Perspective

Radial artery occlusion common after transradial intervention

Radial artery occlusion appears to be a common complication after transradial interventions. Maintenance of radial patency, high-dose heparin and shorter compression times may be recommended to reduce radial artery occlusion, according to a new report in the Journal of the American Heart Association.

Researchers performed a systematic review and meta-analysis of studies of radial artery occlusion in transradial interventions. In total, the analysis included 66 studies (retrospective cohort, randomized, matched/case-control, cohort) comprising 31,345 participants. The mean age of participants was 64 years and 70% were men.

In these studies, incident radial artery occlusion ranged from less than 1% to 33%. The researchers observed variations in incidence based on timing of assessment of radial artery patency. The incidence of radial artery occlusion was 7.7% within 24 hours and 5.5% after 1 week, according to the findings. Sensitivity analyses revealed an increase in the incidence of radial artery occlusion over time.

Higher-dose heparin (5,000 IU) was associated with a decreased incidence of radial artery occlusion compared with lower doses (2,000 IU to 3,000 IU; RR = 0.36; 95% CI, 0.17-0.76). A 15-minute compression time was associated with lower risk for radial artery occlusion compared with a 2-hour compression time (RR = 0.28; 95% CI, 0.05-1.5). Several other factors were associated with reduced radial artery occlusion, such as age, sex, sheath size and radial artery diameter; however, these factors varied across all studies included in the analysis.

Disclosure: The researchers report no relevant financial disclosures.

 

Radial artery occlusion appears to be a common complication after transradial interventions. Maintenance of radial patency, high-dose heparin and shorter compression times may be recommended to reduce radial artery occlusion, according to a new report in the Journal of the American Heart Association.

Researchers performed a systematic review and meta-analysis of studies of radial artery occlusion in transradial interventions. In total, the analysis included 66 studies (retrospective cohort, randomized, matched/case-control, cohort) comprising 31,345 participants. The mean age of participants was 64 years and 70% were men.

In these studies, incident radial artery occlusion ranged from less than 1% to 33%. The researchers observed variations in incidence based on timing of assessment of radial artery patency. The incidence of radial artery occlusion was 7.7% within 24 hours and 5.5% after 1 week, according to the findings. Sensitivity analyses revealed an increase in the incidence of radial artery occlusion over time.

Higher-dose heparin (5,000 IU) was associated with a decreased incidence of radial artery occlusion compared with lower doses (2,000 IU to 3,000 IU; RR = 0.36; 95% CI, 0.17-0.76). A 15-minute compression time was associated with lower risk for radial artery occlusion compared with a 2-hour compression time (RR = 0.28; 95% CI, 0.05-1.5). Several other factors were associated with reduced radial artery occlusion, such as age, sex, sheath size and radial artery diameter; however, these factors varied across all studies included in the analysis.

Disclosure: The researchers report no relevant financial disclosures.

 

    Perspective
    Sunil V. Rao

    Sunil V. Rao

    This is a very nicely done systematic overview by an experienced and well-known group. This study provides a solid base of evidence for what the true radial artery occlusion rate is. It also underscores the point that most radial artery occlusions occurring in the 24 hours after a procedure recanalize within 30 days. The study demonstrates that all transradial procedures require parenteral anticoagulation, even if they are just diagnostic caths, and that the use of non-occlusive hemostasis should be standard practice. I think it is important to understand the role of other strategies such as ulnar compression in reducing radial artery occlusion. There is a real opportunity for industry here. There is very limited availability of low-profile equipment worldwide. In Japan and parts of Southeast Asia, there is much wider availability of “slender” equipment that minimizes radial artery trauma and potentially reduces radial artery occlusion. We need equipment like that in order to keep the field moving forward and make the procedure even safer.

    • Sunil V. Rao, MD, FSCAI, FACC
    • Cardiology Today’s Intervention Editorial Board member Duke University Medical Center Durham VA Medical Center

    Disclosures: Rao reports consulting for Medtronic.