Discussion
postprocedural radial occlusion, bleeding, transient ulnar compression, radial occlusion, lower radial occlusion, contemporary radial occlusion rate, obstructive coronary artery disease, vascular spasm, vascular damage, artery occlusion, radial artery occlusion
BLEEDING, VASCULAR SPASM, EVENT, VASCULAR ACCESS SITE COMPLICATION, PATHOGENESIS, ARTERY OCCLUSION, CORONARY HEART DISEASE, ARTERIAL HYPERTENSION
This study evaluated the incidence of vascular access site complications following transradial coronary angiography in a large cohort of unselected patients including a significant proportion of patients undergoing complex coronary intervention with large-bore access. Key finding was that the contemporary radial occlusion rate was with 4.6% lower as compared to many previously reported results [Radial patency was evaluated on the day following coronary angiography. This early point of time was chosen since the majority of patients were discharged on this day. In previous studies, radial artery patency was evaluated from 24 h up of 30 days following the procedure [In the present study, all patents were screened by duplex ultrasonography regardless of symptoms. This is an important feature of this study and might explain differences as compared to previous data. Earlier studies have infrequently reported even lower radial occlusion rates of less than 4%. However, these were mainly retrospective analyses with lower sample sizes. In some analyses, only symptomatic patients were apparently sent for ultrasound examination [Overall, patients diagnosed with radial occlusion were more often female, had a lower prevalence of arterial hypertension and less frequently a history of coronary heart disease, which might be explained by their younger age. However, these patients were more often active smokers, demonstrated less frequently an obstructive coronary artery disease needing revascularization and had higher creatine kinase levels, which might point to a higher level of physical activity.Young age has already previously been identified as predictor for radial artery occlusion [Another analysis of 1706 patients undergoing transradial catheterization found a correlation of radial artery diameter with female gender, but not with body mass index [The last key predictor of radial occlusion in the present cohort was active smoking, which can be also associated with vascular spasm and has previously been reported to be associated with radial occlusion [Thus, pathogenesis of radial artery occlusion appears to be multifactorial. Sheath insertion and a mismatch between radial artery diameter and sheath size can lead to vascular damage and create a pro-thrombotic environment [The results of the present analysis can certainly help to identify patients at risk for radial occlusion. Most cases of postprocedural radial occlusion occurred in patients undergoing only diagnostic coronary angiography (69 out of 93 in total) and in particular in female patients (In patients needing coronary intervention, key for reduction of radial occlusion appears to be the correct selection of sheath size. Overall, the use of large-bore sheaths was clinically safe in the present cohort with not any major bleeding or neurologic event, which is in line with previous clinical data [The optimal treatment for radial artery occlusion is still not well defined. Mechanical interventions such as an approach with transient ulnar compression has been suggested [