Radial Artery and Ulnar Artery Occlusions Following Coronary Procedures
and the Impact of Anticoagulation: ARTEMIS (Radial and Ulnar ARTEry
Occlusion Meta-AnalysIS) Systematic Review and Meta-Analysis
Background-Incidence of radial artery occclusions (RAO) and ulnar artery
occclusions (UAO) in coronary procedures, factors predisposing to
forearm arteries occlusion, and the benefit of anticoaggulation vary
significantly in existing literature. We sought to determine the
incidence of RAO/UAO and the impact of anticoagulation intensity.
Methods and Results-Meta-analysis of 112 studies assessing RAO and/or
UAO (N = 46 631) were included. Overall, there was no difference between
crude RAO and UAO rates (5.2%; 95% confidence interval [CI], 4.4-6.0
versus 4.0%; 95% CI, 2.8-5.8; P= 0.171). The early occlusion rate
(in-hospital or within 7 days after procedure) was higher than the late
occlusion rate. The detection rate of occlusion was higher with vascular
ultrasonography compared with clinical evaluation only. Low-dose heparin
was associated with a significantly higher RAO rate compared with
high-dose heparin (7.2%; 95% CI, 5.5-9.4 versus 4.3%; 95% CI,
3.5-5.3; Q = 8.81; P = 0.003). Early occlusions in low-dose heparin
cohorts mounted at 8.0% (95% CI, 6.1-10.6). The RAO rate was higher
after diagnostic angiographies compared with coronary interventions,
presumably attributed to the higher intensity of anticoagulation in the
latter group. Hemostatic techniques (patent versus nonpatent
hemostasis), geography (US versus non-US cohorts) and sheath size did
not impact on vessel patency.
Conclusions-RAO and UAO occur with similar frequency and in the order of
7% to 8% when evaluated early by vascular ultrasonography following
coronary procedures. More-intensive anticoagulation is protective. Late
recanalization occurs in a substantial minority of patients