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Radial Artery Occlusion — EECC MCQ

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ModerateCoronary Artery DiseaseRadial Artery OcclusionEECC

A 72-year-old man with NSTEMI undergoes coronary angiography via the right radial artery. The procedure is uncomplicated and a DES is placed in the RCA. Post-procedure, his right hand becomes pale, cold, and pulseless. What is the likely diagnosis?

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Correct answer: E — Radial artery occlusion (RAO) — the most common vascular complication of transradial PCI (occurring in 1-10%); usually asymptomatic due to dual blood supply from the ulnar artery, but symptomatic ischaemia occurs when ulnar collateral is inadequate

Radial artery occlusion (RAO) is the most common complication of transradial catheterisation (1-10% incidence). It is usually asymptomatic because the hand receives dual blood supply (radial + ulnar arteries via the palmar arch). Symptomatic RAO with hand ischaemia is rare (<0.1%) and occurs when: (1) the ulnar artery is hypoplastic/absent; (2) incomplete palmar arch (the pre-procedural Allen test/Barbeau test screens for this); (3) prolonged/aggressive haemostasis compression. Prevention: (1) patent haemostasis technique (maintaining radial flow during compression — reduces RAO from ~10% to <2%); (2) adequate anticoagulation during the procedure; (3) smallest possible sheath size; (4) short compression time; (5) ipsilateral ulnar compression (promotes radial flow during haemostasis). Treatment: UFH infusion, hand elevation, warming; rarely requires vascular surgical intervention.

Reference: ESC (2023): ACS Guidelines