Radial artery thrombosis in optical coherence tomography guided transradial coronary angiography and percutaneous coronary intervention in acute coronary syndrome patients and its risk factors analysis / 中华心血管病杂志

ABSTRACT

Objective: To observe the radial artery thrombosis (RAT) during transradial coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) by optical coherence tomography (OCT), and to investigate the risk factors of RAT during the CAG and/or PCI. Methods: In this retrospective study, we consecutively reviewed the radial artery OCT examination results of the patients who underwent OCT guided transradial CAG and/or PCI for acute coronary syndrome in heart center of Beijing Luhe hospital, Capital Medical University from October 2017 to July 2018. The incidence of RAT was observed. The patients were divided into the RAT group and non-RAT group, clinical data were collected and compared. Moreover, the types and distributions of thrombus in radial artery as well as the acute radial artery injuries under OCT were observed. Univariate analysis followed by multivariate analysis were performed to identify potential risk factors. The radial artery patency and ischemic symptoms of the involved limb were followed up at the 24-hour and the 1-month after procedure. Results: A total of 107 patients were included, the age was (58.1±12.5), and 78.5% were male (n=84). The incidence of RAT was 26.2% (n=28, 95%CI 17.9%-34.5%), and the main type of thrombus was white thrombus (n=15, 53.6%). The commonest position of RAT was the proximal portion of radial artery (n=17, 60.7%). The median thrombus volume was 0.05(0.03, 0.38) mm3, and the median thrombus score was 6.5 (3.3, 13.8). In univariate analysis, the frequency of acute radial artery injury and use of bivalirudin were significantly higher and the procedure time was significantly longer in RAT group than those in non-RAT group (all P<0.05). Multivariate regression analysis showed that the radial artery acute injury (OR=5.82, 95%CI 2.09-16.20, P=0.001) and the procedure time (OR=1.04, 95%CI 1.01-1.06, P=0.006) were independent risk factors of RAT. Rate of radial artery occlusion at 24 hours follow-up was similar between RAT and non-RAT group (7.14%(2/28), vs. 10.13%(8/79), P=1.000). None of the patients complicated severe ischemic symptom of the operative limb. Conclusions: RAT is a high frequency access complication during transradial coronary intervention. This phenomenon can be accurately observed by OCT. Acute radial artery injury and prolonged procedure time are risk factors of RAT during transradial coronary intervention.