Background/Objectives: Radial artery occlusion (RAO) is the most common complication of transradial coronary catheterization. In this study, we aimed to evaluate the incidence of RAO and identify the risk factors that predispose patients to it. Methods: We conducted an investigator-initiated, prospective, multicenter, open-label study involving 1357 patients who underwent cardiac catheterization via the transradial route for angiography and/or a percutaneous coronary intervention (PCI). Univariate and multivariate logistic regression analyses were performed to identify potential predictors of RAO occurrence. Additionally, a subgroup analysis only for patients undergoing PCIs was performed. Results: The incidence of RAO was 9.5% overall, 10.6% in the angiography-only group and 6.2% in the PCI group. Independent predictors of RAO were as follows: (i) the female gender (aOR = 1.72 (1.05–2.83)), (ii) access site cross-over (aOR = 4.33 (1.02–18.39)), (iii) increased total time of the sheath in the artery (aOR = 1.01 (1.00–1.02)), (iv) radial artery spasms (aOR = 2.47 (1.40–4.36)), (v) the presence of a hematoma (aOR = 2.28 (1.28–4.06)), (vi) post-catheterization dabigatran use (aOR = 5.15 (1.29–20.55)), (vii) manual hemostasis (aOR = 1.94 (1.01–3.72)) and (viii) numbness at radial artery ultrasound (aOR = 8.25 (1.70–40)). Contrariwise, two variables were independently associated with increased odds for radial artery patency (RAP): (i) PCI performance (aOR = 0.19 (0.06–0.63)), and (ii) a higher dosage of intravenous heparin per patient weight (aOR = 0.98 (0.96–0.99)), particularly, a dosage of >50 IU/kg (aOR = 0.56 (0.31–1.00)). In the PCI subgroup, independent predictors of RAO were as follows: (i) radial artery spasms (aOR = 4.48 (1.42–14.16)), (ii) the use of intra-arterial nitroglycerin as a vasodilator (aOR = 7.40 (1.67–32.79)) and (iii) the presence of symptoms at echo (aOR = 3.80 (1.46–9.87)), either pain (aOR = 2.93 (1.05–8.15)) or numbness (aOR = 4.66 (1.17–18.57)). On the other hand, the use of intra-arterial verapamil as a vasodilator (aOR = 0.17 (0.04–0.76)) was independently associated with a greater frequency of RAP. Conclusions: The incidence of RAO in an unselected, all-comers European population after transradial coronary catheterization for angiography and/or PCIs is similar to that reported in the international literature. Several RAO prognostic factors have been confirmed, and new ones are described. The female gender, radial artery trauma and manual hemostasis are the strongest predictors of RAO. Our results could help in the future identification of patients at higher risk of RAO, for whom less invasive diagnostic procedures maybe preferred, if possible.

Transradial artery access (TRA) has been established as the default access site for most coronary catheterization procedures with fewer access-related and bleeding complications, rapid hemostasis, early ambulation of the patient and reduction in all-cause mortality compared with transfemoral access. However, radial artery occlusion (RAO) remains the most frequent complication of TRA coronary catheterization procedures. The purpose of our review was to conduct detailed literature research and summarize all the available treatment strategies for RAO, given the lack of a standardized treatment protocol in the literature. Pharmacological treatment with low-molecular-weight-heparin (LMWH) or other anticoagulant, invasive strategies and pharmaco-invasive methods available in the literature were included in our review. Data was derived from case series, case reports, clinical trials and observational studies. Eight studies regarding pharmacological treatment with LMWH or any other anticoagulant and 7 studies of invasive treatment were included in our review. There are only two randomized studies one with LMWH (tinzaparin) and one with apixaban. Furthermore, taking into consideration data derived from the above-mentioned studies a treatment algorithm for RAO was proposed. RAO remains the most frequent complication of coronary procedures with transradial access. Application of preventive strategies and good knowledge of the risk factors remain the key factor for reduction of the incidence of this clinical entity. Therapeutic options include anticoagulation regimens and interventional techniques through the distal radial artery. Large, randomized, multicenter studies should be conducted to evaluate the efficacy of the available treatment methods and define a standardized treatment protocol for RAO.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as a new antihyperglycemic class with the demonstrated advantage of reducing major adverse cardiovascular events (MACE) among individuals with type 2 diabetes (T2DM) and atherosclerotic cardiovascular disease or high cardiovascular risk. Objective: Τo summarize the evidence of systematic reviews (SRs) that assess MACE (cardiovascular mortality, nonfatal myocardial infarction and stroke) and hospitalizations for heart failure in GLP-1RAs-treated patients and to evaluate possible overlap in pertinent SRs. Methods: We performed a comprehensive search via MEDLINE, Cochrane Library, and PROSPERO databases up to February 23, 2020 for SRs examining cardiovascular outcomes of GLP-1RAs in T2DM patients. Three independent authors extracted data and assessed the methodological quality of the included SRs using the ROBIS tool. Results: We found 37 SRs – published between 2009 and 2020 in English – of which 35 collected data only from randomized clinical trials while two from observational studies as well. The methodological quality of the 37 SRs ranged from low to high while only 3 have evaluated the overall quality of evidence outcome using the Grading of Recommendations Assessments, Development and Evaluation (GRADE) approach. All the included SRs showed cardiovascular safety of GLP-1RAs while the latest ones demonstrated reduction in composite MACE endpoint as well as its every individual component and heart failure hospitalizations. Conclusion: In the first overview of SRs about cardiovascular outcomes of GLP-1RAs, they proved favorable effects on reducing cardiovascular events in T2DM patients. There are, however, many overlapping reviews based on relatively few cardiovascular outcomes trials.