Minimising radial injury: prevention is better than cure
Selected in EuroIntervention Journal by S. Brugaletta
Mamas MA, Fraser DG, Ratib K, Fath-Ordoubadi F, El-Omar M, Nolan J, Neyses L.
EuroIntervention. 2014 Nov 20;10(7):824-32
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What is known
Transradial (TR) coronary intervention is associated with fewer access-site-related bleeding complications and is independently associated with a lower risk of mortality following PCI compared to procedures under-taken through the femoral route. However, recent studies that have undertaken imaging of the radial artery through the use of IVUS and OCT, as well as histological studies, suggest that TR cardiac catheterisation is associated with significant injury to the radial artery wall resulting in significant endothelial cell dysfunction. Hence, trauma to the vascular endothelium and subsequent changes in endothelial cell function may contribute to patterns of injury such as intimal hyperplasia and radial artery occlusion observed following TR cardiac catheterisation. Such injury patterns to the radial artery following TR procedures may limit the success and future utility of the TR approach. The purpose of this review is to provide an overview of recent studies which suggest that both occlusive and non-occlusive radial injury following TR cardiac catheterisation are significant and to discuss potential pathophysiological mechanisms that contribute to these processes and eventually procedural and pharmacological strategies which minimise radial injury during TR cardiac catheterisation.
Radial artery injuries following transradial cardiac catheterisation may be classified in this way:
- Non-occlusive injury
> Endothelial dysfunction
> Loss of flow-mediated dilatation
- Occlusive injury
Correct anticoagulation, patent haemostasis, smaller diameter guide catheter, sheath-less guides, minimise catheter exchange and spasm help to minimise radial injury during TR cardiac catheterisation.
This reviewed article is the first one, which tries to make order into radial injuries after cardiac catheterisation, providing a very nice classification of them. In an interventional cardiology era characterised by an increasing interest in radial approach, it is important to keep in mind that this approach may have its own complications, and that everyone should know how to minimise and prevent them.