Transradial access is the current recommended approach for coronary angiography and percutaneous coronary intervention (PCI). This is due to a lower rate of major complications following transradial access as compared to transfemoral access. The most common complications associated with transradial access are: radial artery spasm, radial artery occlusion, and radial artery perforations. This review article discusses prevention and management of these complications.
Radial artery spasm
Radial artery spasm is the most frequent intraprocedural adverse event associated with transradial access and may have an incidence as high as 20%. Preventive measures include routine moderate sedation and analgesia, avoidance of repeated puncture attempts, insertion of a hydrophilic sheath following the transradial access, and the administration of prophylactic antispasmolytic therapy of nitroglycerin following sheath insertion (if nitroglycerin has not already been given.) Treatment ranges from sedation, analgesia and antispasmolytic therapy to an algorithmic escalated approach.
Radial artery occlusion
Radial artery occlusion is the most frequent postprocedural adverse event associated with transradial access and its incidence ranges from <1-33%. It often goes unnoticed because most patients are asymptomatic; however, it is important to preserve patency for potential future interventions. Preventive measures include minimizing number of punctures, avoidance of spasm, use of small sheaths/catheters, adequate anticoagulation, patent hemostasis, and ulnar compression. Treatment consists of anticoagulant therapy and percutaneous revascularization.
Radial artery perforations
Perforations are rare (<1%) but can cause serious bleeding, resulting in compartment syndrome. They tend to occur in patients with tortuous or anomalous arteries. Preventive measures include angiography and use of alternative arterial access. Perforations must be sealed.
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Author: Kelly Schoonderwoerd
Original Article: Circ Cardiovasc Interv. 2019;12: pp.1-14.