Puncture Artery Steno-Occlusion After Transradial and Transulnar Neurointervention: Incidence, Predictors, and Recanalization

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However, radial artery steno-occlusion, though generally asymptomatic, may restrict future vascular access. This study evaluates the incidence, predictors, and recanalization of puncture artery steno-occlusion following trans-wrist neurointervention. Methods A retrospective institutional review was conducted on transradial and transulnar neurointerventions performed between February 2022 and May 2024. Postprocedural ultrasound was performed on the following day to assess puncture artery stenosis or occlusion. Risk factors were evaluated using univariate and multivariate logistic regression analyses. Follow-up ultrasound was conducted when available to assess recanalization. Results Among 343 trans-wrist procedures (247 diagnostic, 96 therapeutic), puncture artery steno-occlusion was observed in 64 cases (19%), including 43 diagnostic (18%) and 21 therapeutic (22%) interventions. Complete occlusion occurred in 31 cases (9%), all asymptomatic. Multivariate analysis identified local anesthesia (OR 8.0, p < 0.05) and absence of preprocedural antiplatelet medication (OR 4.3, p < 0.05) as significant risk factors. The steno-occlusion rate was lower (6.6%) in cases performed under general anesthesia with preprocedural antiplatelets. Follow-up ultrasound (median 4.3 months) was available in 28 cases, revealing spontaneous recanalization or thrombus resolution observed in 19 (66%), including 10 of 17 occlusion cases (59%). Conclusion Puncture artery steno-occlusion occurred in 19% of cases, more frequently in therapeutic interventions. Local anesthesia and the absence of preprocedural antiplatelet medication were significant risk factors. A significant proportion of cases demonstrated spontaneous recanalization. Transradial approach Radial artery occlusion Ultrasound assessment Antiplatelet therapy General anesthesia Balloon guide catheter Figures Figure 1 INTRODUCTION The transradial approach (TRA) is increasingly utilized in neurointervention due to its recognized advantages, including reduced invasiveness and a lower incidence of severe access-related complications, such as large puncture-site hematoma or retroperitoneal hematomas, compared to the transfemoral approach (TFA) [1,2]. However, TRA is associated with a higher incidence of radial artery steno-occlusion, particularly when large-caliber devices are introduced into the relatively small radial artery [3]. Although typically asymptomatic due to well-developed collateral circulation, radial artery occlusion (RAO) remains a concern as it limits future vascular access for repeat interventions. In coronary intervention, the reported incidence of RAO following TRA is approximately 7–8% [4]. However, in neurointervention, the RAO rate appears to be higher, likely due to the use of larger devices. Meta-analyses in coronary intervention have identified risk factors of RAO, including lower doses of heparin and prolonged compression times [4,5], but data specific to neurointervention remain limited. Additionally, while spontaneous recanalization of occluded radial artery has been documented in cardiology, its frequency is not well established [4-6]. This study aims to investigate the incidence and predictors of radial artery steno-occlusion following trans-wrist neurointervention, as detected by ultrasound the day after the procedure. Furthermore, follow-up ultrasound evaluations will be used to assess the rate of spontaneous recanalization in cases of arterial steno-occlusion. MATERIALS AND METHODS This study was approved by the institutional ethics committee (approval number: 123-01) and performed in accordance with the declaration of Helsinki. A retrospective review was conducted on consecutive patients who underwent transradial or transulnar neurointervention at our institution between February 2022 and May 2024. The incidence of puncture artery steno-occlusion was assessed using routine ultrasound examinations performed the day after the procedure. Patients without available postprocedural ultrasound data were excluded. In cases involving therapeutic interventions, potential risk factors for puncture artery steno-occlusion were explored using univariate and multivariate analyses. For patients with confirmed puncture artery steno-occlusion, follow-up ultrasound assessments were conducted when feasible to evaluate the rate of spontaneous recanalization or thrombus resolution. Pre-procedural assessment The choice of vascular access was determined by the operator based on preprocedural assessments and the planned intervention. Computed tomography angiography from the neck to the pelvis was performed to evaluate the access route. The diameters of the radial and ulnar arteries were measured using ultrasound. Based on institutional experience, a vessel diameter at least 70% of the device’s outer diameter was considered sufficient for insertion after radial cocktail administration. Specifically, a ≥2 mm vessel was deemed adequate for sheathless insertion of an 8Fr balloon guide catheter, which has an outer diameter of 2.7 mm. If the radial artery diameter at the anatomical snuffbox was sufficiently large, distal transradial access was preferred. Conversely, if the radial artery was narrow while the ulnar artery was significantly larger, transulnar access was considered as an alternative to TRA [7,8]. Procedure Following radial or ulnar artery puncture­—using ultrasound guidance when necessary—a 4Fr sheath was inserted over a 0.025-inch wire. Diagnostic interventions were performed under local anesthesia using 4Fr catheters, predominantly Simmons-shaped catheters. Therapeutic interventions were conducted under general anesthesia or local anesthesia at the operator’s discretion, considering the patient’s condition and pathology. For therapeutic procedures, the 4Fr sheath was exchanged for guiding sheaths or balloon guide catheters in a sheathless manner. Before the exchange, a radial cocktail (1mg isosorbide nitrate and 2.5mg verapamil) was administered through the 4Fr sheath to prevent vasospasm. Heparin was not administered in diagnostic procedures, whereas in therapeutic interventions 4000 IU (or ≥50 IU/kg) of heparin was given unless contraindicated or if there was a concern for hemorrhagic complications. Hemostasis was achieved using radial-specific hemostatic devices (BLEEDSAFE, Medikit, Japan; or PreludeSync Distal, Merit Medical, USA), with precautions taken to maintain patent hemostasis. Post-procedural assessment of puncture artery steno-occlusion Ultrasound examinations were routinely performed by ultrasound technicians the day after the procedure to assess the punctured artery. Vessel wall morphology and the presence of intraluminal thrombus were evaluated. Blood flow was confirmed using color Doppler and power-doppler imaging. Stenosis was defined as the presence of an intraluminal thrombus with preserved blood flow. Occlusion was diagnosed if the vessel was completely filled with thrombus and exhibited absent flow. Statistical analysis All statistical analyses were conducted using JMP software, version 18.1.0 (SAS Institute, Cary, NC, USA). Continuous variables were expressed as mean ± standard deviation or median (interquartile range) and compared using the Mann–Whitney U test. Categorical variables were analyzed using two-tailed Fisher’s exact test. Variables with a p-value < 0.10 in univariate analyses were included in the multivariate logistic regression model. The final model retained only variables with p < 0.05. Results from the multivariate logistic regression analysis were reported as odds ratios (OR) with corresponding 95% confidence intervals (CI). A p-value < 0.05 was considered statistically significant. RESULTS During the study period, 730 neurointerventional procedures (390 diagnostic, 340 therapeutic) were performed. Of these, 408 procedures (56%) utilized a trans-wrist approach, including 293 diagnostic and 115 therapeutic cases. Access routes within the trans-wrist approach were conventional TRA in 326 cases (80%), distal TRA in 69 cases (17%; 63 diagnostic, 6 therapeutic), and transulnar approach in 13 cases (3%; 8 diagnostic, 5 therapeutic). Postprocedural ultrasound assessment of the punctured artery was available in 343 cases (84%), comprising 247 diagnostic (84%) and 96 therapeutic (83%) procedures, which were included in the analyses (Figure 1). Incidence of Puncture Artery Steno-occlusion Puncture artery stenosis or occlusion was detected in 64 cases (19%), including 43 cases (18%) following diagnostic interventions and 21 cases (22%) following therapeutic interventions. Among these, occlusion without preserved blood flow was identified in 15 diagnostic cases (6%) and 16 therapeutic cases (17%). All steno-occlusive cases were asymptomatic. Predictors of Puncture Artery Steno-Occlusion Baseline characteristics of 96 therapeutic intervention cases are summarized in Table 1 . The median age of the population was 77 [67–82] and 51% of the patients were female. Target diseases included 49 aneurysms, 20 carotid stenosis, 19 acute ischemic stroke, 5 chronic subdural hematoma, 2 dural arteriovenous fistula, and 1 meningioma. Patients were on preprocedural antiplatelet therapy, including loading dose in emergent cases, in 69 (72%) of the cases and anticoagulants in 8 (8%) of the cases. Dual antiplatelets were administered in 63 (66%) of the cases. The median procedural time was 100 [69–132] minutes. The median inner diameter of the punctured artery was 2.3 [2.1–2.4] mm. The median outer diameter of the inserted device was 2.7 [2.4–2.7] mm, where 8Fr balloon guide catheters were used in 50 cases (52%). A sheath was used in only one case, while other cases were treated with either guiding sheath or sheathless insertion of balloon guide catheters. The median artery-to-sheath diameter ratio was 0.88 [0.78–1.00]. Potential predictors of puncture artery steno-occlusion were analyzed ( Table 2) . In univariate analysis, procedures under local anesthesia (p < 0.001), no preprocedural antiplatelet medication (p < 0.001), and no intraprocedural heparin administration (p < 0.001) were significantly associated with puncture artery steno-occlusion. In multivariate analysis, local anesthesia (OR=8.0, 95% CI: 1.2–55.8, p=0.035) and no preprocedural antiplatelet medication (OR=4.3, 95% CI: 1.1–16.8, p=0.038) remained significant risk factors. In a sub-analysis limited to 61 cases performed under general anesthesia with preprocedural antiplatelet medication, puncture artery steno-occlusion occurred in only 4 cases (6.6%, 1 stenosis and 3 occlusions). Spontaneous Recanalization or Thrombus Resolution Of the 64 cases with puncture artery steno-occlusion (43 diagnostic, 21 therapeutic), follow-up ultrasound data were available in 28 cases (44%) with a median follow-up time of 4.3 months. Spontaneous recanalization or thrombus resolution was observed in 19 cases (66%). Among 17 occlusion cases, 10 (59%) exhibited spontaneous recanalization. DISCUSSION This study evaluated the incidence, predictors, and recanalization outcomes of puncture artery steno-occlusion after trans-wrist neurointervention. A notable strength of this study is the high rate of postprocedural ultrasound assessments by technicians, which provides a more accurate and sensitive evaluation of arterial patency compared to physical examination alone [4,5]. Ultrasound enables the detection of not only occlusions but also thrombus formation with reduced blood flow, offering a more comprehensive understanding of vascular complications. The incidence of puncture artery steno-occlusion in this study was 19%, which is lower than some previously reported RAO rates of 27–40% in neurointervention [9-12], but higher than those reported in interventional cardiology [4,5]. This discrepancy is likely due to the larger device sizes used in neurointervention. In fact, 8Fr balloon-guide catheters (outer diameter:2.7 mm) were used sheathlessly in 52% of cases in this study. Since a higher artery-to-sheath diameter ratio is associated with a lower risk of radial artery occlusion, setting a larger vessel diameter as a threshold for access may help reduce the incidence of steno-occlusion [10,13-15]. Predictors of Puncture Artery Steno-Occlusion In therapeutic interventions, local anesthesia and the absence of preprocedural antiplatelet medication were identified as independent risk factors for puncture artery steno-occlusion. This finding aligns with the hypothesis that vessel injury, particularly endothelial damage, can lead to postprocedural thrombus formation, contributing to vessel occlusion [15,16]. Antiplatelet therapy may mitigate this risk by preventing thrombus formation at sites of vascular injury. Additionally, radial artery spasm may exacerbate endothelial damage due to increased friction between the artery and interventional devices. General anesthesia could offer a protective effect by reducing arterial spasm through pain control, muscle relaxation, and sympathetic suppression. The role of anticoagulation, particularly the administration of an adequate intraoperative heparin dose, in preventing RAO is well established in the cardiac literature [4,5]. However, the specific impact of antiplatelet therapy on RAO prevention remains less clearly defined. Furthermore, to our knowledge, no previous studies have reported an association between local anesthesia and RAO. This lack of evidence may be due to the routine use of antiplatelet therapy in cardiac interventions, which are typically performed under local anesthesia, making direct comparisons challenging. Our study's finding that local anesthesia and the absence of antiplatelet medication are associated with a higher risk of puncture artery steno-occlusion could be a novel observation in neurointervention. Interestingly, in a subgroup analysis of cases performed under general anesthesia with preprocedural antiplatelet medication, the incidence of steno-occlusion decreased to 6.6%, comparable to rates reported in interventional cardiology. This suggests that, when feasible, general anesthesia combined with adequate antiplatelet therapy may be a preferred strategy to minimize the risk of puncture artery steno-occlusion in transradial neurointervention. Recanalization of Steno-Occlusio n Our study is among the first to investigate spontaneous recanalization rates of puncture artery steno-occlusion in neurointervention. Although recanalization rates of occluded radial arteries are not well documented even in cardiology, prior studies suggest that radial artery occlusion rates decrease over time, implying that spontaneous recanalization occurs [4-6,17]. In our study, 66% of steno-occlusive cases showed spontaneous recanalization on follow-up ultrasound, with 59% of complete occlusions reopening over time. Notably, cases with 4Fr sheath use for diagnostic procedures exhibited a higher recanalization rate, suggesting that smaller devices induce less severe vessel trauma. The mechanism of puncture artery steno-occlusion likely involves a combination of vessel injury and flow stasis, leading to thrombus formation [18]. Larger devices may cause more significant endothelial trauma, impeding subsequent recanalization. This highlights the importance of optimizing device selection to minimize arterial injury. Limitations This study has several limitations. As a retrospective analysis conducted at a single institution with a relatively small sample size, its generalizability is limited. The selection of radial access was based on preprocedural assessment, potentially introducing selection bias. Late radial stenosis following TRA may result not only from thrombus formation but also from neointimal proliferation due to endothelial injury [16]. However, our early ultrasound data did not allow for evaluation of this process. Additionally, factors such as the number of puncture attempts [19] and duration of hemostasis [20-22], which may influence the development of steno-occlusion, were not evaluated. Furthermore, follow-up ultrasound was available in only 44% of steno-occlusive cases, limiting the ability to identify predictors of spontaneous recanalization. Future multicenter prospective studies with larger patient populations are needed to validate these findings and optimize strategies for minimizing puncture artery complications in neurointervention. CONCLUSION In this single-center retrospective study, puncture artery steno-occlusion after trans-wrist neurointervention was detected in 19% of cases, as identified by ultrasound performed on the day following the procedure. Risk factors for steno-occlusion included procedures under local anesthesia and lack of preprocedural antiplatelet medication. A sub-analysis of cases performed under general anesthesia with antiplatelet medication revealed a 6.6% steno-occlusion rate, even with frequent use of large-bore devices. Notably, spontaneous recanalization or thrombus resolution of the punctured artery occurred in a significant proportion of cases. Declarations The authors have no relevant financial or non-financial interests to disclose. Ethical approval: This study was approved by the institutional ethics committee under approval number 123-01. Author Contribution K.Y. contributed to the conception of the study, data analysis, and interpretation, and drafted the initial manuscript. All authors contributed to data acquisition, critically revised the manuscript for important intellectual content, approved the final version for publication, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Data availability: The datasets analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request. Informed consent: The requirement for informed consent was waived in view of the retrospective nature of the study and all the procedures being performed were part of the routine care. 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Am J Cardiol 120 (3):374-379. https://doi.org/10.1016/j.amjcard.2017.04.037 Tables Table 1 Baseline characteristics of 96 therapeutic intervention cases Patient Variables n (%) or Median [IQR] Procedural Variables n (%) or Median [IQR] Sex (female) 49 (51%) Device outer diameter (mm) 2.7 [2.4–2.7] Age (years) 77 [67–82] Puncture artery inner diameter/device outer diameter ratio 0.9 [0.8–1.0] Height (cm) 158 [151–164] Sheath use 1 (1%) Weight (kg) 55.6 [48.6–64.5] No intraprocedural heparin 18 (19%) Body mass index (BMI) 21.9 [19.8–24.4] Local anesthesia 25 (26%) Puncture artery diameter (mm) 2.3 [2.1–2.4] Ulnar artery access 5 (5.2%) Preprocedural antiplatelets 69 (72%) Distal radial access 6 (6.3%) Preprocedural anticoagulant 8 (8%) Procedural time (min) 100 [69–132] Data are presented as median [interquartile range] or number (percentage). Table 2 Univariate and Multivariate Analyses on Potential Predictors of Puncture Artery Steno-Occlusion Steno-occlusion (n=21) No steno-occlusion (n=75) Univariate analysis (p-value) Multivariate analysis (p-value, OR [95%CI]) Patient Variables Sex (female) 13 (62%) 36 (48%) 0.19 — Age (years) 80 [68–83] 74 [67–81] 0.12 — Height (cm) 156 [148–166] 159 [152–163] 0.69 — Weight (kg) 47.9 [44.8–61.6] 55.6 [49.7–64.5] 0.12 — Body mass index (BMI) 20.6 [19.2–22.5] 22.2 [19.9–24.9] 0.11 — Puncture artery diameter (mm) 2.1 [2.0–2.4] 2.3 [2.1–2.5] 0.34 — Preprocedural antiplatelet 7 (33%) 62 (83%) <0.001 p=0.038, OR 4.3 [1.1–16.8] Preprocedural anticoagulant 2 (10%) 6 (8%) 1.00 — Procedural variables Device outer diameter (mm) 2.7 [2.3–2.7] 2.7 [2.7–2.7] 0.27 — Puncture artery inner diameter/ device outer diameter ratio 0.9 [0.8–1.0] 0.9 [0.8–1.0] 0.41 — Sheath use 0 (0%) 1 (1%) 1.00 — No intraprocedural heparin 11 (52%) 7 (9%) < 0.001 p=1.00 Local anesthesia 14 (67%) 10 (13%) < 0.001 p=0.035, OR 8.0 [1.2–55.8] Distal radial access 0 (0%) 6 (8%) 0.33 — Ulnar artery access 1 (4.8%) 4 (5.3%) 0.70 — Procedural time (min) 100 [69–129] 98 [69–133] 0.85 — Data are presented as median [interquartile range] or number (percentage). p-values were calculated using Mann–Whitney U test or Fisher’s exact test. OR: Odds Ratio; CI: Confidence Interval. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 05 Jul, 2025 Read the published version in Neuroradiology → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6117479","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":422033118,"identity":"c79b80d3-b75f-4471-bf36-b918ef20c7d9","order_by":0,"name":"Keisuke Yoshida","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYHACNoaEAww8jPMfHwByJGSI18LckJYA0sJDnBYGoPnsDTkGIB5hLQbH2589eHDGRoa34cznVzdqLHgY2A8f3YBXy5kz5gYJN9J4JBt7t1nnHAM6jCct7QZeLTdy2CQSPhzmMWzm3WYMZPMAvWNGQEv6M6CW/zz2x3ieGef8I0pLgplEwo0DPIw9PMyPc9uI0CJ55gxQy5lkHsYZbGbMuX0SPGyE/MIHDDHJH8fs7BlnMD/+nPOtTo6f/fAxvFoUDiDYbBJgEp9yEJBvQLCZPxBSPQpGwSgYBSMTAAB7wUs7xMab7wAAAABJRU5ErkJggg==","orcid":"","institution":"Mihara Memorial Hospital","correspondingAuthor":true,"prefix":"","firstName":"Keisuke","middleName":"","lastName":"Yoshida","suffix":""},{"id":422033119,"identity":"20308d70-35fc-4a41-8fed-2e1dfb21b496","order_by":1,"name":"Kazuma Kowata","email":"","orcid":"","institution":"Mihara Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kazuma","middleName":"","lastName":"Kowata","suffix":""},{"id":422033120,"identity":"c3a1ba23-8592-4b64-abc4-22eab941696c","order_by":2,"name":"Takayuki Yatsu","email":"","orcid":"","institution":"Mihara Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Takayuki","middleName":"","lastName":"Yatsu","suffix":""},{"id":422033122,"identity":"6a666b93-cb2e-4856-9f33-85062da0949d","order_by":3,"name":"Naoko Shibusawa","email":"","orcid":"","institution":"Mihara Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Naoko","middleName":"","lastName":"Shibusawa","suffix":""},{"id":422033124,"identity":"4d5c80f6-c9f2-46ea-bfd1-813c072b2931","order_by":4,"name":"Natsumi Sato","email":"","orcid":"","institution":"Mihara Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Natsumi","middleName":"","lastName":"Sato","suffix":""},{"id":422033125,"identity":"958bb975-cbdf-417d-96ce-eba84558b302","order_by":5,"name":"Rikako Mogi","email":"","orcid":"","institution":"Mihara Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Rikako","middleName":"","lastName":"Mogi","suffix":""},{"id":422033127,"identity":"f50be821-f243-40fc-b10b-5f2202f31be3","order_by":6,"name":"Kazunori Akaji","email":"","orcid":"","institution":"Mihara Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kazunori","middleName":"","lastName":"Akaji","suffix":""}],"badges":[],"createdAt":"2025-02-27 04:53:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6117479/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6117479/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00234-025-03703-0","type":"published","date":"2025-07-05T15:56:59+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":77681557,"identity":"c198d787-7785-4e51-b1ad-eaa00b811afe","added_by":"auto","created_at":"2025-03-04 08:39:45","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":545480,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of patient enrollment and postprocedural ultrasound findings.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6117479/v1/50043d86955b213884b09300.jpeg"},{"id":86178880,"identity":"160f51a9-bd6d-43eb-8fd3-9b920560c9e8","added_by":"auto","created_at":"2025-07-07 16:07:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1237562,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6117479/v1/c96911a0-303e-4793-8c1f-5cd3a5c426cd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Puncture Artery Steno-Occlusion After Transradial and Transulnar Neurointervention: Incidence, Predictors, and Recanalization","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe transradial approach (TRA) is increasingly utilized in neurointervention due to its recognized advantages, including reduced invasiveness and a lower incidence of severe access-related complications, such as large puncture-site hematoma or retroperitoneal hematomas, compared to the transfemoral approach (TFA) [1,2]. However, TRA is associated with a higher incidence of radial artery steno-occlusion, particularly when large-caliber devices are introduced into the relatively small radial artery [3]. Although typically asymptomatic due to well-developed collateral circulation, radial artery occlusion (RAO) remains a concern as it limits future vascular access for repeat interventions.\u003c/p\u003e\n\u003cp\u003eIn coronary intervention, the reported incidence of RAO following TRA is approximately 7\u0026ndash;8% [4]. However, in neurointervention, the RAO rate appears to be higher, likely due to the use of larger devices. Meta-analyses in coronary intervention have identified risk factors of RAO, including lower doses of heparin and prolonged compression times [4,5], but data specific to neurointervention remain limited. Additionally, while spontaneous recanalization of occluded radial artery has been documented in cardiology, its frequency is not well established [4-6].\u003c/p\u003e\n\u003cp\u003eThis study aims to investigate the incidence and predictors of radial artery steno-occlusion following trans-wrist neurointervention, as detected by ultrasound the day after the procedure. Furthermore, follow-up ultrasound evaluations will be used to assess the rate of spontaneous recanalization in cases of arterial steno-occlusion.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eThis study was approved by the institutional ethics committee (approval number: 123-01) and performed in accordance with the declaration of Helsinki. A retrospective review was conducted on consecutive patients who underwent transradial or transulnar neurointervention at our institution between February 2022 and May 2024. The incidence of puncture artery steno-occlusion was assessed using routine ultrasound examinations performed the day after the procedure. Patients without available postprocedural ultrasound data were excluded. In cases involving therapeutic interventions, potential risk factors for puncture artery steno-occlusion were explored using univariate and multivariate analyses. For patients with confirmed puncture artery steno-occlusion, follow-up ultrasound assessments were conducted when feasible to evaluate the rate of spontaneous recanalization or thrombus resolution.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePre-procedural assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe choice of vascular access was determined by the operator based on preprocedural assessments and the planned intervention. Computed tomography angiography from the neck to the pelvis was performed to evaluate the access route. The diameters of the radial and ulnar arteries were measured using ultrasound. Based on institutional experience, a vessel diameter at least 70% of the device\u0026rsquo;s outer diameter was considered sufficient for insertion after radial cocktail administration. Specifically, a \u0026ge;2 mm vessel was deemed adequate for sheathless insertion of an 8Fr balloon guide catheter, which has an outer diameter of 2.7 mm. If the radial artery diameter at the anatomical snuffbox was sufficiently large, distal transradial access was preferred. Conversely, if the radial artery was narrow while the ulnar artery was significantly larger, transulnar access was considered as an alternative to TRA [7,8].\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing radial or ulnar artery puncture\u0026shy;\u0026mdash;using ultrasound guidance when necessary\u0026mdash;a 4Fr sheath was inserted over a 0.025-inch wire. Diagnostic interventions were performed under local anesthesia using 4Fr catheters, predominantly Simmons-shaped catheters. Therapeutic interventions were conducted under general anesthesia or local anesthesia at the operator\u0026rsquo;s discretion, considering the patient\u0026rsquo;s condition and pathology. For therapeutic procedures, the 4Fr sheath was exchanged for guiding sheaths or balloon guide catheters in a sheathless manner. Before the exchange, a radial cocktail (1mg isosorbide nitrate and 2.5mg verapamil) was administered through the 4Fr sheath to prevent vasospasm. Heparin was not administered in diagnostic procedures, whereas in therapeutic interventions 4000 IU (or \u0026ge;50 IU/kg) of heparin was given unless contraindicated or if there was a concern for hemorrhagic complications. Hemostasis was achieved using radial-specific hemostatic devices (BLEEDSAFE, Medikit, Japan; or PreludeSync Distal, Merit Medical, USA), with precautions taken to maintain patent hemostasis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePost-procedural assessment of puncture artery steno-occlusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUltrasound examinations were routinely performed by ultrasound technicians the day after the procedure to assess the punctured artery. Vessel wall morphology and the presence of intraluminal thrombus were evaluated. Blood flow was confirmed using color Doppler and power-doppler imaging. Stenosis was defined as the presence of an intraluminal thrombus with preserved blood flow. Occlusion was diagnosed if the vessel was completely filled with thrombus and exhibited absent flow.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll statistical analyses were conducted using JMP software, version 18.1.0 (SAS Institute, Cary, NC, USA). Continuous variables were expressed as mean \u0026plusmn; standard deviation or median (interquartile range) and compared using the Mann\u0026ndash;Whitney U test. Categorical variables were analyzed using two-tailed Fisher\u0026rsquo;s exact test. Variables with a p-value \u0026lt; 0.10 in univariate analyses were included in the multivariate logistic regression model. The final model retained only variables with p \u0026lt; 0.05. Results from the multivariate logistic regression analysis were reported as odds ratios (OR) with corresponding 95% confidence intervals (CI). A p-value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eDuring the study period, 730 neurointerventional procedures (390 diagnostic, 340 therapeutic) were performed. Of these, 408 procedures (56%) utilized a trans-wrist approach, including 293 diagnostic and 115 therapeutic cases. Access routes within the trans-wrist approach were conventional TRA in 326 cases (80%), distal TRA in 69 cases (17%; 63 diagnostic, 6 therapeutic), and transulnar approach in 13 cases (3%; 8 diagnostic, 5 therapeutic). Postprocedural ultrasound assessment of the punctured artery was available in 343 cases (84%), comprising 247 diagnostic (84%) and 96 therapeutic (83%) procedures, which were included in the analyses (Figure 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIncidence of Puncture Artery Steno-occlusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePuncture artery stenosis or occlusion was detected in 64 cases (19%), including 43 cases (18%) following diagnostic interventions and 21 cases (22%) following therapeutic interventions. Among these, occlusion without preserved blood flow was identified in 15 diagnostic cases (6%) and 16 therapeutic cases (17%). All steno-occlusive cases were asymptomatic.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePredictors of Puncture Artery Steno-Occlusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBaseline characteristics of 96 therapeutic intervention cases are summarized in \u003cstrong\u003eTable 1\u003c/strong\u003e. The median age of the population was 77 [67\u0026ndash;82] and 51% of the patients were female. Target diseases included 49 aneurysms, 20 carotid stenosis, 19 acute ischemic stroke, 5 chronic subdural hematoma, 2 dural arteriovenous fistula, and 1 meningioma. Patients were on preprocedural antiplatelet therapy, including loading dose in emergent cases, in 69 (72%) of the cases and anticoagulants in 8 (8%) of the cases. Dual antiplatelets were administered in 63 (66%) of the cases. The median procedural time was 100 [69\u0026ndash;132] minutes. The median inner diameter of the punctured artery was 2.3 [2.1\u0026ndash;2.4] mm. The median outer diameter of the inserted device was 2.7 [2.4\u0026ndash;2.7] mm, where 8Fr balloon guide catheters were used in 50 cases (52%). A sheath was used in only one case, while other cases were treated with either guiding sheath or sheathless insertion of balloon guide catheters. The median artery-to-sheath diameter ratio was 0.88 [0.78\u0026ndash;1.00].\u003c/p\u003e\n\u003cp\u003ePotential predictors of puncture artery steno-occlusion were analyzed (\u003cstrong\u003eTable 2)\u003c/strong\u003e. In univariate analysis, procedures under local anesthesia (p \u0026lt; 0.001), no preprocedural antiplatelet medication (p \u0026lt; 0.001), and no intraprocedural heparin administration (p \u0026lt; 0.001) were significantly associated with puncture artery steno-occlusion. In multivariate analysis, local anesthesia (OR=8.0, 95% CI: 1.2\u0026ndash;55.8, p=0.035) and no preprocedural antiplatelet medication (OR=4.3, 95% CI: 1.1\u0026ndash;16.8, p=0.038) remained significant risk factors. In a sub-analysis limited to 61 cases performed under general anesthesia with preprocedural antiplatelet medication, puncture artery steno-occlusion occurred in only 4 cases (6.6%, 1 stenosis and 3 occlusions).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSpontaneous Recanalization or Thrombus Resolution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 64 cases with puncture artery steno-occlusion (43 diagnostic, 21 therapeutic), follow-up ultrasound data were available in 28 cases (44%) with a median follow-up time of 4.3 months. Spontaneous recanalization or thrombus resolution was observed in 19 cases (66%). Among 17 occlusion cases, 10 (59%) exhibited spontaneous recanalization.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study evaluated the incidence, predictors, and recanalization outcomes of puncture artery steno-occlusion after trans-wrist neurointervention. A notable strength of this study is the high rate of postprocedural ultrasound assessments by technicians, which provides a more accurate and sensitive evaluation of arterial patency compared to physical examination alone [4,5]. Ultrasound enables the detection of not only occlusions but also thrombus formation with reduced blood flow, offering a more comprehensive understanding of vascular complications.\u003c/p\u003e\n\u003cp\u003eThe incidence of puncture artery steno-occlusion in this study was 19%, which is lower than some previously reported RAO rates of 27\u0026ndash;40% in neurointervention [9-12], but higher than those reported in interventional cardiology [4,5]. This discrepancy is likely due to the larger device sizes used in neurointervention. In fact, 8Fr balloon-guide catheters (outer diameter:2.7 mm) were used sheathlessly in 52% of cases in this study. Since a higher artery-to-sheath diameter ratio is associated with a lower risk of radial artery occlusion, setting a larger vessel diameter as a threshold for access may help reduce the incidence of steno-occlusion [10,13-15].\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePredictors of Puncture Artery Steno-Occlusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn therapeutic interventions, local anesthesia and the absence of preprocedural antiplatelet medication were identified as independent risk factors for puncture artery steno-occlusion. This finding aligns with the hypothesis that vessel injury, particularly endothelial damage, can lead to postprocedural thrombus formation, contributing to vessel occlusion [15,16]. Antiplatelet therapy may mitigate this risk by preventing thrombus formation at sites of vascular injury. Additionally, radial artery spasm may exacerbate endothelial damage due to increased friction between the artery and interventional devices. General anesthesia could offer a protective effect by reducing arterial spasm through pain control, muscle relaxation, and sympathetic suppression.\u003c/p\u003e\n\u003cp\u003eThe role of anticoagulation, particularly the administration of an adequate intraoperative heparin dose, in preventing RAO is well established in the cardiac literature [4,5]. However, the specific impact of antiplatelet therapy on RAO prevention remains less clearly defined. Furthermore, to our knowledge, no previous studies have reported an association between local anesthesia and RAO. This lack of evidence may be due to the routine use of antiplatelet therapy in cardiac interventions, which are typically performed under local anesthesia, making direct comparisons challenging.\u0026nbsp;Our study\u0026apos;s finding that local anesthesia and the absence of antiplatelet medication are associated with a higher risk of puncture artery steno-occlusion could be a novel observation in neurointervention.\u003c/p\u003e\n\u003cp\u003eInterestingly, in a subgroup analysis of cases performed under general anesthesia with preprocedural antiplatelet medication, the incidence of steno-occlusion decreased to 6.6%, comparable to rates reported in interventional cardiology. This suggests that, when feasible, general anesthesia combined with adequate antiplatelet therapy may be a preferred strategy to minimize the risk of puncture artery steno-occlusion in transradial neurointervention.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecanalization of Steno-Occlusio\u003c/strong\u003en\u003c/p\u003e\n\u003cp\u003eOur study is among the first to investigate spontaneous recanalization rates of puncture artery steno-occlusion in neurointervention. Although recanalization rates of occluded radial arteries are not well documented even in cardiology, prior studies suggest that radial artery occlusion rates decrease over time, implying that spontaneous recanalization occurs [4-6,17]. In our study, 66% of steno-occlusive cases showed spontaneous recanalization on follow-up ultrasound, with 59% of complete occlusions reopening over time. Notably, cases with 4Fr sheath use for diagnostic procedures exhibited a higher recanalization rate, suggesting that smaller devices induce less severe vessel trauma. The mechanism of puncture artery steno-occlusion likely involves a combination of vessel injury and flow stasis, leading to thrombus formation [18]. Larger devices may cause more significant endothelial trauma, impeding subsequent recanalization. This highlights the importance of optimizing device selection to minimize arterial injury.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has several limitations. As a retrospective analysis conducted at a single institution with a relatively small sample size, its generalizability is limited. The selection of radial access was based on preprocedural assessment, potentially introducing selection bias. Late radial stenosis following TRA may result not only from thrombus formation but also from neointimal proliferation due to endothelial injury [16]. However, our early ultrasound data did not allow for evaluation of this process. Additionally, factors such as the number of puncture attempts [19] and duration of hemostasis [20-22], which may influence the development of steno-occlusion, were not evaluated. Furthermore, follow-up ultrasound was available in only 44% of steno-occlusive cases, limiting the ability to identify predictors of spontaneous recanalization. Future multicenter prospective studies with larger patient populations are needed to validate these findings and optimize strategies for minimizing puncture artery complications in neurointervention.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn this single-center retrospective study, puncture artery steno-occlusion after trans-wrist neurointervention was detected in 19% of cases, as identified by ultrasound performed on the day following the procedure. Risk factors for steno-occlusion included procedures under local anesthesia and lack of preprocedural antiplatelet medication. A sub-analysis of cases performed under general anesthesia with antiplatelet medication revealed a 6.6% steno-occlusion rate, even with frequent use of large-bore devices. Notably, spontaneous recanalization or thrombus resolution of the punctured artery occurred in a significant proportion of cases.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003ch2\u003eEthical approval:\u003c/h2\u003e\n\u003cp\u003eThis study was approved by the institutional ethics committee under approval number 123-01.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eK.Y. contributed to the conception of the study, data analysis, and interpretation, and drafted the initial manuscript. All authors contributed to data acquisition, critically revised the manuscript for important intellectual content, approved the final version for publication, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u003c/p\u003e\n\u003ch2\u003eData availability:\u003c/h2\u003e\n\u003cp\u003eThe datasets analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003eInformed consent:\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe requirement for informed consent was waived in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSnelling BM, Sur S, Shah SS, Marlow MM, Cohen MG, Peterson EC (2018) Transradial access: lessons learned from cardiology. J Neurointerv Surg 10 (5):487-492. https://doi.org/10.1136/neurintsurg-2017-013295\u003c/li\u003e\n\u003cli\u003eSweid A, Weinberg JH, Khanna O et al. (2021) Lessons Learned After 760 Neurointerventions via the Upper Extremity Vasculature: Pearls and Pitfalls. Neurosurgery 88 (6):E510-E522. https://doi.org/10.1093/neuros/nyab084\u003c/li\u003e\n\u003cli\u003eBrunet MC, Chen SH, Peterson EC (2020) Transradial access for neurointerventions: management of access challenges and complications. J Neurointerv Surg 12 (1):82-86. https://doi.org/10.1136/neurintsurg-2019-015145\u003c/li\u003e\n\u003cli\u003eHahalis G, Aznaouridis K, Tsigkas G et al. (2017) 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. J Am Heart Assoc 6 (8). https://doi.org/10.1161/JAHA.116.005430\u003c/li\u003e\n\u003cli\u003eRashid M, Kwok CS, Pancholy S et al. (2016) Radial Artery Occlusion After Transradial Interventions: A Systematic Review and Meta-Analysis. J Am Heart Assoc 5 (1). https://doi.org/10.1161/JAHA.115.002686\u003c/li\u003e\n\u003cli\u003ePancholy S, Coppola J, Patel T, Roke-Thomas M (2008) Prevention of radial artery occlusion-patent hemostasis evaluation trial (PROPHET study): a randomized comparison of traditional versus patency documented hemostasis after transradial catheterization. Catheter Cardiovasc Interv 72 (3):335-340. https://doi.org/10.1002/ccd.21639\u003c/li\u003e\n\u003cli\u003eDossani RH, Waqas M, Tso MK, Rajah GB, Popoola D, Rai HH, Levy EI, Siddiqui AH, Davies JM (2021) Safety and feasibility of ulnar artery access for neuroangiography and neurointervention: a case series. J Neurointerv Surg 13 (2):109-113. https://doi.org/10.1136/neurintsurg-2020-016416\u003c/li\u003e\n\u003cli\u003eManzoor MU, Almulhim IA, Alrashed AA, Alturki AY, Alghabban FA, Al-Qahtani SM (2022) Common ground, different path: Ulnar artery access for interventional neurovascular procedures. Interv Neuroradiol 28 (4):463-468. https://doi.org/10.1177/15910199211040280\u003c/li\u003e\n\u003cli\u003eBoeken T, Altayeb A, Shotar E, Premat K, Lenck S, Boch AL, Drir M, Sourour NA, Clarencon F (2022) Prohibitive Radial Artery Occlusion Rates Following Transradial Access Using a 6-French Neuron MAX Long Sheath for Intracranial Aneurysm Treatment. Clin Neuroradiol 32 (4):1031-1036. https://doi.org/10.1007/s00062-022-01177-8\u003c/li\u003e\n\u003cli\u003eFuga M, Tanaka T, Tachi R, Tomoto K, Kazami K, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y (2023) Risk factors for radial artery occlusion after neurointervention for unruptured intracranial aneurysm via transradial access. Interv Neuroradiol:15910199231189927. https://doi.org/10.1177/15910199231189927\u003c/li\u003e\n\u003cli\u003eAllard J, Shotar E, Premat K, Lenck S, Boch AL, Drir M, Sourour NA, Clarencon F (2024) Radial artery occlusion after aneurysm treatment using the rist guide catheter: Single center cohort study. J Neuroradiol 51 (3):249-253. https://doi.org/10.1016/j.neurad.2023.11.004\u003c/li\u003e\n\u003cli\u003eOnodera K, Yoshimura M, Azekami K, Kimura R, Yahagi N, Kajimoto R, Kohyama S (2024) Feasibility and radial artery occlusion rate of sheathless distal transradial access using balloon guide catheters. Neurosurg Rev 47 (1):795. https://doi.org/10.1007/s10143-024-02994-w\u003c/li\u003e\n\u003cli\u003eSaito S, Ikei H, Hosokawa G, Tanaka S (1999) Influence of the ratio between radial artery inner diameter and sheath outer diameter on radial artery flow after transradial coronary intervention. Catheter Cardiovasc Interv 46 (2):173-178. https://doi.org/10.1002/(sici)1522-726x(199902)46:2\u0026lt;173::Aid-ccd12\u0026gt;3.0.Co;2-4\u003c/li\u003e\n\u003cli\u003eUhlemann M, M\u0026ouml;bius-Winkler S, Mende M et al. (2012) The Leipzig prospective vascular ultrasound registry in radial artery catheterization: impact of sheath size on vascular complications. JACC Cardiovasc Interv 5 (1):36-43. https://doi.org/10.1016/j.jcin.2011.08.011\u003c/li\u003e\n\u003cli\u003eHahalis G, Tsigkas G, Kounis N et al. (2018) Prevention of Radial Artery Occlusions Following Coronary Procedures: Forward and Backward Steps in Improving Radial Artery Patency Rates. Angiology 69 (9):755-762. https://doi.org/10.1177/0003319718754466\u003c/li\u003e\n\u003cli\u003eWagener JF, Rao SV (2015) Radial artery occlusion after transradial approach to cardiac catheterization. Curr Atheroscler Rep 17 (3):489. https://doi.org/10.1007/s11883-015-0489-6\u003c/li\u003e\n\u003cli\u003eSinha SK, Jha MJ, Mishra V et al. (2017) Radial Artery Occlusion - Incidence, Predictors and Long-term outcome after TRAnsradial Catheterization: clinico-Doppler ultrasound-based study (RAIL-TRAC study). Acta Cardiol 72 (3):318-327. https://doi.org/10.1080/00015385.2017.1305158\u003c/li\u003e\n\u003cli\u003eYonetsu T, Kakuta T, Lee T et al. (2010) Assessment of acute injuries and chronic intimal thickening of the radial artery after transradial coronary intervention by optical coherence tomography. Eur Heart J 31 (13):1608-1615. https://doi.org/10.1093/eurheartj/ehq102\u003c/li\u003e\n\u003cli\u003eCosta F, van Leeuwen MA, Daemen J et al. (2016) The Rotterdam Radial Access Research: Ultrasound-Based Radial Artery Evaluation for Diagnostic and Therapeutic Coronary Procedures. Circ Cardiovasc Interv 9 (2):e003129. https://doi.org/10.1161/CIRCINTERVENTIONS.115.003129\u003c/li\u003e\n\u003cli\u003ePancholy SB, Patel TM (2012) Effect of duration of hemostatic compression on radial artery occlusion after transradial access. Catheter Cardiovasc Interv 79 (1):78-81. https://doi.org/10.1002/ccd.22963\u003c/li\u003e\n\u003cli\u003eDharma S, Kedev S, Patel T, Kiemeneij F, Gilchrist IC (2015) A novel approach to reduce radial artery occlusion after transradial catheterization: postprocedural/prehemostasis intra-arterial nitroglycerin. Catheter Cardiovasc Interv 85 (5):818-825. https://doi.org/10.1002/ccd.25661\u003c/li\u003e\n\u003cli\u003eDangoisse V, Guedes A, Chenu P et al. (2017) Usefulness of a Gentle and Short Hemostasis Using the Transradial Band Device after Transradial Access for Percutaneous Coronary Angiography and Interventions to Reduce the Radial Artery Occlusion Rate (from the Prospective and Randomized CRASOC I, II, and III Studies). Am J Cardiol 120 (3):374-379. https://doi.org/10.1016/j.amjcard.2017.04.037\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003eBaseline characteristics of 96 therapeutic intervention cases\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"626\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient Variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%) or Median [IQR]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProcedural Variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%) or Median [IQR]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eSex (female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e49 (51%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eDevice outer diameter (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.7 [2.4\u0026ndash;2.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e77 [67\u0026ndash;82]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003ePuncture artery inner diameter/device outer diameter ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.9 [0.8\u0026ndash;1.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eHeight (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e158 [151\u0026ndash;164]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eSheath use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eWeight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e55.6 [48.6\u0026ndash;64.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eNo intraprocedural heparin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e18 (19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eBody mass index (BMI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e21.9 [19.8\u0026ndash;24.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eLocal anesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e25 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003ePuncture artery diameter (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e2.3 [2.1\u0026ndash;2.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eUlnar artery access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e5 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003ePreprocedural antiplatelets\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e69 (72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eDistal radial access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e6 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003ePreprocedural anticoagulant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e8 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eProcedural time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e100 [69\u0026ndash;132]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as median [interquartile range] or number (percentage).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 2\u003c/strong\u003e Univariate and Multivariate Analyses on Potential Predictors of Puncture Artery Steno-Occlusion\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"709\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSteno-occlusion (n=21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo steno-occlusion (n=75)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnivariate analysis (p-value)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariate analysis (p-value, OR [95%CI])\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 709px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient Variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eSex (female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e13 (62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e36 (48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e80 [68\u0026ndash;83]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e74 [67\u0026ndash;81]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eHeight (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e156 [148\u0026ndash;166]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e159 [152\u0026ndash;163]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eWeight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e47.9 [44.8\u0026ndash;61.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e55.6 [49.7\u0026ndash;64.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eBody mass index (BMI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e20.6 [19.2\u0026ndash;22.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e22.2 [19.9\u0026ndash;24.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003ePuncture artery diameter (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2.1 [2.0\u0026ndash;2.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e2.3 [2.1\u0026ndash;2.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003ePreprocedural antiplatelet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e7 (33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e62 (83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003ep=0.038, OR 4.3 [1.1\u0026ndash;16.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003ePreprocedural anticoagulant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e6 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 709px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProcedural variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eDevice outer diameter (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2.7 [2.3\u0026ndash;2.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e2.7 [2.7\u0026ndash;2.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003ePuncture artery inner diameter/\u003c/p\u003e\n \u003cp\u003edevice outer diameter ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.9 [0.8\u0026ndash;1.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.9 [0.8\u0026ndash;1.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eSheath use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eNo intraprocedural heparin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e11 (52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e7 (9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003ep=1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eLocal anesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e14 (67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e10 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003ep=0.035, OR 8.0 [1.2\u0026ndash;55.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eDistal radial access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e6 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eUlnar artery access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e4 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eProcedural time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e100 [69\u0026ndash;129]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e98 [69\u0026ndash;133]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as median [interquartile range] or number (percentage). p-values were calculated using Mann\u0026ndash;Whitney U test or Fisher\u0026rsquo;s exact test. OR: Odds Ratio; CI: Confidence Interval.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Transradial approach, Radial artery occlusion, Ultrasound assessment, Antiplatelet therapy, General anesthesia, Balloon guide catheter","lastPublishedDoi":"10.21203/rs.3.rs-6117479/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6117479/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose \u003c/strong\u003eThe transradial approach is increasingly used in neurointervention due to its minimally invasive nature and lower risk of severe access-related complications. However, radial artery steno-occlusion, though generally asymptomatic, may restrict future vascular access. This study evaluates the incidence, predictors, and recanalization of puncture artery steno-occlusion following trans-wrist neurointervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eA retrospective institutional review was conducted on transradial and transulnar neurointerventions performed between February 2022 and May 2024. Postprocedural ultrasound was performed on the following day to assess puncture artery stenosis or occlusion. Risk factors were evaluated using univariate and multivariate logistic regression analyses. Follow-up ultrasound was conducted when available to assess recanalization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eAmong 343 trans-wrist procedures (247 diagnostic, 96 therapeutic), puncture artery steno-occlusion was observed in 64 cases (19%), including 43 diagnostic (18%) and 21 therapeutic (22%) interventions. Complete occlusion occurred in 31 cases (9%), all asymptomatic. Multivariate analysis identified local anesthesia (OR 8.0, p \u0026lt; 0.05) and absence of preprocedural antiplatelet medication (OR 4.3, p \u0026lt; 0.05) as significant risk factors. The steno-occlusion rate was lower (6.6%) in cases performed under general anesthesia with preprocedural antiplatelets. Follow-up ultrasound (median 4.3 months) was available in 28 cases, revealing spontaneous recanalization or thrombus resolution observed in 19 (66%), including 10 of 17 occlusion cases (59%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003ePuncture artery steno-occlusion occurred in 19% of cases, more frequently in therapeutic interventions. Local anesthesia and the absence of preprocedural antiplatelet medication were significant risk factors. A significant proportion of cases demonstrated spontaneous recanalization.\u003c/p\u003e","manuscriptTitle":"Puncture Artery Steno-Occlusion After Transradial and Transulnar Neurointervention: Incidence, Predictors, and Recanalization","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-04 08:39:37","doi":"10.21203/rs.3.rs-6117479/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a3ca8ec3-5e37-41ea-abf6-7ec940ba1952","owner":[],"postedDate":"March 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-07T15:59:40+00:00","versionOfRecord":{"articleIdentity":"rs-6117479","link":"https://doi.org/10.1007/s00234-025-03703-0","journal":{"identity":"neuroradiology","isVorOnly":false,"title":"Neuroradiology"},"publishedOn":"2025-07-05 15:56:59","publishedOnDateReadable":"July 5th, 2025"},"versionCreatedAt":"2025-03-04 08:39:37","video":"","vorDoi":"10.1007/s00234-025-03703-0","vorDoiUrl":"https://doi.org/10.1007/s00234-025-03703-0","workflowStages":[]},"version":"v1","identity":"rs-6117479","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6117479","identity":"rs-6117479","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}