7%) and 118 females (31.3%). HRO was present in 51 patients (13.5%). Overall mean pain score was 2.6 (SD 2.5). HRO was associated with a higher mean pain score than normal anatomy (3.3 (SD 2.9) vs. 2.4 (SD 2.4) p=0.027). HRO was not associated with increased procedural failure, screening time or procedure time. When pain score was dichotomized into mild pain (<4.0) and moderate-to-severe pain (≥4.0), HRO was associated with almost double the frequency of moderate-to-severe pain (37.2% vs. 21.1%, p=0.012). Using a logistic regression model, only female gender, younger age and HRO remained significant predictors of moderate-to-severe pain. ConclusionsThere was significantly increased pain in patients with HRO without increased procedure/screening time or procedural failure. Female gender and younger age were also found to be significant predictors of increased pain.

Radial artery anomalies in the Macedonian population during transradial angiography procedures

Objective: To assess the incidence of arterial anomalies of the radial artery in the Macedonian population registered during transradial access (TRA) angiography procedures in a large series of patients. Background: Transradial angiography (TRA) is now the recommended access for percutaneous coronary intervention, but technically is a more challenging approach for angiography procedures mostly due to the anatomic anomalies on the radial artery, which may influence the success rate of transradial angiographic procedures. Methods: All consecutive 19292 patients from our Center, in the period from March 2011 until December 2014 were examined. Preprocedural radial artery angiography was performed in all patients. Clinical and procedure characteristics, type and incidence of vascular anatomy variants and access site complications were analyzed. Results: Anatomical variants were present in 1625 (8.8%) patients. The most frequent was high-bifurcating radial artery origin from the axillary and brachial arteries in 1017 (5.5%) patients, 227 (1.2%) had extreme radial artery tortuosity, 176 (0.95%) had a full radial loop, 32 (0.17%) with hypoplastic radial artery and 173 (0.9%) had tortuous brachial, subclavian and axillary arteries. Radial artery spasm was very common in patients with present radial artery anomalies. Conclusion: Radial artery anomalies are very common in the general population. Knowing the anatomy of the radial artery helps the interventional cardiologist in successfully planning and performing this procedure. Radial artery angiography is strongly encouraged in every patient before the begining of the transradial angiography procedures.

Abstract 15311: Anomaly and Narrowing of Radial Artery and its Impact to the Transradial Angiography and Intervention

[Background] Increasing number of transradial coronary procedures are now performed because of the advantage of reduced access site complications. However, transradial approach sometimes ends in failure or vascular complication due to arterial anomaly or stenosis. [Objective] The objective of this study was to clarify the types and frequency of radial or brachial arterial anomaly and narrowing in patients who undergone cardiac catheterization. [Methods] Total of 1135 consecutive patients who underwent transradial cardiac angiography or intervention from Jan. 2013 to May 2015 were subjected. In all cases, angiography of radial and brachial arteries was performed through the inserted sheath. After removing the duplicating cases, we analyzed 826 arms of 786 patients. [Results] Of total 826 angiographies, 622 were identified as normal. There were 20 (2.4%) cases of 'high-bifurcation' in which radial artery originates proximal of the intercondylar line of the humerus. 'Radial loop' with a full 360 degree loop of the radial artery and accompanied by the recurrent artery which originates at the loop was identified in 9 (1.1%) cases. 'Radial simple loop' and 'brachial simple loop' with a full 360 degree loop without recurrent artery were observed in 5 (0.6%) and 6 (0.7%) cases, respectively. 'Radial or brachial tortuosity' with a bend of more than 90 degree existed in 64 (7.7%) and 45 (5.4%) cases, and 'narrow radial or brachial' with the vessel diameter &lt;2.0mm in 113 (13.7%) and 5 (0.6%) cases (some cases were duplicated). In high bifurcation, loop, or tortuosity cases, narrowing of the vessels of catheter route also coexisted in 20-89% cases. Cardiac catheterization ended in failure in 7 (1.1%) of normal radial and brachial artery cases, and in 31 (11.6%) cases of radial or brachial arterial abnormalities (p&lt;0.0001). Among the 31 failure cases with radial or brachial artery abnormalities, the cause of the failure was narrowing of a catheter route in 24 (77%) cases, and 1 case with both radial tortuosity and narrowing ended in radial artery perforation. [Conclusion] Radial artery anomaly and narrowing are not infrequent and often coexist, and lead to procedure failure or even vascular complications, indicating a need of confirmation of vascular anatomy by angiography.

Radial artery anomalies in patients undergoing transradial coronary procedures – An Egyptian multicenter experience

Abstract Objectives We investigated the incidence of radial anomalies (RA) in patients undergoing transradial (TR) coronary procedure and their impact on procedural outcome in the Egyptian population. Background Radial anomalies (RA) are considered an important factor for procedural failure. Information about anatomical variation is limited in our Egyptian population. Methods We performed a multicentre prospective study in Egypt. A total of 650 consecutive patients undergoing their first TR coronary procedure were recruited from January 2013 till January 2015. By retrograde radial arteriography we assessed the frequency of RA and their impact on procedural outcome. Results 650 consecutive patients were studied, 74% male, mean (SD) age 55 (10) years. The overall incidence of radial artery anomaly was 12.6% (n = 82). 40 (6.2%) patients had a high-bifurcating radial origin, 8 (1.2%) had a full radial loop, 14 (2.1%) had extreme radial artery tortuosity and 20 (3%) had other anomalies such as persistent left subclavian artery and extreme subclavian tortuosity. Overall transradial procedural success was 95%. Procedural failure was more common in patients with anomalous anatomy (39%) than in patients with normal anatomy (0.2%). Procedural failure was highest in patients with radial loop (87.5%), followed by those with subclavian tortuosity (45%), then high radial bifurcation (30%), and severe radial tortuosity (28.5%). 14 (2.1%) vascular complications occurred, all of which were treated conservatively. Conclusion There is a relatively significant presence of radial anomalies, with different degrees of impact on procedural failure rate, in our Egyptian population. Further collaborative studies are recommended to increase our success rates.

Feasibility and utility of pre‐procedure ultrasound imaging of the arm to facilitate transradial coronary diagnostic and interventional procedures (PRIMAFACIE‐TRI)

To assess feasibility and utility of imaging of both arms using ultrasound to facilitate transradial (TR) and transulnar (TU) coronary angiograms (CA) and intervention. Despite well recognized advantages, transradial approach (TRA) has challenges that reduce procedural success including small arterial size, anatomical variations, and anomalies of radial artery (RA). The utility of routine pre-procedural ultrasound of the arm arteries (PPUAA) in facilitating TRA has not been previously studied. To determine the role of PPUAA, we performed a single center registry of consecutive patients undergoing diagnostic and interventional procedures between 2006 and 2011. All patients underwent PPUAA of the right and left radial, ulnar (UA), as well as the brachial arteries (BA) in the antecubital fossa using a linear probe. End-points assessed included the incidence and correlates of arterial sizes, vascular anomalies, procedure success, and fluoroscopy as well as ultrasound assessment times. RA occlusion rates were studied in the last 10 months of the study period. Complete data on radial (mean 1.9 mm (male);1.7 mm (female)) and ulnar artery size (mean 1.8 mm (male); 1.6 mm (female)) and data on brachial branching anatomy were available in 2,344 patients; 1,872 of whom underwent a TR or TU procedure. The mean time to perform bilateral PPUAA was 6.4 min ± 1.8 min. The incidence of arterial abnormalities was 9.8% in PPUAA. Procedure success was 98.7% for CA and 97.5% for percutaneous coronary intervention. Outcomes were better in this cohort compared with remaining 3,781 patients in whom PPUAA data were not available. This single center prospective registry shows that PPUAA is feasible, requires minimum time, and provides anatomical information that may improve procedure success while reducing patient discomfort, arterial spasm, and fluoroscopy time. These findings should be confirmed in a randomized trial.

Transradial angiography procedure approach in with and without radial artery anomalies

Introduction: The transradial coronary angiography has several benefits such as the reducetion in access site complications especially in fully anticoagulated patients. The presence of arterial anomalies in upper limb arteries has an important role in procedural success. Methods: retrograde transarterial sheath injection was done in patients with transradial coronary angiography. Arterial anomalies in the upper limb evaluated. Cannulation time, the time of catheter passage to ascending aorta, and Angiographic time, were also meseared. Results: in 2011, 165 consecutive patients were studied, 116 (70.3%) male, age 56.7 ± 11.1 years. With 96.6% success rate in procedure, totally 59 anomolies were observed in 44 patients (26.7%). Radial artery by itself had ?25 anomalies (15.1%). The most frequent anomaly was abnormal origin of radial artery in 14 patients (8.5%) followed by tortuosities in 10 ulnar (6%). 9 brachial (5.4%), 7 radial (4/2%), 5 subclavian (3%) and 3 brachiocephalic arteries (1.8%). There also were 4 loops in ulnar artery (2.4%) and one in radial and brachinl arteries (each 0.6%). Other anomalies include 4 patients (2.4%), except cannulation time (p = 0.97), there were associations between anomalies and each of other times (p = 0.001) and contrast volume (p = 0.009). Anomalies didn’t have any effect on procedural success rate and just in one patient with sulclavian loop procedure changed to femoral approach (p = 0.19).

Radial Artery Anomalies and Subsequent Impact on Transradial Coronary Procedures—A Single Centre Experience

Background: Wollongong Hospital is a regional tertiary referral centre in NSW. A transradial approach for coronary angiography and intervention was commenced in March 2010. The transradial approach has a number of significant advantages over the femoral approach; however various technical challenges have impeded its utilisation. Some of these challenges relate to radial artery anatomy. Our aim is evaluate the incidence and influence of radial artery anomalies with regards to transradial procedures. Methods: Data related to baseline characteristics, procedure variables, radial artery anatomy and procedure outcome were collected on patients due to have retrograde radial arteriography performed between June 2011 and March 2012. Results: 135 patients were included in this study. Mean age was 67.05 years, M:F (75:60). In total 128 patients underwent retrograde arteriography (seven arteries unable to be viewed). The incidence of radial artery anomaly was 13/128 (10%). Anomalies identified were tortuous arteries (n = 5, 4%), loops (n = 4, 3%) and high bifurcations (n = 4, 3%). Overall success was 121/135 (89.6%). The success rate in patients with normal radial anatomy was 110/115 (95.6%) and in those with anomalies 11/13 (84.6%). The breakdown of success rate was 80% (4/5) in tortuous arteries and 75% (3/4) in both high bifurcations and loops. Of note the failure in the high bifurcation artery was due to spasm. Conclusion: Our study shows that radial artery anomalies are relatively common and the success rate of coronary procedures is also lower in these patients. The use of retrograde radial angiography can help operators evaluate radial artery anatomy and devise strategies to improve success rate.

Radial artery anomaly and its influence on transradial coronary procedural outcome

Background: The transradial approach for percutaneous coronary procedures has the advantage of reduced access site complications but is associated with specific technical challenges in comparison with the transfemoral approach. Transradial...