Treatment of radial artery occlusion after transradial coronary catheterization: a review of the literature and proposed treatment algorithm.

Abstract

Transradial artery access (TRA) has been established as the default access site for most coronary catheterization procedures with fewer access-related and bleeding complications, rapid hemostasis, early ambulation of the patient and reduction in all-cause mortality compared with transfemoral access. However, radial artery occlusion (RAO) remains the most frequent complication of TRA coronary catheterization procedures. The purpose of our review was to conduct detailed literature research and summarize all the available treatment strategies for RAO, given the lack of a standardized treatment protocol in the literature. Pharmacological treatment with low-molecular-weight-heparin (LMWH) or other anticoagulant, invasive strategies and pharmaco-invasive methods available in the literature were included in our review. Data was derived from case series, case reports, clinical trials and observational studies. Eight studies regarding pharmacological treatment with LMWH or any other anticoagulant and 7 studies of invasive treatment were included in our review. There are only two randomized studies one with LMWH (tinzaparin) and one with apixaban. Furthermore, taking into consideration data derived from the above-mentioned studies a treatment algorithm for RAO was proposed. RAO remains the most frequent complication of coronary procedures with transradial access. Application of preventive strategies and good knowledge of the risk factors remain the key factor for reduction of the incidence of this clinical entity. Therapeutic options include anticoagulation regimens and interventional techniques through the distal radial artery. Large, randomized, multicenter studies should be conducted to evaluate the efficacy of the available treatment methods and define a standardized treatment protocol for RAO.