19. Radial artery ultrasound predicts the success of transradial coronary angiography

Abstract

Smaller radial artery diameter, CSA, and perimeter is associated with higher vascular access complications during coronary angiography. The transradial approach has become the preferred vascular access during conventional coronary angiography (CCA). A small mean radial artery diameter (RAD), however, may lead to higher rates of vascular access complications (VAC). To date, there are no data regarding the effect of the radial artery cross-sectional area (CSA) and perimeter. We evaluated the impact of preprocedure radial artery diameters, the CSA, and the perimeter on vascular complications. We conducted a single-center prospective analysis of 513 patients who underwent CCA. Radial artery ultrasonography was performed before and after CCA to measure the RAD, CSA, and perimeter.The average RAD, CSA, and perimeter were 2.60 ± 0.48 mm, 6.2 ± 3.0 mm2, and 8.9 ± 1.7 mm, respectively. The same measurements were significantly larger in men than in women: 2.8 ± 0.5 vs. 2.4 ± 0.4 mm (P < 0.0001), 6.6 ± 3.4 vs. 5.3 ± 1.5 mm (P < 0.0001), and 9.3 ± 1.7 vs. 8.2 ± 1.5 mm (P< 0.0001), respectively. In all, 56 patients (11%) had VACs. The RAD, CSA, and perimeter were significantly smaller in patients whose procedures had VACs than in those with no complications: 2.3 ± 0.5 vs. 2.70 ± 0.54 mm (P = 0.0001), 4.9 ± 2.1 vs. 6.4 ± 3 mm2 (P = 0.001), and 7.6 ± 2.1 vs. 9.2 ± 1.6 mm (P = 0.0001), respectively. Univariate logistic regression showed that radial ultrasonographic parameters can independently predict VACs as follows: odds ratio (OR) 1.2, 95% CI 1.12–1.28 (P < 0.0001) for RAD; OR 1.55. 95% CI 1.29–1.84, (P < 0.0001) for CSA; OR 1.83, 95% CI 1.5–2.46 (P < 0.0001) for the perimeter.Ultrasonographic study of the radial artery before CCA can provide important information regarding vascular access. We found that a small radial diameter, CSA, and perimeter are associated with higher VAC rates.