Effects of topical medications on radial artery spasm in patients undergoing transradial coronary procedures

Objectives: To test a novel diagnostic technique to assess radial artery perfusion after transradial catheterization. Background: Despite being mostly asymptomatic, radial artery occlusion (RAO) is not a benign complication, and its diagnosis is frequently missed because it requires time-consuming diagnostic testing. We developed a novel operator-independent diagnostic test to assess RAO after coronary procedures through a transradial access (TRA) by means of hand Laser Perfusion Imaging (LPI). Methods: One hundred patients were evaluated before and after TRA by means of the LPI. A radial perfusion index (RPI) was calculated as the ratio between the total perfusion measured during ulnar occlusion and total basal perfusion. Vascular Duplex scan (VDS) was used as the standard of reference to assess the artery patency. Results: LPI correctly identified RAO in 100% of cases. Post-procedural RPI was 0.89 ± 0.13 in patients with radial patency vs. 0.15 ± 0.04 in patients with RAO (p < 0.001). In line with these results, ROC analysis showed an excellent diagnostic performance of the LPI, that correctly identified all RAO cases (Area Under the Curve, AUC = 1.0; p < 0.001), with an optimal diagnostic cutoff at 0.2 RPI. Conclusions: LPI is a reliable diagnostic technique for RAO, offering the advantages of being quick and simple to perform.

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Anomalous Medial Branch of Radial Artery: A Rare Variant

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2016.98 ◽

2016 ◽

Vol 59 (3) ◽

pp. 100-103 ◽

Cited By ~ 1

Author(s):

Surbhi Wadhwa ◽

Vandana Tomar

Keyword(s):

Radial Artery ◽

Anatomical Variations ◽

Medial Branch ◽

Normal Pattern ◽

Access Site ◽

Capillary Vessel ◽

Radial Forearm ◽

Coronary Procedures ◽

Technical Failures ◽

Flexor Carpi Radialis Muscle

Radial artery is an important consistent vessel of the upper limb. It is a useful vascular access site for coronary procedures and its reliable anatomy has resulted in an elevation of radial forearm flaps for reconstructive surgeries of head and neck. Technical failures, in both the procedures, are mainly due to anatomical variations, such as radial loops, ectopic radial arteries or tortuosity in the vessel. We present a rare and a unique anomalous medial branch of the radial artery spiraling around the flexor carpi radialis muscle in the forearm with a high rising superficial palmar branch of radial artery. Developmentally it probably is a remanent of the normal pattern of capillary vessel maintenance and regression. Such a case is of importance for reconstructive surgeons and coronary interventionists, especially in view of its unique medial and deep course.

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A Randomized Trial Comparing Short versus Prolonged Hemostasis with Rescue Recanalization by Ipsilateral Ulnar Artery Compression: Impact on Radial Artery Occlusion—The RESCUE-RAO Trial

Journal of Interventional Cardiology ◽

10.1155/2020/7928961 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Dmitrii V. Ognerubov ◽

Alexander Sedaghat ◽

Sergey I. Provatorov ◽

Andrey S. Tereshchenko ◽

Olivier F. Bertrand ◽

...

Keyword(s):

Coronary Angiography ◽

Randomized Trial ◽

Hospital Discharge ◽

Radial Artery ◽

Ulnar Artery ◽

Artery Occlusion ◽

Puncture Site ◽

Coronary Procedures ◽

Baseline Characteristics ◽

Radial Artery Occlusion

Background. Despite the enormous benefits of radial access, this route is associated with a risk of radial artery occlusion (RAO). Objective. We compared the incidence of RAO in patients undergoing transradial coronary angiography and intervention after short versus prolonged hemostasis protocol. Also we assessed the efficacy of rescue 1-hour ipsilateral ulnar artery compression if RAO was observed after hemostasis. Material and Methods. Patients referred for elective transradial coronary procedures were eligible. After 6 F radial sheath removal, patients were randomized to short (3 hours) (n = 495) or prolonged (8 hours) (n = 503) hemostasis and a simple bandage was placed over the puncture site. After hemostasis was completed, oximetry plethysmography was used to assess the patency of the radial artery. Results. One thousand patients were randomized. Baseline characteristics were similar between both groups with average age 61.4 ± 9.4 years (71% male) and PCI performed on half of the patients. The RAO rate immediately after hemostasis was 3.2% in the short hemostasis group and 10.1% in the prolonged group ( p < 0.001 ). Rescue recanalization was successful only in the short group in 56.2% (11/19); at hospital discharge, RAO rates were 1.4% in the short group and 10.1% in the prolonged group ( p < 0.001 ). Conclusion. Shorter hemostasis was associated with significantly less RAO compared to prolonged hemostasis. Rescue radial artery recanalization was effective in > 50%, but only in the short hemostasis group.

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Comparison of Verapamil versus Heparin as Adjunctive Treatment for Transradial Coronary Procedures: The VERMUT Study

Cardiology ◽

10.1159/000488852 ◽

2018 ◽

Vol 140 (2) ◽

pp. 74-82 ◽

Cited By ~ 3

Author(s):

Matteo Tebaldi ◽

Simone Biscaglia ◽

Carlo Tumscitz ◽

Annamaria Del Franco ◽

Francesco Gallo ◽

...

Keyword(s):

Radial Artery ◽

Primary Outcome ◽

Study Groups ◽

Adjunctive Treatment ◽

Access Site ◽

Double Blind ◽

Access Site Complication ◽

Heparin Administration ◽

Coronary Procedures ◽

Sheath Insertion

Objective: We sought to demonstrate that the combination of a local vasodilator (verapamil), modern materials, patent hemostasis, and intravenous anticoagulant only in the case of percutaneous coronary intervention, as compared to default heparin administration after sheath insertion, may optimize a combined endpoint, including radial artery occlusion (RAO), radial artery spasm (RAS), and access site complication. Methods: This is a prospective, single-center, double-blind randomized trial. Overall, 418 patients undergoing a transradial approach (TRA) for coronary procedures were randomized 1: 1 to receive intraradial verapamil (5 mg) or heparin (5,000 IU) after a 6-Fr sheath insertion. The primary outcome was the 24-h occurrence of RAO (ultrasound confirmation), access site complication, and RAS requiring the bailout administration of vasodilators. Results: The combined primary outcome occurred in 127 (30%) patients. It was significantly lower in patients randomized to verapamil as compared to others (26 vs. 35%, p = 0.03). This was mainly due to a significant reduction in RAS (3 vs. 10%, p = 0.006). The 24-h and 30-day occurrence of RAO did not differ between the study groups. Conclusion: Local administration of verapamil versus heparin reduces RAS, without increasing RAO, which appears to be strictly related to radial artery diameter and hemostasis time.

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