Influence of radial anatomy on pain experienced during transradial coronary angiography

BackgroundThe transradial route has become the primary approach for coronary angiography with the presence of radial artery anomalies found to be 10-20%. There has been limited study on the influence of these anomalies on procedural pain. Our aims were to determine local prevalence of the high radial origin (HRO) anatomical variant; to investigate factors influencing transradial procedural pain; and to determine if HRO specifically was associated with increased pain.MethodsRadial artery anatomy was characterized by arteriography in sequential patients undergoing angiography. Patients were asked to mark their perceived procedural pain on a visual analog scale, which was converted to a pain score.Results382 patients were enrolled, 5 were excluded. There were 259 males (68.7%) and 118 females (31.3%). HRO was present in 51 patients (13.5%). Overall mean pain score was 2.6 (SD 2.5). HRO was associated with a higher mean pain score than normal anatomy (3.3 (SD 2.9) vs. 2.4 (SD 2.4) p = 0.027). HRO was not associated with increased procedural failure, screening time or procedure time. When pain score was dichotomized into mild pain (< 4.0) and moderate-to-severe pain (≥ 4.0), HRO was associated with almost double the frequency of moderate-to-severe pain (37.2% vs. 21.1%, p = 0.012). Using a logistic regression model, only female gender, younger age and HRO remained significant predictors of moderate-to-severe pain.ConclusionsThere was significantly increased pain in patients with HRO without increased procedure/screening time or procedural failure. Female gender and younger age were also found to be significant predictors of increased pain.