Sakellariou XM, Nikas DΝ, Papanagiotou P, Liberopoulos E, Florentin M, Bechlioulis A, Mastoridou EM, Kolettis TM. Structural radial artery modifications following transradial access: Mechanisms, clinical implications, and preventive strategies. World J Cardiol 2025; 17(7): 107772 [DOI: 10.4330/wjc.v17.i7.107772]
Corresponding Author of This Article
Xenofon M Sakellariou, 2nd Department of Cardiology, University Hospital of Ioannina, Stavros Niarchos Avenue, Ioannina 45500, Greece. xensakel@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Jul 26, 2025; 17(7): 107772 Published online Jul 26, 2025. doi: 10.4330/wjc.v17.i7.107772
Structural radial artery modifications following transradial access: Mechanisms, clinical implications, and preventive strategies
Xenofon M Sakellariou, Dimitrios Ν Nikas, Panagiotis Papanagiotou, Evangelos Liberopoulos, Matilda Florentin, Aris Bechlioulis, Eleftheria M Mastoridou, Theofilos M Kolettis
Xenofon M Sakellariou, Aris Bechlioulis, 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina 45500, Greece
Dimitrios Ν Nikas, 1st Department of Cardiology, University Hospital of Ioannina, Ioannina 45500, Greece
Panagiotis Papanagiotou, Department of Radiology, Aretaieion University Hospital, Athens 11528, Greece
Evangelos Liberopoulos, 1st Propaedeutic Department of Medicine, Laiko Hospital, Athens 11527, Greece
Matilda Florentin, Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina 45221, Greece
Eleftheria M Mastoridou, Theofilos M Kolettis, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina 45500, Greece
Author contributions: Sakellariou XM, Nikas DN, and Kolettis TM were responsible for the study design and conceptualization; Sakellariou XM, Nikas DN, Papanagiotou P, Liberopoulos E, and Florentin M designed the methodology; Sakellariou XM, Bechlioulis A, Florentin M, and Mastoridou EM performed the investigation; Sakellariou XM, Bechlioulis A, and Mastoridou EM drafted the manuscript; Nikas DN, Papanagiotou P, and Liberopoulos E contributed to writing and editing of each subsequent version of the manuscript; Nikas DN and Kolettis TM provided supervision of the overall project; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xenofon M Sakellariou, 2nd Department of Cardiology, University Hospital of Ioannina, Stavros Niarchos Avenue, Ioannina 45500, Greece. xensakel@gmail.com
Received: April 7, 2025 Revised: May 5, 2025 Accepted: July 7, 2025 Published online: July 26, 2025 Processing time: 108 Days and 16.4 Hours
Abstract
Transradial access (TRA) has emerged as the preferred vascular access route for coronary angiography and percutaneous coronary interventions due to its superior safety profile compared to transfemoral access. However, its widespread adoption raises concerns regarding structural alterations in the radial artery, which may impact long-term vascular health and future procedural feasibility. TRA is associated with histopathologic changes in the arterial wall, such as intimal injury and hyperplasia, medial remodeling and adventitial inflammation, collectively contributing to radial artery remodeling. Moreover, TRA can induce changes in radial artery lumen diameter driven by an inflammatory response due to arterial puncture and mechanical friction during the procedure. Nonetheless, a more clinically significant consequence is radial artery occlusion, which is influenced by various procedural and patient-related factors. Strategies to minimize remodeling include meticulous pre-procedural ultrasound assessment to ensure appropriate sheath-to-artery size matching, periprocedural pharmacological interventions and implementation of patent hemostasis techniques. This review synthesizes current knowledge regarding the mechanisms, clinical implications, and preventive strategies related to radial artery remodeling following TRA. Further research is needed to elucidate the long-term consequences of radial artery remodeling and to refine preventive strategies for preserving radial artery patency and its suitability for future interventions.
Core Tip: Transradial access has become the preferred approach for coronary interventions due to its superior safety profile compared to transfemoral access. However, this intervention can induce structural alterations, reduce the radial artery lumen diameter or result in radial artery occlusion. Preventing these modifications requires a targeted approach. Meticulous pre-procedural ultrasound assessment is essential for appropriate sheath-to-artery size matching. Intra-procedurally, smaller sheath sizes minimize vascular trauma, while adequate anticoagulation reduces thrombus formation and vasospasm. Post-procedural care should emphasize patent hemostasis with time-guided compression to promptly restore arterial flow. By integrating these measures, clinicians can optimize radial artery patency, preserving its suitability for future interventions.
