Frequency and Predictors of Radial Artery Occlusion after Coronary Procedure through Transradial Approach: A Vascular Doppler-guided Study (original) (raw)
Related papers
PubMed, 2015
Objectives: To evaluate the incidence and predictors of radial artery occlusion (RAO) after transradial coronary angioplasty (TRA). Background: RAO can occur after TRA but has not been well studied by serial vascular Doppler examination. Methods: A total of 198 patients undergoing TRA were included. Radial pulse and Doppler examination of the radial artery were performed 1 day before, 1 day after, and 3 months after the procedure. RAO was defined as an absence of antegrade flow on Doppler studies. Logistic regression analysis was done to evaluate the predictors of RAO. Results: The mean radial arterial diameter was 2.8 ± 0.4 mm. On the day after TRA, radial artery Doppler examination revealed RAO in 30 patients (15.2%). Radial pulse was still palpable in 30.0% of these patients. All of them were asymptomatic. At 3-month follow-up, no new RAO was noted. Interestingly, the radial artery had spontaneously recanalized in 8 patients (26.7%) with RAO. Patients with persistent RAO remained asymptomatic. On univariate analysis, female sex, diabetes, lower body mass index, radial artery diameter ≤2.5 mm, lower peak systolic velocity, and radial artery to sheath ratio <1 were predictors of RAO. Interestingly, procedural characteristics and duration of the procedure were not identified as predictors of RAO. On multivariate analysis, radial artery diameter ≤2.5 mm and preprocedural peak systolic velocity emerged as independent predictors for RAO. Conclusion: Asymptomatic RAO occurs in about 15% of patients after TRA. Spontaneous recanalization occurs in about one-fourth of these patients. Preprocedure radial artery inner diameter ≤2.5 mm and peak systolic velocity are the independent predictors of RAO.
Cardiology Journal, 2014
. 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. Methods: 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. Results: 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. Conclusions: 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. (Cardiol J 2014; 21, 4: 350-356)
Angiology, 2018
Radial artery (RA) occlusion (RAO) remains the Achilles heel of transradial coronary procedures. Although of silent nature, RAO is relatively frequent, results in graft shortage for future coronary artery bypass surgery, and may occur even after short-lasting, 5F coronary angiography (CAG). The most frequent predictors of RAO are RA size, body size, female gender, and periprocedural anticoagulation intensity. Methods to detect RAO are variable, of which the Barbeau test and ultrasonography have similar diagnostic accuracy. Data indicate that late RAO recanalization may occur. Meticulous handling of RA and the use of appropriate hemostatic devices and techniques along with sufficient heparin dose appear important measures to reduce RAO rates. Recent contradictory studies indicate that the decreasing incidence of RAO overtime is not as uniform as previously thought. In 2 meta-analyses, the benefit of higher over lower anticoagulation intensity became evident. As "it may all be ap...
Incidence and Predictors of Radial Artery Occlusion Associated Transradial Catheterization
International Journal of Medical Sciences, 2000
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 3 rd h of intervention, the radial artery was checked by palpation; color doppler ultrasonography was performed at the 24 th 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.
The Anatolian Journal of Cardiology, 2022
Transfemoral vascular access is the most common approach for both diagnostic as well as therapeutic coronary interventions; however, higher rate of vascular complications and bleeding have been reported especially in women and older patients than with radial access (1). Transradial approach (TRA) is now being increasingly used and is the preferred vascular access for cardiac interventions (2). TRA offers advantages such as minimal invasion, ease of performance of diagnostic and therapeutic coronary interventions, minimum patient discomfort, early ambulation, shorter hospital stay, and lower hospital costs (3-7). In addition, there are lower local site complications, morbidity, and mortality in patients who specifically present with acute coronary syndromes (6, 7). Radial artery occlusion (RAO) is one of the most frequent complications of TRA that affects a sizeable proportion of patients (8, 9). Post transradial coronary intervention (TCI), early RAO may occur because of radial artery spasm and thrombosis, which may be precipitated by combined effects of catheter-induced endothelial injury and decrease in blood flow after sheath and catheter insertion (8). The incidence of RAO varies in different studies ranging from 1% to 42%, and has been determined by the timing of evaluation and the method used for the diagnosis of RAO. Various patient-specific and procedure-related factors influence the occurrence and consequences of RAO (8-17). However, the predictors of RAO after TCI are not clearly defined. In this study, we determine the incidence and patient-specific and procedure-related predictors of RAO among patients undergoing TCI.
Pakistan Journal of Medical and Health Sciences, 2021
Objective: The aim of this study was to determine the frequency of radial artery occlusion (RAO) in patients undergoing percutaneous cardiac catheterization. Study Design: Prospective study Place and Duration: The study was conducted at cardiology department of Cat A Hospital Batkhela and Fauji Foundation Hospital Peshawar for six months duration from January 2021 to June 2021. Methods: Total one hundred and forty patients of both genders were included in this study. Patients’ detailed demographics including age, sex and body mass index were recorded after taking informed written consent. Patients who underwent percutaneous cardiac catheterization were presented in this study. Hypertension, diabetes mellitus and smoking history were analyzed. Frequency of radial artery occlusion (RAO) was measured by Barbeau test. Chi square test and fisher test was used to measure prevalence of RAO with respect to comorbidities. Complete data was analyzed by SPSS 23.0 version. Results: There were 1...
Cardiovascular Intervention and Therapeutics, 2023
Protocols for hemostasis after trans-radial approach (TRA) vary depending on the institute as there is no established evidencebased protocol. This study aimed to investigate the clinical implications of radial compression protocols. Consecutive patients who underwent outpatient invasive catheter angiography before and after April 2018 were treated with traditional and new protocols, respectively. Using the same hemostasis band, in the conventional protocol, fixed amount of air was removed soon after the procedure, 2 h later, and 3 h later, whereas the air was removed as much as possible every 30 min in the new protocol. A total of 1842 patients (71 ± 10 years old, 77% male) were included. Compared with the traditional protocol group (n = 1001), the new protocol group (n = 841) had a significantly lower rate of dual antiplatelet therapy (35% and 24% in the traditional and new groups, respectively, p < 0.001). The time required for complete hemostasis was approximately one-third with the new protocol (190 ± 16 and 66 ± 32 min, p < 0.001) with no clinically relevant bleeding. The incidence of radial artery occlusion (RAO) was 9.8% and 0.9% in the traditional and new protocol groups, respectively (p < 0.001). After adjusting for covariates, the new protocol was associated with a reduced risk of RAO (odds ratio 0.10, p < 0.001) and a shorter hemostasis time (odds ratio 0.01, p < 0.001). The new protocol for hemostasis after TRA was strongly associated with a shorter hemostasis time and a lower rate of RAO.
The American Journal of Cardiology, 1993
Quantitation of coronary collateral flow in patients has been limited to angiographk techniques, whkh are subJect to well-known methodologk limitations. The use of a Doppler-tipped angioplastyguidewirepermltsmeasurementof both antegrade and MrogrAe flow distal to totally or subtotally occluded vesseis that may be supplied with acutely recruitable or angiographitally mature collateral conduits. Using coronary fkwvdocity as an imlkator of collateral flow, Mrogrx& flow vekcity was quantitated in 17 pathts.
Coronary artery occlusions diagnosed by transthoracic Doppler
Cardiovascular Ultrasound, 2014
Background: Our aim was to assess whether anterograde flow velocities in septal perforating branches could identify an occluded contralateral coronary artery, and to assess the feasibility and accuracy of diagnosing occlusions in the three main coronary arteries by the combined use of several noninvasive parameters indicating collateral flow. Methods: A total of 108 patients scheduled for coronary angiography because of chest pain or acute coronary syndromes were studied using transthoracic Doppler echocardiography. Results: Anterograde peak diastolic flow velocities (pDV) in septal perforating branches were higher in patients with angiographic occluded contralateral artery compared with corresponding velocities in patients without significant disease in the contralateral artery (0.80 ± 0.31 m/sec versus 0.37 ± 0.13 m/sec, p < 0.001). Receiver operating characteristic curve showed pDV ≥ 0.57 m/sec to be the optimal cutoff value to identify occluded contralateral artery, with a sensitivity of 79% and a specificity of 69%. Demonstration of at least one positive parameter (retrograde flow in main coronary arteries, reversed flow in septal perforating and left circumflex marginal branches, pDV ≥ 0.57 m/sec, or demonstration of other epicardial or intramyocardial collaterals) indicating collateral flow to an occluded main coronary artery had sensitivity, specificity, positive and negative predictive value of 89%, 94%, 63%, and 99%, respectively, for detection of a coronary occlusion. With this combined use of several parameters, 25 of 28 coronary occlusions were identified.