This document describes a novel technique for recanalizing the radial artery after late occlusion. The technique involves puncturing the deep palmar arterial arch as a distal entry point for retrograde recanalization of the radial artery. The technique was attempted in 22 patients with late radial artery occlusion, with a success rate of 90.1%. Only one complication occurred, a perforation of the radial artery. Preliminary results suggest the deep palmar arch provides good access for recanalization when the radial artery forearm segment is totally occluded or the stump is short. However, a learning curve is required to reliably use this new entry point.

1. NOVEL TECHNIQUE OF RETROGRADE
RECANALIZATION OF RADIAL ARTERY LATE
OCCLUSION
Avtandil M. Babunashvili
Center of Endosurgery, Moscow, Russia

2. Disclosure: Avtandil M. Babunashvili, MD
I have no conflict of interests to disclose

3. 5.6
17.4
29.5
36.9
52.9
64.1
10.1
22.9
32.5
41.2
45.1
53
0
20
40
60
80
2010 2011 2012 2013 2014 2015
Interventions
Diagnostic angio
TRI in Russian Federation 2010-2014
RAO: Is it a real problem ?

4. RAO: Is it a real problem ?
For patients – may be not . . . Clinically asymptomatic, no change QOL
For Interventionalists – Yes, because …
 sometime we need repeat access (multistage
PCI or repeat PCI or control angio)
 procedures requiring two access site (eg, CTO
recanalization)
 PCI in case of severe aorto-iliac disease
(occlusion or aorto-bifemoral grafting)

5. How often we need in repeat (multistage) interventions?
0
1600
2012 2013 2014
all TRI repeat TRI RAO
22,4%
6,6%
23,9%
5,0%
23,7%
7,6%

6. Long stump
Short stump
Mechanism of distal postocclusion RA puncture

7. Long stump (>20mm)
angiographic predictor
of procedure success
Short stump (<10mm) -
predictor of procedure
failure/complication

13. Previous
puncture

14. Same as used for CTO coronary
or tibial arteries
(Fielder, Miracle series etc)
Instruments
Wire strategy
Recanalization technique
Final lumen formation
● escalation
● penetration
● True lumen
● Subintimal and reentry
● Hydrodynamic
recanalization
● “Dotter” technique
● Balloon angioplasty
● Mixed
RAO recanalization

17. PRELIMINARY RESULTS (n= 22)
age 59,3 ± 8,5
diabetes 18,2%
Occlusion length, cm 14,2 ± 4,3
Days after previous TRI (mean) 766,1 (7 days 7 years)
Duration, min / % from TRI 28,3 ± 1,2 /(mean 51,1%)
Dose / % from TRI 124,7 ± 111,2 µGy/m2 /(mean 2,5%)
success 20 (90,1%)
complication 1 (4,5%) – RA perforation
Recanalization technique
Dotter type 10
Balloon dilation 14
Subintimal and
reentry
3
TRI type
diagnostic 14
PCI 8

18. RA PERFORATION

19. Collateral channel as a bridge from distal postocclusion segment of RA
to another major forearm arteries
Interossea - as an access artery in case of RAO recanalization failure
Collateral circulation in case of RAO
82 y.o. woman, previous TRI 2 months later

20. Interossea - as an access artery in case of RAO recanalization failure

21. Interossea - as an access artery in case of RAO recanalization failure

22.  We used novel entry point in 22 patients with late or subacute
RAO
 In 20 (90,1%) cases retrograde recanalization was successful
 In 1 case failure was occurred despite of correct puncture of
deep palmar arch
 No major hematomas or ischemic complications of the wrist
were detected.
PRELIMINARY RESULTS

23. CONCLUSIONS
1. New distal entry point of RA (Deep palmar arterial arch) provides good
conditions for RAO recanalization in case of total occlusion of forearm
part of RA or its short stump
2. Learning curve is needed for reliable and effective use of this novel entry
point.