Feasibility and Safety of Distal Radial Artery Access with Recanalization of a Chronic Radial Artery Occlusion for Subsequent Coronary Angiography and Intervention.

Aims: This study aims to verify the feasibility and safety of percutaneous coronary intervention (PCI) after a distal transradial approach (dTRA) with radial artery occlusion (RAO) recanalization. Methods: Between July 2018 and January 2022, 30 patients underwent PCI following attempted RAO recanalization via dTRA. Among these cases, the target radial arteries could not be recanalized in five patients, necessitating alternative vascular access. The remaining 25 patients with successful RAO recanalization were divided into a standard group (n = 19) and tough group (n = 6), the latter requiring more than 10 minutes and complex techniques and devices for recanalization. Results: The procedural success rate was 96.7%, with vascular access-site complications occurring in 20% of the cases, including five perforations easily managed with prolonged balloon inflation and one pseudoaneurysm without flow limitation. In the tough group, no significant increase in procedural complications, access-site vascular complications, or total major adverse cardiac and cerebrovascular events was observed. However, Doppler ultrasound one month later for the recanalized radial artery revealed a significantly higher rate of severe stenosis and re-occlusion at 100% compared to 10% in the standard group, as supported by receiver operating characteristic curve analysis. Conclusions: The feasibility and safety of PCI following RAO recanalization via dTRA were acceptable. We propose a 10-minute threshold to differentiate between standard and tough groups during RAO recanalization. Given the uncertainty of long-term patency in recanalized RAs, the primary goal in tough cases is to ensure the guide catheter reaches the ascending aorta for subsequent PCI.