Abstract

Background: Transradial approach for percutaneous coronary procedures has the advantage of reduced access site complications but is associated with specific technical challenges when compared to transfemoral approach. Transradial procedure failures can sometimes be due to variation in radial artery anatomy. However, there are limited data describing such variations.

Objective: To evaluate the frequency and impact of radial artery anomalies in patients undergoing transradial coronary procedures.

Methods: Retrograde radial arteriography was performed in all patients presenting for a first-time radial procedure. Patient characteristics, radial artery anatomy and procedural outcome were assessed.

Results: 1540 consecutive patients were studied, 70.6% male, aged 63.6±11.1 years. The overall frequency of radial artery anomaly was 13.8% (n=212). 7.0% of patients had a high-bifurcating radial origin, 2.3 % had a full radial loop, 2.0% had extreme radial artery tortuosity and 2.5% had miscellaneous anomalies such as radial atherosclerosis and accessory branches. Overall transradial procedural success was 96.8%. Procedural failure was more common in patients with anomalous anatomy than patients with normal anatomy (14.2% versus 0.9%, p<0.0001). Procedural failure in patients with high radial bifurcation, radial loop, severe radial tortuosity and other anomalies were 4.6%, 37.1%, 23.3% and 12.9% respectively. There were 15 (1%) vascular complications, all of which were treated conservatively without ischaemic sequelae.

Conclusion: Anomalous radial artery anatomy is relatively common and is a significant cause of procedural failure. Furthermore, within each specific anomalous pattern there is a differential procedural failure rate. This has implications for clinical practice and suggests a need for imaging of radial artery after sheath insertion.