Recent studies reported a high rate of transradial access (TRA) induced vascular injury which leads to chronic intimal thickening and is associated with radial artery spasm (RAS) and radial artery occlusion (RAO). It is likely to be caused by radial artery puncture, sheath introduction and sheath friction caused by radial artery inner diameter-sheath outer diameter (RAID/SOD) mismatch. However, using Optical Coherence Tomography (OCT), post procedural radial artery (RA) damage was also found in the proximal part of the RA, where the vessel has a larger diameter and radial artery internal diameter/sheath outer diameter (RAID/SOD) mismatch is less likely to be the cause of vascular damage. One of the possible mechanisms is intimal damage caused by the space between the guidewire and the,catheter tip which shaves the vessel wall (“razor” effect).
van der Heijden DJ, et al. EuroIntervention 2019. (Epub ahead of print).