Challenges in Coronary Angiography Through Radial Artery Access due to Anatomic Variations: A Single-Center Experience
Abstract Body (Do not enter title and authors here): Background Radial artery (RA) access has become common in cardiac catheterization due to fewer vascular complications and MACE compared to transfemoral approach (TFA). However, anatomic variations are more profound in the upper-extremity.
Research Question What are common anatomic variations encountered during transradial approach (TRA) coronary angiography and what association do they have with adverse outcomes and procedural challenges?
Methods We performed a single-center retrospective analysis of 926 patients who underwent coronary angiography through TRA via the right upper-extremity where RA angiogram was performed from 01/2010 to 01/2023. Multivariate logistic regression was utilized to estimate the odds ratio (OR) of the association between anatomic variations and adverse outcomes and procedural challenges.
Results A total of 926 patients with a mean age of 59.9 years were studied with 30.4% being female. Common comorbidities were HTN (82.2%), HLD (51.8%), and DM (45%). About 32% of patients had an anatomic variation. Prevalences were 14.4% radial tortuosity, 12% high RA bifurcation, 11.9% M-sign, and 1% RA loops. These patients were older (P<0.001) and more likely to have HLD (P=0.049). They had high odds of high contrast dose (OR 1.73; 95% CI 1.28-2.34, P<0.001), long fluoroscopy time (OR 2.02; 95% CI 1.50-2.73, P<0.001), high radiation exposure (OR 2.47; 95% CI 1.79-3.42, P<0.001), difficulty engaging coronary arteries (OR 2.70; 95% CI 1.94-3.74, P<0.001), and transfer to TFA (OR 4.89; 95% CI 2.36-10.12, P<0.001). Females (OR 2.89; 95% CI 2.01-4.15, P<0.001), small RA size (OR 2.61; 95% CI 1.76-3.86, P<0.001), high RA bifurcation (OR 1.68; 95% CI 1.02-2.75, P=0.04), and M-sign (OR 2.04; 95% CI 1.24-3.35, P=0.005) were associated with RA spasm. Major complications were not significant.
Conclusion We found a high prevalence of anatomic variations. They were associated with high odds of adverse outcomes and procedural challenges during TRA coronary angiography.
Harmouch, Wissam
( University of Texas Medical Branch
, Galveston
, Texas
, United States
)
Khalife, Wissam
( University of Texas Medical Branch
, Galveston
, Texas
, United States
)
Villarreal Rizzo, Alan
( Mayo Clinic School of Graduate Medical Education
, Rochester
, Minnesota
, United States
)
Thakker, Ravi
( University of Texas Medical Branch
, Galveston
, Texas
, United States
)
Abdurrahman, Selma
( Houston Methodist
, Houston
, Texas
, United States
)
Patel, Vishal
( University of Texas Medical Branch
, Galveston
, Texas
, United States
)
Kumar, Neha
( University of Texas Medical Branch
, Galveston
, Texas
, United States
)
Farooqui, Salman
( University of Texas Medical Branch
, Galveston
, Texas
, United States
)
El Haddad, Danielle
( University of Texas Medical Branch
, Galveston
, Texas
, United States
)
Gilani, Syed
( University of Texas Medical Branch
, Galveston
, Texas
, United States
)
Author Disclosures:
Wissam Harmouch:DO NOT have relevant financial relationships
| Wissam Khalife:DO NOT have relevant financial relationships
| Alan Villarreal Rizzo:No Answer
| Ravi Thakker:DO NOT have relevant financial relationships
| Selma Abdurrahman:No Answer
| Vishal Patel:No Answer
| Neha Kumar:No Answer
| Salman Farooqui:DO NOT have relevant financial relationships
| Danielle El Haddad:No Answer
| Syed Gilani:No Answer
