A Retrospective Analysis of Radial Artery Occlusion Rates in ACS Patients Undergoing Transradial PCI: A Single-Center Experience

Year 2025, Volume: 26 Issue: 3, 309 - 318, 22.09.2025

Hüseyin Tezcan , Turgut Uygun

https://doi.org/10.69601/meandrosmdj.1655299

Abstract

Background: Transradial access (TRA) has become the preferred approach for percutaneous coronary intervention (PCI) due to reduced vascular complications. However, radial artery occlusion (RAO) remains a recognized complication. We evaluated RAO rates in acute coronary syndrome (ACS) patients undergoing transradial PCI at a high-volume center and compared outcomes between those receiving ticagrelor versus clopidogrel.

Methods: We retrospectively analyzed 240 ACS patients who underwent transradial PCI from June 1, 2022 to June 1, 2024 at Konya City Hospital. All patients received standard heparin (weight-based), immediate sheath removal, and radial compression with Terumo or Shunmei close pads. Barbeau Test results at follow-up (1 month) were used to detect RAO (Type D waveform). Clinical and laboratory characteristics, including echocardiographic ejection fraction (EF), were compared between ticagrelor and clopidogrel groups.

Results: Mean age was 60.4±11.2 years, and 71.7% were male. Overall, 66.7% presented with ST-elevation myocardial infarction (STEMI) and 33.3% with non-STEMI (NSTEMI). Laboratory profiles and EF (~48%) did not differ between ticagrelor (n=140) and clopidogrel (n=100) groups. Radial artery patency was high: only 5 patients (2.1% ) had RAO (Barbeau Type D). No significant difference in RAO rates was observed between ticagrelor (2.1%) and clopidogrel (2.0%) groups (p=0.96).

Conclusions: In this retrospective analysis, standardized transradial PCI procedures achieved low RAO rates (~2%) with no significant difference between ticagrelor and clopidogrel. These findings underscore the safety and efficacy of radial interventions when performed by experienced operators using best practices, and confirm that RAO should be viewed as a manageable complication.

Keywords

Radial artery occlusion , Transradial PCI , Acute coronary syndrome , Ticagrelor , Clopidogrel

Transradial PCI Uygulanan AKS Hastalarında Radiyal Arter Oklüzyon Oranlarının Retrospektif Analizi: Tek Merkez Deneyimi

Abstract

Amaç: Transradial erişim (TRA), vasküler komplikasyonların azalması nedeniyle perkütan koroner girişim (PKG) için tercih edilen yaklaşım haline gelmiştir. Ancak, radyal arter oklüzyonu (RAO) bilinen bir komplikasyon olmaya devam etmektedir. Yüksek hacimli bir merkezde transradial PKG uygulanan akut koroner sendrom (AKS) hastalarında RAO oranlarını değerlendirdik ve tikagrelor ile klopidogrel alanlar arasındaki sonuçları karşılaştırdık.

Gereç ve Yöntemler: 1 Haziran 2022 ile 1 Haziran 2024 tarihleri arasında XXX'te transradial PKG uygulanan 240 AKS hastasını retrospektif olarak analiz ettik. Tüm hastalara standart heparin (ağırlığa göre dozlam), işlem sonrası hemen kılıf çıkarma ve Terumo veya Shunmei kapalı pedlerle radyal kompresyon uygulandı. RAO'nu (Tip D dalga formu) tespit etmek için takipteki (1 ay) Barbeau Testi sonuçları kullanıldı. Ekokardiyografik ejeksiyon fraksiyonu (EF) dahil olmak üzere klinik ve laboratuvar özellikleri, tikagrelor ve klopidogrel grupları arasında karşılaştırıldı.

Bulgular: Ortalama yaş 60,4±11,2 yıldı ve %71,7'si erkekti. Genel olarak, %66,7'si ST yükselmeli miyokard enfarktüsü (STYMI) ve %33,3'ü ST yükselmesiz miyokard enfarktüsü (STYzMI) idi. Laboratuvar profilleri ve EF (~%48) tikagrelor (n=140) ve klopidogrel (n=100) grupları arasında farklılık göstermedi. Radyal arter açıklığı yüksekti: sadece 5 hastada (%2,1) RAO vardı (Barbeau Tip D). Tikagrelor (%2,1) ve klopidogrel (%2,0) grupları arasında RAO oranlarında anlamlı bir fark gözlenmedi (p=0,96).

Sonuç: Bu retrospektif analizde, standardize transradyal PKG prosedürleri düşük RAO oranlarına (~%2) ulaştı ve tikagrelor ile klopidogrel arasında anlamlı bir fark görülmedi. Bu bulgular, en iyi uygulamaları kullanan deneyimli operatörler tarafından gerçekleştirildiğinde radyal müdahalelerin güvenliğini ve etkinliğini vurgulamakta ve RAO'nun yönetilebilir bir komplikasyon olarak görülmesi gerektiğini doğrulamaktadır.

Keywords

Radiyal arter oklüzyonu , Transradial perkütan koroner girişim (PCI) , Akut koroner sendrom , Tikagrelor , Klopidogrel

References

• 1. Campeau, L. “Percutaneous radial artery approach for coronary angiography.” Catheterization and cardiovascular diagnosis vol. 16,1 (1989): 3-7. doi:10.1002/ccd.1810160103
• 2. Jolly, Sanjit S et al. “Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial.” Lancet (London, England) vol. 377,9775 (2011): 1409-20. doi:10.1016/S0140-6736(11)60404-2
• 3. Valgimigli, Marco et al. “Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial.” Lancet (London, England) vol. 385,9986 (2015): 2465-76. doi:10.1016/S0140-6736(15)60292-6
• 4. Roffi, Marco et al. “2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC).” European heart journal vol. 37,3 (2016): 267-315. doi:10.1093/eurheartj/ehv320
• 5. Kotowycz, Mark A, and Vladimír Dzavík. “Radial artery patency after transradial catheterization.” Circulation. Cardiovascular interventions vol. 5,1 (2012): 127-33. doi:10.1161/CIRCINTERVENTIONS.111.965871
• 6. Rashid, Muhammad et al. “Radial Artery Occlusion After Transradial Interventions: A Systematic Review and Meta-Analysis.” Journal of the American Heart Association vol. 5,1 e002686. 25 Jan. 2016, doi:10.1161/JAHA.115.002686
• 7. Bertrand, Olivier F et al. “Transradial approach for coronary angiography and interventions: results of the first international transradial practice survey.” JACC. Cardiovascular interventions vol. 3,10 (2010): 1022-31. doi:10.1016/j.jcin.2010.07.013
• 8. da Silva RL, Britto PF, Joaquim RM, Andrade PB, Abizaid AA, Filippini FB, et al. Clinical accuracy of reverse Barbeau test in the diagnosis of radial artery occlusion after transradial catheterization. J Transcat Intervent. 2021;29:eA20200037. http://dx.doi.org/10.31160/JOTCI202129A20200037
• 9. Omedè, Pierluigi et al. “Radial and femoral access for interventional fellows performing diagnostic coronary angiographies: the LEARN-Cardiogroup II, a prospective multicenter study.” Journal of cardiovascular medicine (Hagerstown, Md.) vol. 19,11 (2018): 650-654. doi:10.2459/JCM.0000000000000716
• 10. Riangwiwat, Tanawan et al. “Coronary Angiography in Patients with Arteria Lusoria via Right Radial Access: A Case Series and Literature Review.” Cardiovascular revascularization medicine : including molecular interventions vol. 21,3 (2020): 417-421. doi:10.1016/j.carrev.2019.06.001
• 11. Tsigkas, Grigorios et al. “Preventing and Managing Radial Artery Occlusion following Transradial Procedures: Strategies and Considerations.” Journal of cardiovascular development and disease vol. 10,7 283. 30 Jun. 2023, doi:10.3390/jcdd10070283
• 12. Stella, P R et al. “Incidence and outcome of radial artery occlusion following transradial artery coronary angioplasty.” Catheterization and cardiovascular diagnosis vol. 40,2 (1997): 156-8. doi:10.1002/(sici)1097-0304(199702)40:2<156::aid-ccd7>3.0.co;2-a
• 13. Sanmartin, Marcelo et al. “Interruption of blood flow during compression and radial artery occlusion after transradial catheterization.” Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions vol. 70,2 (2007): 185-9. doi:10.1002/ccd.21058
• 14. Pancholy, Samir et al. “Prevention of radial artery occlusion-patent hemostasis evaluation trial (PROPHET study): a randomized comparison of traditional versus patency documented hemostasis after transradial catheterization.” Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions vol. 72,3 (2008): 335-340. doi:10.1002/ccd.21639
• 15. Qin, Zheng et al. “Different Antiplatelet Strategies for Radial Artery Protection After Transradial Coronary Angiography-A Prospective Observational Cohort Study.” Frontiers in cardiovascular medicine vol. 9 913008. 14 Jun. 2022, doi:10.3389/fcvm.2022.913008
• 16. Mason, Peter J et al. “An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association.” Circulation. Cardiovascular interventions vol. 11,9 (2018): e000035. doi:10.1161/HCV.0000000000000035
• 17. Patel, Keshav et al. “Intra-arterial nicardipine versus verapamil during transradial access coronary catheterization.” Cardiovascular revascularization medicine : including molecular interventions, S1553-8389(24)00632-8. 20 Aug. 2024, doi:10.1016/j.carrev.2024.08.008
• 18. Riangwiwat, Tanawan, and James C Blankenship. “Vascular Complications of Transradial Access for Cardiac Catheterization.” US cardiology vol. 15 e04. 8 Mar. 2021, doi:10.15420/usc.2020.23
• 19. Mann, T et al. “Stenting in acute coronary syndromes: a comparison of radial versus femoral access sites.” Journal of the American College of Cardiology vol. 32,3 (1998): 572-6. doi:10.1016/s0735-1097(98)00288-5
• 20. Bigler, Marius R et al. “Association of Palmar Arch Collateral Function and Radial Artery Occlusion After Transradial Access.” The American journal of cardiology vol. 168 (2022): 151-158. doi:10.1016/j.amjcard.2021.12.020
• 21. Hobby, Shawn, et al. "Transradial access: a comprehensive review." Vascular & Endovascular Review 2021;4:e02.; DOI: https://doi.org/10.15420/ver.2020.17
• 22. Ferrante, Giuseppe et al. “Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials.” JACC. Cardiovascular interventions vol. 9,14 (2016): 1419-34. doi:10.1016/j.jcin.2016.04.014