Radial access during percutaneous interventions in patients with acute coronary syndromes: should we routinely monitor radial artery patency by ultrasonography promptly after the procedure and in long-term observation?

摘要

Access-site vascular complications in patients undergoing transradial coronary procedures are rare but may have relevant clinical consequences. The aim of the study was to evaluate: (1) radial artery’s (RA) patency immediately after the procedure and in long-term observation, (2) factors influencing the frequency of radial artery’s occlusion (RAO) after percutaneous coronary intervention (PCI) procedures performed via transradial access in the group of 220 patients with acute coronary syndromes (ACS). RA ultrasound was performed 48–72 h after the procedure and in those who were diagnosed with RAO-again after 6–12 months. According to the ultrasonographic findings, the patients were divided into two sub-groups: 187 pts (85 %) with patent RA after PCI and 33 pts (15 %) with RAO. Both sub-groups significantly statistically differed with regard to the frequency of local hematomas—15 versus 27.3 % (p = 0.02), the frequency of applying IIbIIIa inhibitors in PCI—6.4 versus 15.1 % (p = 0.015) and procedure duration—0.59 ± 0.37 versus 0.77 ± 0.38 (p = 0.014), respectively. In a multifactorial analysis the only factor influencing RA patency promptly after the procedure was PCI duration (p < 0.05, r = −0.22). In the follow-up, right RA remained still obstructed in 28 patients (12.7 %) whereas in five patients (2.3 %) the regular flow in RA was resumed. The chronic RAO was clinically silent. Due to insignificant frequency of the occurrence of RAO after PCI procedure in patients with ACS as well as practically lack of clinical consequences of this artery’s occlusion in long-term observation, we do not see any implications to routine ultrasound periprocedural RA evaluation.