Radial artery occlusion (RAO) is an unresolved complication after radialartery (RA) puncture. Coronarycatheterization (CC) via transradial access (TRA) can reduce the complicationsrelated to the approach site and improve the comfort of early walking for patients . The latest ESC guidelines recommend it as the standard method of CC .However, TRA also has some complications, such as haematoma, arteriovenousfistula, pseudoaneurysm, osteofascial compartment syndrome, and radial arteryocclusion (RAO) . Of these, RAO is a complication that has not been well resolved . The incidence of RAO is reported to be between 1% and 10% . Inaddition, the failure rates of a second puncture and intubation using the sameradial artery (RA) are 3.5% (male) and 7.9%.

Theobservational study was conducted at Fuwai Hospital from June 2021 to March2022. The patients who had undergone Coronarycatheterization using TRA were routinely examined for RAObefore puncture. If the RA pulsation could not be felt but the distal RA pulsationwas good, puncture of the distal RA was attempted first. Finally, 28 patientswho had a successful puncture of the distal RA at the anatomical snuffbox andconfirmed RAO by angiography were included in the study. Patients or the public werenot involved in the design, orconduct, or reporting, or dissemination plans of our research.Beforepuncture, the patient formed a fist to fully expose the snuffbox area, which aidsin feeling the distal RA pulse and choosing the site with the strongest pulsefor puncture .Local anaesthesia with 2%lidocaine was administered in the snuffbox area, and the distal RA waspunctured with a steel needle or trocar at an angle of approximately 30-45degrees. After observing the blood return, a 5 ml syringe was usedto perform angiography to confirm RAO. Then, a percutaneous coronaryintervention (PCI) guide wire was used to attempt to pass through the occludedsegment of the RA. When the guide wire successfully passed through the RA tothe brachial artery or subclavian artery, the puncture needle was withdrawn,and the balloon was positioned to expand at the occluded segment of the RA.Radial arteriography was performed again to determine whether the RA was open,and according to the stenosis of the RA, balloons of different sizes wereselected to expand until the blood flow recovered satisfactorily. Then, thehalf sheath was positioned at the styloid process of the radius (Figure 3).After the resumption of blood flow, we injected 3000 U heparin via the sheathand then inserted a 5 Fr Terumo TIG diagnostic catheter to perform coronaryangiography (CAG). For PCI, the sheath was changed to a 6 Fr over the PCI guidewire.

Twenty-sevenpatients were punctured through the right distal RA, and 1 patient waspunctured through the left distal RA. The average number of attempts was 1.6 ± 0.8, and the average puncture time was 4.6 ± 3.4 minutes. Twenty-two patients required oneguidewire, 6 patients required two guidewires, and 1 patient required threeguidewires to try to pass through the occluded RA. Among them, 27 patients’guidewires successfully passed through the occluded RA to the brachial arteryor the subclavian artery. One balloon was used in 12 patients, two balloonswere used in 13 patients, and three balloons were used in 2 patients to dilatethe occluded segment of the RA. The recanalization rate of the occluded RA was96.4% (27/28).

Inour study, only 1 patient had forearm haematoma after theprocedure,andno other complications, such as haemorrhage or nerve disorders,were observed. Therefore,dTRA is a safe technique for therecanalization of RAO.Thegreatest significance of this study is to try to resolve RAO throughthedTRA technique. Recanalization ofthe RA is extremely important for the majority of patients who need CAG and PCIand provides a better choice for patients who need RA for other uses,such as dialysis andtotal artery bypass. so DTRA is a safe and feasible technique to recanalize the occluded RA, which may be of great value in clinical use.