The Radial Artery Occlusion Paradox: The Larger-Bore Sheath via the Thinner Distal Radial Artery for Coronary Interventional Procedures.

BACKGROUND

The incidence of postoperative complications resulting from radial artery occlusion (RAO) via transradial access (TRA) is relatively high in patients who require percutaneous coronary procedure, especially when complex coronary intervention requires a larger-bore sheath (≥ 7-F). In theory, there should be more RAO following the insertion of a larger-bore sheath via the thinner distal radial artery (dRA) if this artery is chosen as the access for the intervention. Few studies have used 7-F sheaths via distal TRA (dTRA).

AIMS: This study aimed to evaluate the association between the use of a 7-F thin-walled sheath via dTRA and the risk of early (within 24 h) RAO.

METHODS

A total of 705 patients who underwent distal transradial catheterization using a thin-walled 7-F sheath were enrolled. The primary endpoint was the rate of early RAO, which was evaluated by Doppler ultrasound within 24 h after the operation.

RESULTS

Early RAO occurred in 27 cases (3.8%). Multivariate logistic regression analysis revealed that a dRA inner diameter/sheath outer diameter ratio (artery-to-sheath ratio, ASR) < 0.75 (p = 0.035), a body mass index (BMI) < 18.5 kg/m2 (p = 0.042) and diabetes (p = 0.031) were independent risk factors for the development of early RAO. Receiver operating characteristic (ROC) curve analysis of the ASR for predicting RAO yielded an optimal cutoff of 0.648 (sensitivity 81.8%, specificity 83.0%).

CONCLUSION

According to our study, although the inner diameter of dRA was smaller than that of the RA, the incidence of early RAO after the use of a 7-F thin-walled sheath for dRA was relatively low.

CLINICAL TRIAL REGISTRATION: As an observational cohort, this study was not prospectively registered in a clinical trial registry.