Author + information
- Received May 14, 2019
- Revision received July 8, 2019
- Accepted July 11, 2019
- Published online November 18, 2019.
- Ivo Bernat, MD, PhDa,∗,
- Adel Aminian, MDb,∗,
- Samir Pancholy, MDc,
- Mamas Mamas, MD, PhDd,
- Mario Gaudino, MDe,
- James Nolan, MDd,
- Ian C. Gilchrist, MDf,
- Shigeru Saito, MD, PhDg,
- George N. Hahalis, MD, PhDh,
- Antonio Ziakas, MD, PhDi,
- Yves Louvard, MDj,
- Gilles Montalescot, MD, PhDk,
- Gregory A. Sgueglia, MD, PhDl,
- Maarten A.H. van Leeuwen, MD, PhDm,
- Avtandil M. Babunashvili, MDn,
- Marco Valgimigli, MD, PhDo,
- Sunil V. Rao, MDp,
- Olivier F. Bertrand, MD, PhDq,∗ (, )
- for the RAO International Group
- aDepartment of Cardiology, University Hospital and Faculty of Medicine Pilsen, Charles University, Pilsen, Czech Republic
- bDepartment of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
- cDepartment of Cardiology, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
- dKeele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
- eDepartment of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
- fHeart and Vascular Institute, Pennsylvania State University, Hershey, Pennsylvania
- gDepartment of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
- hDepartment of Cardiology, Patras University Hospital Rio, Patras, Greece
- i1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece
- jInstitut Cardiovasculaire Paris Sud, Hopital Jacques Cartier, Massy, France
- kSorbonne Université, ACTION Study Group, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
- lDivision of Cardiology, Sant'Eugenio Hospital, Rome, Italy
- mDepartment of Cardiology, Isala Heart Center, Zwolle, the Netherlands
- nDepartment of Cardiovascular Surgery, Center for Endosurgery and Lithotripsy, Moscow, Russian Federation
- oDepartment of Cardiology, Bern University Hospital, Bern, Switzerland
- pDuke Clinical Research Institute, Durham, North Carolina
- qQuebec Heart and Lung Institute, Quebec City, Canada
- ↵∗Address for correspondence:
Dr. Olivier F. Bertrand, Interventional Cardiology Laboratories, Quebec Heart-Lung Institute, Quebec City, QC G1V 4G5, Canada.
• RAO remains the most frequent post-procedural complication of transradial access, restricting the use of the same radial artery for future procedures, as a conduit for coronary artery bypass grafting or for arteriovenous fistula creation in patients requiring hemodialysis.
• The real-world reported incidence of RAO remains high, with wide variability in the uptake of RAO prevention strategies.
• The paper reviews the main recent advances in the field of RAO prevention and provides a series of expert recommendations to prevent RAO.
• This consensus document is meant to provide guidance to increase the adoption of simple and effective methods to achieve an institutional rate of RAO <5%, as demonstrated in the most recent large randomized trials.
Transradial access (TRA) is increasingly used worldwide for percutaneous interventional procedures and associated with lower bleeding and vascular complications than transfemoral artery access. Radial artery occlusion (RAO) is the most frequent post-procedural complication of TRA, restricting the use of the same radial artery for future procedures and as a conduit for coronary artery bypass graft. The authors review recent advances in the prevention of RAO following percutaneous TRA diagnostic or interventional procedures. Based on the available data, the authors provide easily applicable and effective recommendations to prevent periprocedural RAO and maximize the chances of access in case of repeat catheterization or coronary artery bypass grafting surgery.
↵∗ Drs. Bernat and Aminian contributed equally to this work and are joint first authors.
Dr. Bertrand has served as the International Chair on Interventional Cardiology and Transradial Approach, Laval University, Quebec City, Canada. Dr. Aminian has received consulting/lecture fees from Terumo. Dr. Pancholy owns equity in Vasoinnovations, Inc.; and has served as a speaker for Medtronic and Terumo. Dr. Gilchrist has served as a consultant for Terumo and Cardinal Health. Dr. Montalescot has received institutional research grants or consulting/lecture fees from Abbott, Amgen, Actelion, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham Women’s Hospital, Cardiovascular Research Foundation, Daiichi-Sankyo, Idorsia, Europa, Elsevier, Fédération Française de Cardiologie, ICAN, Medtronic, Journal of the American College of Cardiology, Lead-Up, Menarini, MSD, Novo-Nordisk, Pfizer, Sanofi, Servier, The Mount Sinai School, TIMI Study Group, and WebMD. Dr. Valgimigli has received grants and personal fees from Abbott; has received personal fees from Chiesi, Bayer, Daiichi-Sankyo, Amgen, Alvimedica, Biosensors, and Idorsia outside the submitted work; has received grants and personal fees from Terumo and AstraZeneca; and has received grants from Medicure. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 14, 2019.
- Revision received July 8, 2019.
- Accepted July 11, 2019.
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