Analysis Of Risk Factors Associated With Radial Artery Occlusion After Transradial Coronary Intervention

Objective: The purpose of this study was to investigate the risk factors of radial artery occlusion(RAO)after transradial coronary intervention.With the improvement of living conditions,the incidence of coronary heart disease in China is increasing year by year.Coronary angiography(CAG)and Percutaneous Coronary intervention(PCI)are indispensable in the diagnosis and treatment of Coronary heart disease.Compared with the femoral artery approach,the transradial approach has the advantages of less trauma,faster recovery and fewer complications.It has been recommended by many guidelines and widely used in clinic.With the improvement of interventional level,the interventional treatment of acute myocardial infarction can be completed through radial artery,and the left main lesion,bifurcation lesion,complete occlusion and other more difficult interventional treatment.It has been reported that RAO is less likely to occur via the radial artery route,and the probability of thrombotic occlusion is about 1-10%.RAO does not cause severe blood supply insufficiency in the hand,but it may prevent re-intervention via the radial artery and may make it difficult for the patient to undergo coronary artery bypass grafting or hemodialysis.Therefore,it is of great clinical significance to explore the Rao related factors in order to prevent the occurrence of RAO.Method:From August 2019 to February 2021 in Northern Jiangsu people’s Hospital,447 patients were selected according to the inclusion criteria and exclusion criteria,including 336 males and 111 females.The patients were divided into occlusive group(n = 24)and non occlusive group(n = 423)according to whether the radial artery had forward blood flow.SPSS 25.0 software was used to analyze the baseline data and related surgical data between the two groups to screen out the related risk factors.According to the dosage of heparin,the patients were divided into low dosage(3000u)and high dosage(> 3000u),and the effect of heparin dosage on radial artery occlusion was compared.Result:1.According to multivariate regression analysis,the risk factors of Rao were screened out.Age(or = 1.05,95% CI: 1.007-1.095,P = 0.024)doubled the risk of Rao for every 20 years.For patients with previous puncture history(or = 4.888,95%CI: 1.892-12.63,P = 0.001),the risk of Rao increased by 3.888 times.Patients with sheath diameter / artery diameter > 1(or = 3.17,95% CI: 1.092-9.205,P = 0.034)had a 2.17-fold increased risk of Rao;patients with compression time(or = 1.23,95% CI:1.063-1.422,P = 0.005)had a 0.46-fold increased risk of Rao every 2 hours.2.Among the 287 patients using heparin alone,there were 8 patients(9.2%)with low-dose heparin and 5 patients(2.5%)with high-dose heparin in the radial artery occlusion group compared with the non occlusion group(P = 0.012).The proportion of occlusive patients with low-dose heparin is higher than that with high-dose heparin,which indicates that high-dose heparin has protective effect.Conclusion:1.Age,previous puncture history,sheath diameter / artery diameter > 1,compression time were related risk factors of radial artery occlusion.Using ultrasound measurement before operation and selecting small-size sheath or thin-walled sheath according to the specific situation may further reduce the damage to radial artery.On the premise of using the same compressor,adjusting the additional pressure of the compressor according to different patients and shortening the compression time as much as possible can reduce the risk of thrombosis.2.Compared with CAG alone,high dose heparin used in PCI has protective effect on radial artery occlusion.