Symptomatic acute radial artery occlusion

1. SYMPTOMATIC ACUTE
RADIAL ARTERY OCCLUSION
Olivier F. Bertrand, MD, PhD
Associate-Professor of Medicine, Laval University
Adjunct-Professor, Department of Mechanical Engineering, McGill University
International Chair on Interventional Cardiology andTransradial Approach
Quebec Heart-Lung Institute
NYCTRAC-June 29, 2013

2. DISCLOSURES
• Consultant: OPSENS

3. Fujii et aL. J Inv Cardiol 2010;22:536-40
UPPER LIMBVASCULARIZATION

4. Courtesy ofT Mann

5. INCIDENCE OF RAO

6. 0
5
10
15
20
0 90 180 270 360
RAO(%)
Days
Bracelet- typeBandage
TR Band

7. HEMOSTASISTECHNIQUES
BERTRAND ET AL. JACC INTV 2010;3:1022-31

8. RAO PATHOPHYSIOLOGY
• Acute thrombosis favored by vessel trauma
and flow reduction during procedure ±
inadequate anticoagulation... (minutes!)
• Clot formation favored by occlusive
hemostasis...(Hours)
• Persisting occlusion leads to organizing
thrombus, then late chronic fibrotic
occlusion...(Days-weeks)

9. RADIAL ARTERY OCCLUSION
Adapted from S Pancholy

10. ‘ACUTE’ RAOTHERAPY
1- Follow radial artery patency every 15 min, 2- If
plethysmography signal indicates RAO, compress UA for 1 h
Bernat I et al. Am J Cardiol 2011;107:1698-1701

11. ‘PHARMACOLOGIC” RX OF RAO

12. CASE STORY
• 38 y old man
• Initial primary PCI on LAD
• Referred 1 week later for staged RCA PCI
• Both PCI through right radial approach
• Low final ACT and no patent hemostasis achievable, repeat
heparin bolus
• Asymptomatic RAO diagnosed at SD hospital discharge, attempt
of overnight UA compression + LMWH for 1 week
• Symptoms ++ 1 week later and RAO confirmed by US

18. POST RAO RECANALIZATION

19. 1 WEEK LATER