title: The Rotterdam Radial Access Research: Ultrasound-Based Radial Artery Evaluation for Diagnostic and Therapeutic Coronary Procedures.
abstract: BACKGROUND
  Radial artery wall might be damaged after cannulation for cardiac catheterization. We investigated structural changes of the radial artery wall after catheterization to understand whether these might predict radial pulsation loss or occlusion and local pain or functional impairment of the upper extremity.
  
  
  RESULTS
  Ninety patients underwent transradial coronary angiography or intervention and were scanned with a high-resolution 40-MHz ultrasound before cannulation and at 3 hours and 30 days after procedure. Acute injuries of the radial artery occurred in all patients: dissection and intramural hematoma were the most common. However, these phenomena did not predict loss of radial pulsation or occlusion, local pain, or functional impairment at 30 days. Overall, the radial artery lumen was significantly reduced distal to the puncture site. Radial artery intima and total wall thickness increased 3 hours after puncture and persisted at 30 days. Radial occlusion and pulsation loss were observed in 3.9% and 9.2% of patients, respectively, at 30 days. Smaller radial artery lumen at baseline increased the risk of radial pulsation loss at 30 days (odds ratio, 1.23; P=0.049). The number of radial puncture attempts predicted pulsation loss (odds ratio, 2.64; P=0.027), occlusion (odds ratio, 3.49; P=0.022), and symptoms (odds ratio, 2.24; P=0.05) at 30-day follow-up.
  
  
  CONCLUSIONS
  After catheterization, radial artery puncture site is associated with increased intima and total wall thickness and with modest decrease of inner lumen diameter. Acute injuries of the vessel wall were ubiquitous, but contrary to repeated puncture attempts, did not seem to affect postprocedural radial occlusion or loss of pulsation.
authors.affiliation: From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.).
authors.forename: Francesco
authors.initials: F
authors.lastname: Costa
authors.affiliation: From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.).
authors.forename: Maarten A H
authors.initials: MA
authors.lastname: van Leeuwen
authors.affiliation: From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.).
authors.forename: Joost
authors.initials: J
authors.lastname: Daemen
authors.affiliation: From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.).
authors.forename: Roberto
authors.initials: R
authors.lastname: Diletti
authors.affiliation: From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.).
authors.forename: Floris
authors.initials: F
authors.lastname: Kauer
authors.affiliation: From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.).
authors.forename: Robert-Jan
authors.initials: RJ
authors.lastname: van Geuns
authors.affiliation: From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.).
authors.forename: Jurgen
authors.initials: J
authors.lastname: Ligthart
authors.affiliation: From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.).
authors.forename: Karen
authors.initials: K
authors.lastname: Witberg
authors.affiliation: From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.).
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
authors.affiliation: From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.).
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.affiliation: From the Department of Interventional cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., J.D., R.D., F.K., R.-J.v.G., J.L., K.W., F.Z., M.V., N.M.V.M.); Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Messina, Italy (F.C.); Department of Interventional Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L.); and Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland (M.V.). n.vanmieghem@erasmusmc.nl.
authors.forename: Nicolas M
authors.initials: NM
authors.lastname: Van Mieghem
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011677:Punctures / Q000009:adverse effects*; D017534:Radial Artery / Q000000981:diagnostic imaging* / Q000601:surgery*; D012042:Registries; D014463:Ultrasonography
keywords: cardiac catheterization; coronary angiography; percutaneous coronary intervention; punctures; radial artery