Background Radial artery occlusion (RAO) may occur posttransradial intervention and limits the radial artery as a future access site, thus precluding its use as an arterial conduit. In this study, we investigate the incidence and factors influencing the RAO in the current literature.

Methods and Results We searched MEDLINE and EMBASE for studies of RAO in transradial access. Relevant studies were identified and data were extracted. Data were synthesized by meta‐analysis, quantitative pooling, graphical representation, or by narrative synthesis. A total of 66 studies with 31 345 participants were included in the analysis. Incident RAO ranged between 1 week follow‐up). The most efficacious measure in reducing RAO was higher dose of heparin, because lower doses of heparin were associated with increased RAO (risk ratio 0.36, 95% CI 0.17–0.76), whereas shorter compression times also reduced RAO (risk ratio 0.28, 95% CI 0.05–1.50). Several factors were found to be associated with RAO including age, sex, sheath size, and diameter of radial artery, but these factors were not consistent across all studies.

Conclusions RAO is a common complication of transradial access. Maintenance of radial patency should be an integral part of all procedures undertaken through the radial approach. High‐dose heparin along with shorter compression times and patent hemostasis is recommended in reducing RAO.

Radial Artery Occlusion After Transradial Interventions: A Systematic Review and Meta-Analysis.

General Cardiology AbstractsPrognostic value of myeloperoxidase in patients with chest pain

https://www.internationaljournalofcardiology.com/article/S0167-5273(04)00394-8/pdf

Idiopathic spontaneous coronary artery dissection: incidence, diagnosis and treatment

Highlights •RAO remains the most frequent post-procedural complication of transradial access, restricting the use of the same radial artery for future procedures, as a conduit for coronary artery bypass grafting or for arteriovenous fistula creation in patients requiring hemodialysis. •The real-world reported incidence of RAO remains high, with wide variability in the uptake of RAO prevention strategies. •The paper reviews the main recent advances in the field of RAO prevention and provides a series of expert recommendations to prevent RAO. •This consensus document is meant to provide guidance to increase the adoption of simple and effective methods to achieve an institutional rate of RAO

Best Practices for the Prevention of Radial Artery Occlusion After Transradial Diagnostic Angiography and Intervention: An International Consensus Paper

Effects of Radial versus Femoral Artery Access in Patients with Acute Coronary Syndromes with or without ST-segment Elevation

Coronary stenting is associated with an acute increase in plasma myeloperoxidase in stable angina patients but not in patients with acute myocardial infarction.

Objective
To determine the impact of ostial guiding catheter disengagement during measurement of fractional flow reserve (FFR) in patients with an isolated proximal left anterior descending artery (LAD) stenosis.

Methods
Measurements of FFR were performed in 21 patients with an isolated intermediate lesion of the proximal LAD. Proximal aortic pressure (Pa), distal post stenotic pressure (Pd), and Pd/Pa were recorded at baseline, after at least 90 sec of intravenous (IV) adenosine infusion with the guiding catheter still engaged in the coronary ostium (Pa1, Pd1, FFReng), and after at least 30 sec of guiding catheter disengagement back to the aorta (Pa2, Pd2, FFRdis).

Results
The average value of Pd/Pa at baseline was 0.92 ± 0.04. After 110 ± 8 sec of IV adenosine infusion, FFReng was 0.81 ± 0.07, which decreased to 0.77 ± 0.08 (FFRdis) after 38 ± 6 sec of guiding catheter disengagement. The mean ΔFFR (FFReng − FFRdis) was 0.05 ± 0.04. As compared to baseline values, the mean change in FFR values was significantly increased after disengagement of the guiding catheter (Pd/Pabaseline − FFRdis vs. Pd/Pabaseline − FFReng, 0.15 ± 0.05 vs. 0.10 ± 0.04, P < 0.0001). Before guiding catheter disengagement, eight patients (38%) had an FFR value ≤ 0.8. Following disengagement of the guiding catheter, the new FFR values decreased below 0.8 in six additional patients (28%), with subsequent change in treatment strategy.

Conclusions
During FFR assessment of isolated intermediate proximal LAD lesions, guiding catheter disengagement is associated with a decrease in mean FFR values. In patients with FFR values lying close to the treatment threshold, this can have an impact on treatment strategy. © 2014 Wiley Periodicals, Inc.

Importance of guiding catheter disengagement during measurement of fractional flow reserve in patients with an isolated proximal left anterior descending artery stenosis.

In this report, we present the case of a patient with hemodynamically significant thrombosis of a mitral bioprosthesis occurring 11 years after valve replacement. The diagnosis was suspected on the basis of a subacute increase in the transvalvular gradient seen on transthoracic echocardiography and was con- firmed by transesophageal echocardiography which disclosed unusual features. A hypercoagulable work up showed raised plasma factor VIII levels. The patient was successfully managed with oral anticoagulation.

An unusual case of late bioprosthetic mitral valve thrombosis successfully managed with anticoagulation.

https://www.internationaljournalofcardiology.com/article/S0167-5273(00)00272-2/pdf

Spontaneous coronary artery dissection in old woman treated with coronary artery bypass graft.

Several clinical and epidemiological studies have demonstrated that a high level of plasma fibrinogen is an independent risk factor for coronary, cerebral and peripheral artery disease. The role of fibrinogen in cardiovascular diseases is mainly due to thrombotic complications in advanced stages of the atherothrombotic disease. However, fibrinogen also plays an active role in the initiation and development of atheromatous plaques. The relations between fibrinogen and ischemic cardiopathies, other vasculopathies and diabetes mellitus are discussed. The controversial effects of statins on fibrinogen are also described.

[Recent progress in the "fibrinogen hypothesis"].

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