Background: Radial artery occlusion (RAO) is considered the most common and devastating complication of transradial approach (TRA). It has been described as the "Achilles' heel" of the transradial technique. Our aim was to assess the incidence and predictors of radial artery occlusion after transradial coronary catheterization.
Results: This was a prospective study enrolling 164 patients undergoing percutaneous coronary interventions (PCI) via the transradial approach (TRA) using 6-F catheters. Doppler ultrasonography assessment of the radial artery (RA) was conducted on day 1 and 6 months following the procedure. The studied group included 104 male (63.4%) and 60 female (36.6%) patients with a mean age of 57.7 ± 8.8 years and a mean RA diameter of 2.8 ± 0.5 mm. On day 1, Doppler examination revealed RAO in 54 patients (32.9%). After 6 months, RAO was detected in 49 patients (29.9%). Interestingly, only 1 new case (0.9%) of RAO was noted, and 6 patients (11.1%) had regained their RA patency. On multivariate analysis, female gender, age, manual compression, and RA diameter emerged as independent predictors of RAO. Using TR band for hemostasis for only 2 h was recognized as a potent independent predictor of RA patency on day 1 and 6 months after the procedure (n = 2, 3.7% in the RAO group, vs. n = 23, 20.9% in the non-RAO group, p = 0.004).
Conclusion: RAO, although clinically a silent issue, has been the main complication following TRA. In patients with high predictors of RAO, careful management and close follow-up are required to ensure radial artery long-term patency.