Successive transradial access for coronary procedures: experience of Quebec Heart-Lung Institute.

Background Transradial approach (TRA) for cardiac catheterizations and interventions improves clinical outcomes compared with transfemoral access, and its use is increasing worldwide. However, there are limited data on successive use of same artery for repeat procedures. Methods Between May 2010 and May 2011, all consecutive patients undergoing a repeat TRA procedure (>= 2) were retrospectively identified. Success rates and reasons for failure to use ipsilateral radial artery for repeat access were identified. Results A total of 519 patients underwent 1,420 procedures. In 480 patients (92%), right radial artery was used as initial access, and left radial artery, in 39 patients. All patients underwent >= 2 procedures; 218 patients, >= 3; 87 patients, >= 4; 39 patients, >= 5; 19 patients, >= 6; 11 patients, >= 7; and 5 patients, >= 8 procedures. Two patients had, respectively, 9 and 10 procedures. The success rate for second attempt was 93%, 81% for third, and declining to 60% for >= 8. Linear regression analysis estimated a 5% failure rate for each repeat attempt (R-2 = 0.87, P = .007). The main reason for failure was related to clinical radial artery occlusion (RAO) including absent or faint pulse, poor oximetry, and failed puncture. All patients with clinical RAO were asymptomatic. By multivariate analysis, female gender (odds ratio [OR] 3.08, 95% CI 1.78-5.39, P < .0001), prior coronary artery bypass graft (OR 5.26, 95% CI 2.67-10.42, P < .0001), and repeat radial access (OR 2.14, 95% CI 1.70-2.76, P < .0001) were independent predictors of radial access failure. Conclusion Successive TRA is both feasible and safe in most cases for up to 10 procedures. However, failure rate for TRA increases with successive procedures, primarily due to clinical RAO. Strategies to minimize the risks of chronic clinical RAO and allow repeat use of ipsilateral radial artery need to be further defined. (Am Heart J 2013;165:325-31.)