Objective
Radial artery occlusion (RAO) is a notable complication in transradial coronary interventions (TRI). The incidence of RAO varies across different studies, and its predictors remain incompletely understood. This case study aims to investigate the factors influencing RAO in patients undergoing transradial coronary intervention, specifically in the Indian population.
Study Overview
This prospective, single-center study was conducted from October 2018 to September 2019. A total of 1,754 patients were enrolled, all of whom underwent TRI and were evaluated for RAO 24 hours post-procedure. The study aimed to identify both patient and procedure-related factors contributing to the occurrence of RAO.
Methods
Patients undergoing transradial coronary angiography or angioplasty were included in the study. RAO was assessed 24 hours after the procedure using ultrasound and other diagnostic tools. Univariate and multivariate analyses were used to determine significant predictors of RAO. Factors considered included:
- Patient characteristics (e.g., age, glomerular filtration rate)
- Procedure-related variables (e.g., puncture attempts, sheath size, complexity of the intervention)
Results
Among the 1,754 patients:
- 1,374 patients (78.3%) underwent angioplasty, while 380 patients (21.7%) underwent angiography alone.
- RAO was diagnosed in 11.97% of patients, indicating a relatively high incidence in the Indian cohort compared to global averages.
The analysis identified several independent predictors of RAO:
- Lower Glomerular Filtration Rate (GFR): Patients with compromised kidney function were at higher risk for RAO.
- Multiple Puncture Attempts: Difficulty in accessing the radial artery led to higher rates of RAO.
- Larger Sheath Size: Using larger arterial sheaths during the procedure increased the likelihood of RAO.
- Complex Interventions: Procedures with greater complexity showed a higher incidence of RAO.
- Longer Hemostasis Time: Prolonged compression of the artery post-procedure raised the risk of occlusion.
- Forearm Hematoma Formation: Hematoma in the forearm was linked to a higher chance of RAO.
Conclusion
This study found that RAO is not an uncommon complication following transradial coronary interventions, with an incidence rate of nearly 12%. Key predictors such as lower GFR, multiple puncture attempts, larger sheath size, procedural complexity, longer hemostasis time, and forearm hematoma formation should be carefully considered to reduce the risk of RAO. Understanding these predictors can help interventional cardiologists in the Indian population take preventive measures, thereby improving patient outcomes in transradial coronary interventions.