Feasibility of Transradial Access for Coronary Interventions Via Percutaneous Angioplasty of the Radial Artery in Cases of Functional Radial Occlusion


AIMS: Transradial access (TRA) has become a standard approach for cardiac catheterization. However, an obstacle to TRA is the risk of radial artery occlusion (RAO) after radial access in about 5%-10% of patients. We analyzed the safety and efficacy of getting vascular access after RAO by percutaneous transluminal angioplasty in cases of chronic radial occlusion.

METHODS AND RESULTS: Chronic RAO was confirmed by Allen test and color Doppler in 8 patients. TRA was achieved by puncture in the distal tabatiere (anatomical snuffbox) using Seldinger’s technique followed by insertion of a 5 Fr radial introducer sheath. Angiogram was obtained before percutaneous transluminal angioplasty with a 2.0 mm coronary balloon to reopen the artery. Puncture of the occluded radial artery, percutaneous transluminal angioplasty, and subsequent coronary catheterization and PCI were successful in all 8 patients. One complication was a dissection of the radial artery without further adverse events. No hemorrhage or compartment syndrome occurred.

CONCLUSIONS: With increased application of TRA, the incidence of RAO is also rising. Some patients with RAO require repeat cardiac catheterization. Given the risk of damaging the contralateral radial artery in subsequent procedures, using the same access site is desirable. We demonstrate that it is feasible to get access to an occluded radial artery by percutaneous transluminal angioplasty.

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Schulte-Hermes M, Klein-Wiele O, Vorpahl M, Seyfarth M. J Invasive Cardiol 2018;30:355–9.