Radial artery occlusion in transradial coronary catheterization: incidence and prognostic factors

Background Transradial access has evolved as the preferred approach for coronary angiography and percutaneous coronary intervention. Radial artery occlusion (RAO) is the most common complication of transradial coronary catheterization. Purpose To evaluate the incidence of RAO and its predisposing factors. Methods Prospective, multicenter, open-label study involving 1,357 patients (mean age: 64.8±11.7 years, females: 24.9%) who underwent cardiac catheterization via the transradial route for angiography and/or a percutaneous coronary intervention (PCI). RAO was diagnosed with radial artery ultrasound in the first 24 hours after successful hemostasis. Univariate and multivariate logistic regression analyses were performed to identify potential predictors of RAO occurrence. Results The incidence of RAO was 9.5% overall, 10.6% in the angiography-only group and 6.2% in the PCI group. Independent predictors of RAO were as follows: (i) the female gender [aOR = 1.72 (1.05–2.83)], (ii) access site cross-over [aOR = 4.33 (1.02–18.39)], (iii) increased total time of the sheath in the artery [(aOR = 1.01 (1.00–1.02)], (iv) radial artery spasm [aOR = 2.47 (1.40–4.36)], (v) presence of hematoma [aOR = 2.28 (1.28–4.06)], (vi) post-catheterization dabigatran use [aOR = 5.15 (1.29–20.55)], (vii) manual hemostasis [aOR = 1.94 (1.01–3.72)] and (viii) numbness [aOR = 8.25 (1.70–40)]. Contrariwise, two variables were independently associated with increased odds for radial artery patency (RAP): (i) PCI performance [aOR = 0.19 (0.06–0.63)], and (ii) a higher dosage of intravenous heparin per patient weight [aOR = 0.98 (0.96–0.99)], particularly, a dosage of >50 IU/kg [aOR = 0.56 (0.31–1.00)]. Conclusion The incidence of RAO in an unselected, all-comers European population after transradial coronary catheterization for angiography and/or PCIs is similar to that reported in the international literature. Several RAO prognostic factors have been confirmed, and new ones are described. The female gender, radial artery trauma and manual hemostasis are the strongest predictors of RAO. Our results could help in the future identification of patients at higher risk of RAO, for whom less invasive diagnostic procedures may be preferred, if possible.