Journal of Invasive Cardiology

Transradial access has gained popularity over the past decade due to its benefits such as improved patient comfort and decrease in access site bleeding complications. It is limited by difficulties that arise as a result of spasm as well as anatomic variations. Radial artery occlusion is a fairly infrequent complication of transradial access.¹ It is clinically quiescent in properly selected cases and rarely results in ischemia. It is probably related to the size of the catheter,^2,3 and more likely related to the ratio of the arterial diameter to the sheath.⁴ Despite its benign clinical course, it makes transradial access impossible from that radial artery. Certain factors have been found to affect its occurrence. Repeated cannulations predispose the patient to occlusion.⁵ Heparinization has been found to be effective in reducing the occurrence of radial artery occlusion.⁶ This has led to the suspicion that thrombus formation may be the mechanism, or at least the precursor, to the process leading to cessation of flow, although histologic proof of this does not exist. There are no reports of reaccessing the radial artery once it has occluded. We have now attempted radial access in 14 patients with documented radial artery occlusion and succeeded in 12 of these patients. We describe a representative case where radial access was successfully obtained in an occluded radial artery proven by ultrasonography or angiography. We also report the histopathologic findings of the occlusion-causing material extracted from the sheath.