Acute vessel wall injury is common after transradial catheterisation but is not linked to radial artery occlusion

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Francesco Costa (Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands) and others report in Circulation: Cardiovascular Interventions that acute vessel wall injury is common after transradial catheterisation but it is not associated with an increased risk of radial artery occlusion or loss of radial artery pulsation.

According to Costa et al, radial artery occlusion may affect ≤30% of patients undergoing the transradial approach and can affect future use of the radial artery as an access site for catheterisation. Therefore, there is a need to understand the pathophysiological mechanisms of the complication; the authors write that the aim of the R-RADAR (Rotterdam Radial Access Research) study was to determine if the structural changes to the radial artery wall that can occur after transradial catheterisation “might predict radial artery occlusion or loss of pulsation, local pain, or functional impairment of the upper extremity.”

One hundred consecutive patients who were due to undergo transradial catheterisation for diagnostic coronary angiography at the authors’ centre (Erasmus Medical Center) were enrolled in the R-RADAR registry. Of these, 90 successful underwent the procedure and, therefore, constituted the final study population. The clinical endpoints, evaluated at three hours and 30 days after the transradial catheterisation, were radial artery occlusion, radial artery pulsation loss, pain or discomfort in the upper extremity, and functional impairment in the upper extremity.

Costa et al comment that acute wall injuries—as assessed with ultrasound—at the puncture site were “ubiquitous”, noting that 97.7% of patients showed acute injuries at three hours and 96.1% showed such injuries at 30 days. “Radial dissection and wall haematoma were most frequent both at three hours (89.8% for dissection and 73.9% for dissection) and 30 days (83.1% and 64.9%, respectively). More than half of the patients had lumen narrowing at any timepoint. Pseudoaneurysms were observed in 14.8% of patients at three hours, increasing up to 55.8% at 30-day follow-up. Thrombus formation at any timepoint was seen in 4% of patients,” they state.

However, these ultrasound findings did not appear to correlate with the occurrence of radial artery occlusion, which occurred in 3.4% of patients immediately after the procedure and persisted at 30-day follow-up, or with radial artery pulsation loss (observed in 6.1% of patients at three hours and in 9.2% at 30 days). Acute vessel wall injuries also did not seem to predict either pain/discomfort in the upper extremity (36.8% of patients at three days and 32% of patients at 30 days) or loss of function (14.1% and 12%, respectively). Costa et al report: “Smaller radial arteries at baseline had higher risk for radial artery pulsation loss both at three-hour and at 30-day follow-up but no higher risk of radial artery occlusion, pain and discomfort, or functional impairment.” They add that the number of puncture attempts was associated with pulsation loss, radial artery occlusion, and pain and discomfort at 30 days, “with increasing risk after each further attempt”.

The authors comment: “In our data set, the acute wall injuries of the radial artery were not associated with radial artery occlusion, radial artery pulsation loss, symptoms, or functional impairment. This may be related to a lack of statistical power caused by the relatively low occurrence of radial artery occurrence and radial artery pulsation loss.” They add that the lower rate of radial artery occlusion and pulsation loss observed in their study compared with previous studies “may result from a strict protocol including routine use of periprocedural anticoagulation, non-occlusive compression, and relative short-term compression times.”