Background Compare with transfemoral percutaneous coronary intervention, the access site complication is less with transradial percutaneous coronary intervention (TRI). The acute radial artery occlusion (Acute RAO) is the most common complication following TRI. Although the incidence of acute RAO is less (0∼10%) and acute RAO couldn't induce upper-extremity ischaemia with positive Allen test patients, it makes re-TRI procedures impossible. To elucidate the risk factors of acute RAO is the best way to prevent it occurring.

Methods A total of 1256 positive Allen test patients (≥60 years old) who underwent TRI (during May, 2004 to May, 2009) were divided into two groups: normal group and RAO group, according to whether the patient without or with acute RAO. Risk factors of acute RAO were analysed by logistic regression model.

Results Acute RAO occurred in 28 patients (2.2%). Univariate analysis showed, the smaller size of sheath used, the higher incidence of acute RAO occurred. As compared to the patients in normal group, there are more female and diabetes mellitus patients in RAO group. The dose of heparin used in the operational procedure in RAO group were significantly less than normal group (3826±523 IU vs 7425±980 IU, p< 0.01). The post-procedure duration of high-pressure compression haemostasis were longer in RAO group than normal group (378.9±35.4 min vs 264.7±43.2 min, p=0.03). Logistic regression analyses showed that the dosage of heparin used in the procedure (RR: 2.812, 95% CI 1.116 to 6.732, p=0.016), the size of sheath (risk tatio: 4.978, 95% CI 3.211 to 10.675, p=0.001) and the post-procedure compression time (RR: 2.431, 95% CI 1.389 to 5.010, p=0.034) were independent risk factors for acute RAO.

Conclusion The incidence of acute RAO can be minimised by proper sheath selection, appropriate anticoagulation used during operational procedure, and avoiding prolonged duration of high-pressure compression haemostasis following the procedure.