This document discusses the prevention and treatment of radial artery occlusion (RAO) following transradial procedures. It addresses: - The scope of the RAO problem and methods for prevention, including anticoagulation regimens, maintaining a small catheter to artery ratio, and use of hemostasis devices and techniques. - Treatment options, including pharmacological therapies like antiplatelets and thrombolytics as well as non-pharmacological approaches such as compression and assisted ulnar artery compression. - The importance of patent hemostasis, early detection of RAO, and early intervention for successful recanalization.

1. Radial Artery Occlusion:
Prevention and Treatment
Olivier F. Bertrand, MD, PhD
Associate-Professor of Medicine, Laval University
Adjunct-Professor, Department of Mechanical Engineering, McGill University
Quebec Heart-Lung Institute
RITA PRAGUE, SEPTEMBER 2011
Friday, September 30, 2011

2. Plan
Scope of the problem
Prevention
Anticoagulation (agent, dose, route)
catheter/artery ratio
Hemostasis devices and technique
Treatment
Pharmacological
Non-Pharmacological
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3. Upper Limb Vascularization
FUJII ET AL. J INV CARDIOL 2010;22:536-40
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4. Radial Artery Occlusion
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5. WHICH TEST PRIOR TRA ?
BERTRAND OF ET AL. JACC INTV 2010;3:1022-31
Friday, September 30, 2011

6. TO PREVENT RADIAL OCCLUSION, HEPARIN ?
BERTRAND OF ET AL. JACC INTV 2010;3:1022-31
Friday, September 30, 2011

7. WHICH METHOD TO ASSESS RAO ?
BERTRAND OF ET AL. JACC INTV 2010;3:1022-31
Friday, September 30, 2011

8. Radial Artery Occlusion
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9. Radial Artery Occlusion
Comp Device TR/Raco All Enreg. (All)
20
15
RAO (%)
10
Bracelet- type
Bandage
TR Band
5
0
0 90 180 270 360
Days
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10. Hemostasis Techniques
BERTRAND OF ET AL. JACC INTV 2010;3:1022-31
Friday, September 30, 2011

11. Hemostasis Devices
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12. RAO: Anticoagulation Agent
PCI ANGIO N = 400
CCI 2010;76:654-8
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13. RAO Prevention: IV or IA?
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14. Friday, September 30, 2011

15. RAO Prevention: PROPHET I
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16. “Patent Hemostasis” Protocol
ADAPTED FROM S. PANCHOLY
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17. “Patent Hemostasis” Protocol
ADAPTED FROM S. PANCHOLY
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18. “Patent Hemostasis” Protocol
ADAPTED FROM S. PANCHOLY
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19. 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)
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20. Radial Artery Occlusion
ACUTE CHRONIC
ADAPTED FROM S. PANCHOLY
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21. “Acute” RAO Therapy
1) VERIFY RADIAL ARTERY PATENCY POST-HEMOSTASIS
2) IF RAO, 1-HOUR ULNAR COMPRESSION
BERNAT I ET AL. AM J CARDIOL 2011;107:1698-1701
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22. “Pharmacological” RAO Therapy
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23. Retrograde Recanalization
MALE, 38 Y
RAO POST STAGED RCA PCI
FAILED ULNAR COMPR.
FAILED LMWH
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24. Retrograde Recanalization
MALE, 38 Y
RAO POST STAGED RCA PCI
FAILED ULNAR COMPR.
FAILED LMWH
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25. Retrograde Recanalization
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26. Retrograde Recanalization
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27. Patent Hemostasis with Assisted Ulnar Occlusion
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28. Post Retrograde Recanalization
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29. 1 Week Post-Recanalization
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30. Conclusion
Prevention of RAO is part of optimal TRA care
Best preventive methods = anticoagulation,
small catheters (C/A ratio!), controlled “active”
hemostasis
Distal ischemia can be due to emboli >> RAO
Early intervention probably provides best
chance of success
Other therapies to be tested: Rx ultrasound,
direct thrombin inhibitor, ...
Friday, September 30, 2011