Lounes Mohamed Sofiane, Meftah Abdelouahed, Bedjaoui Ali, Belhadi Chamseddine, Allal Karima, Boulaam Hacene, Sayah Adel, Hafidi Ilies, Tebache Elhadi, Allali Abdelhakim, Benkhedda Salim
Cardiology Department, Military Central Hospital, Argel, Argelia Cardiology Department Military Central Hospital Argel Argelia.
Cardiology Oncology Collaborative Research Group "COCRG Laboratory", Faculty of Medicine, University1 Benyoucef BENKHEDDA, Argel, Argelia Cardiology Oncology Collaborative Research Group "COCRG Laboratory" Faculty of Medicine University1 Benyoucef BENKHEDDA Argel Argelia.
REC Interv Cardiol. 2025 Feb 24;7(1):15-22. doi: 10.24875/RECIC.M24000479. eCollection 2025 Jan-Mar.
The use of transradial access for percutaneous coronary procedures has increased due to its advantages over the femoral approach. However, this benefit comes at the expense of a higher rate of radial artery occlusion (RAO). Our objective was to assess the incidence and predictors of RAO following transradial catheterization. Additionally, we studied anatomic variations of the radial artery (RA).
This prospective study enrolled 427 patients who underwent coronary angiography or angioplasty via transradial access. The forearm arteries were evaluated by ultrasound. If RAO was present, follow-up ultrasound examinations were performed at 1 and 3 months postprocedure.
Our study population included 288 men (67.4%) and 139 women (32.6%). The mean age was 61.9 ± 11.1 years. RAO occurred in 48 patients (11.24%), and spontaneous recanalization was observed within 3 months in 15 patients (32.6%). On multivariate analysis, independent predictors of RAO were younger age (OR, 0.642; 95%CI, 0.480-0.858; P = .031), low periprocedural systolic blood pressure (OR, 0.598; 95%CI, 0.415-0.862; P = .007), a small radial diameter (OR, 0.371; 95%CI, 0.323-0.618; P = .031), insufficient anticoagulation (OR, 0.287; 95%CI, 0.163-0.505; P < .001), occlusive hemostasis (OR, 0.128; 95%CI, 0.047-0.353; P < .001), and long duration of hemostasis. The overall incidence of RA anatomic variations was 14.8% (n = 63). Among these, 40 patients (63.5%) had a high radial origin, 18 (28.6%) had extreme RA tortuosity, and 5 (7.9%) had a complete radioulnar loop.
The main modifiable predictors of RAO are insufficient heparinization and occlusive hemostasis. Preventive strategies should focus primarily on these 2 predictive factors to reduce the risk of RAO.
由于经桡动脉途径相较于股动脉途径具有优势，经桡动脉途径在经皮冠状动脉介入治疗中的应用有所增加。然而，这一优势是以较高的桡动脉闭塞（RAO）发生率为代价的。我们的目的是评估经桡动脉导管插入术后RAO的发生率及预测因素。此外，我们还研究了桡动脉（RA）的解剖变异情况。
这项前瞻性研究纳入了427例行经桡动脉途径冠状动脉造影或血管成形术的患者。通过超声评估前臂动脉。若存在RAO，则在术后1个月和3个月进行超声随访检查。
我们的研究人群包括288名男性（67.4%）和139名女性（32.6%）。平均年龄为61.9±11.1岁。48例患者（11.24%）发生了RAO，15例患者（32.6%）在3个月内观察到自发再通。多因素分析显示，RAO的独立预测因素为年龄较小（OR，0.642；95%CI，0.480 - 至0.858；P = 0.031）、围手术期收缩压较低（OR，0.598；95%CI，0.415 - 至0.862；P = 0.007）、桡动脉直径较小（OR，0.371；95%CI，0.323 - 至0.618；P = 0.031）、抗凝不足（OR，0.287；95%CI，0.163 - 至0.505；P < 0.001）、闭塞性止血（OR，0.128；95%CI，0.047 - 至0.353；P < 0.001）以及止血时间较长。RA解剖变异的总体发生率为14.8%（n = 63）。其中，40例患者（63.5%）有高位桡动脉起始，18例（28.6%）有极度桡动脉迂曲，5例（7.9%）有完整的桡尺环。
RAO的主要可改变预测因素是肝素化不足和闭塞性止血。预防策略应主要关注这两个预测因素以降低RAO风险。
