Successive transradial access for coronary procedures: Experience of Quebec Heart-Lung Institute Eltigani Abdelaal, MD, a Pierre Molin, MD, a Guillaume Plourde, MS, a Jimmy MacHaalany, MD, a Yoann Bataille, MD, a Cynthia Brousseau-Provencher, MD, a Sarah Montminy, MS, a Éric Larose, MD, a Louis Roy, MD, a Onil Gleeton, MD, a Gérald Barbeau, MD, a Can M. Nguyen, MD, a Bernard Noël, MD, a Olivier Costerousse, PhD, a and Olivier F. Bertrand, MD, PhD, a Quebec, Canada Background Transradial approach (TRA) for cardiac catheterizations and interventions improves clinical outcomes compared with transfemoral access, and its use is increasing worldwide. However, there are limited data on successive use of same artery for repeat procedures. Methods Between May 2010 and May 2011, all consecutive patients undergoing a repeat TRA procedure (≥2) were retrospectively identified. Success rates and reasons for failure to use ipsilateral radial artery for repeat access were identified. Results A total of 519 patients underwent 1,420 procedures. In 480 patients (92%), right radial artery was used as initial access, and left radial artery, in 39 patients. All patients underwent ≥2 procedures; 218 patients, ≥3; 87 patients, ≥4; 39 patients, ≥5; 19 patients, ≥6; 11 patients, ≥7; and 5 patients, ≥8 procedures. Two patients had, respectively, 9 and 10 procedures. The success rate for second attempt was 93%, 81% for third, and declining to 60% for ≥8. Linear regression analysis estimated a 5% failure rate for each repeat attempt (R 2 = 0.87, P = .007). The main reason for failure was related to clinical radial artery occlusion (RAO) including absent or faint pulse, poor oximetry, and failed puncture. All patients with clinical RAO were asymptomatic. By multivariate analysis, female gender (odds ratio [OR] 3.08, 95% CI 1.78-5.39, P b .0001), prior coronary artery bypass graft (OR 5.26, 95% CI 2.67-10.42, P b .0001), and repeat radial access (OR 2.14, 95% CI 1.70-2.76, P b .0001) were independent predictors of radial access failure. Conclusion Successive TRA is both feasible and safe in most cases for up to 10 procedures. However, failure rate for TRA increases with successive procedures, primarily due to clinical RAO. Strategies to minimize the risks of chronic clinical RAO and allow repeat use of ipsilateral radial artery need to be further defined. (Am Heart J 2013;165:325-31.) Radial access for coronary angiography and interven- tion is increasingly used worldwide. 1 Several meta- analyses and randomized trials have consistently shown significantly lower risk of bleeding and vascular compli- cations with radial access compared with femoral access. 2-5 However, despite abundant data on its many advantages, radial access has some of its own limitations such as spasm and radial artery occlusion, which, although largely quiescent, may limit future use of ipsilateral radial access. 6 There are currently limited data on how many times the same radial access can be used for repeat coronary procedures. 7,8 Acute radial artery occlusion may limit early repeat access, but delayed recanalization may occur in 50% of the times. Hence, the true incidence of late chronic radial artery occlusion (RAO) or injury is currently unknown. We, therefore, undertook this observational study to describe our own experience in a default high-volume tertiary level radial center, to determine how many times the same radial artery could be used for successive access and resulting failure rate. Methods Study population Using the catheterization laboratory database, we identified all consecutive patients who had undergone ≥2 repeat transradial coronary procedures between May 2010 and May 2011 at our institution. Data entry is completed at the end of procedure by operator and verified the next day by a dedicated research nurse. Recorded data included baseline characteristics, pre- procedural laboratory tests, oximetry tests, access site, From the Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada. a For the Interventional Cardiologists at Quebec Heart-Lung Institute. Submitted July 22, 2012; accepted October 9, 2012. Reprint requests: Olivier F. Bertrand, MD, Interventional Cardiology Laboratory, Quebec Heart-Lung Institute, 2725, Chemin Ste Foy, Quebec City, Quebec, Canada G1V 4G5. E-mail: olivier.bertrand@crhl.ulaval.ca 0002-8703/$ - see front matter © 2013, Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.ahj.2012.10.016