Radial Artery Spasm in Transradial PCI: Risk Factors and Protective Role of the Combo Technique

Abstract

Background: Transradial percutaneous coronary intervention (PCI) has gained widespread acceptance due to its lower bleeding complications, improved patient comfort, and quicker ambulation compared to the transfemoral approach. However, one of the notable challenges during transradial access is radial artery spasm (RAS), which can lead to procedural difficulty, patient discomfort, and even access site failure. This study aims to identify the risk factors associated with radial artery spasm during trans-radial PCI and evaluate the protective role of the Combo technique compared to the conventional 6Fr catheter approach. Methods: This cross-sectional observational study was carried out in the Department of Cardiology at the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, from July 2020 to June 2021. Study subjects were divided into two groups, Group I: Transradial PCI using ―the Combo technique, and Group II: Transradial PCI using the conventional 6 Fr guide catheter technique, and in each group, 64 patients were included. Data were analyzed using SPSS (Statistical Package for Social Sciences) Version 24.0. Result: In this study involving 128 patients undergoing trans-radial PCI, no significant differences were observed between the Combo technique group (Group I) and the conventional 6Fr group (Group II) in terms of age, gender, clinical diagnosis, or traditional cardiovascular risk factors such as hypertension, diabetes, dyslipidemia, smoking, or family history of CAD. However, multivariate regression analysis identified the Combo technique as an independent protective factor against radial artery spasm (OR 0.312, 95% CI 0.118–0.826, p=0.019). Conclusion: This study underscores that while traditional cardiovascular risk factors such as hypertension, diabetes, smoking, dyslipidemia, and prior myocardial infarction did not significantly predict the occurrence of radial artery spasm (RAS) during transradial percutaneous coronary intervention (PCI), the use of the Combo technique emerged as an independent protective factor.