{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T23:21:58Z","timestamp":1778628118559,"version":"3.51.4"},"reference-count":18,"publisher":"Texas Heart Institute Journal","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:p>The radial artery approach for coronary angiography and intervention is rapidly replacing the femoral artery approach, largely because it reduces bleeding and vascular access site complications. However, complications associated with transradial access warrant attention, notably radial artery occlusion. This report focuses on a case of radial artery occlusion after percutaneous coronary intervention in a 46-year-old woman with CREST (calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome, which ultimately led to acute hand ischemia necessitating amputation of her middle and index fingers.<\/jats:p>","DOI":"10.14503\/thij-19-6988","type":"journal-article","created":{"date-parts":[[2021,1,20]],"date-time":"2021-01-20T23:30:10Z","timestamp":1611185410000},"page":"319-321","source":"Crossref","is-referenced-by-count":4,"title":["Acute Hand Ischemia and Digital Amputation After Transradial Coronary Intervention in a Patient With CREST Syndrome"],"prefix":"10.14503","volume":"47","author":[{"given":"Thomas J.","family":"Earl","sequence":"first","affiliation":[{"name":"Michigan Heart & Vascular Specialists, McLaren Northern Michigan, Petoskey, Michigan 49770"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"5628","reference":[{"issue":"9775","key":"i1526-6702-47-4-319-b1","series-title":"Lancet","first-page":"1409","article-title":"Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial [published errata appear in Lancet 2011;377(9775):1408 and Lancet 2011;378(9785):30]","volume":"377","year":"2011","unstructured":"Jolly\n              SS,\n            \n            \n              Yusuf\n              S,\n            \n            \n              Cairns\n              J,\n            \n            \n              Niemela\n              K,\n            \n            \n              Xavier\n              D,\n            \n            \n              Widimsky\n              P,\n            \n          \n          .\n\t\t\t\t\tRadial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial [published errata appear in Lancet 2011;377(9775):1408 and Lancet 2011;378(9785):30].\n\t\t\t\t\tLancet2011;377(9775):1409\u201320."},{"issue":"14","key":"i1526-6702-47-4-319-b2","series-title":"JACC Cardiovasc Interv","first-page":"1419","article-title":"Radial versus femoral access for coronary interventions across the entire spectrum of patients with coronary artery disease: a meta-analysis of randomized trials","volume":"9","year":"2016","unstructured":"Ferrante\n              G,\n            \n            \n              Rao\n              SV,\n            \n            \n              Juni\n              P,\n            \n            \n              Da Costa\n              BR,\n            \n            \n              Reimers\n              B,\n            \n            \n              Condorelli\n              G,\n            \n          \n          .\n\t\t\t\t\tRadial versus femoral access for coronary interventions across the entire spectrum of patients with coronary artery disease: a meta-analysis of randomized trials.\n\t\t\t\t\tJACC Cardiovasc Interv2016;9(14):1419\u201334."},{"issue":"7","key":"i1526-6702-47-4-319-b3","series-title":"Catheter Cardiovasc Interv","first-page":"1093","article-title":"Influence of radial versus femoral access site on coronary angiography and intervention outcomes: a systematic review and meta-analysis","volume":"90","year":"2017","unstructured":"Brener\n              MI,\n            \n            \n              Bush\n              A,\n            \n            \n              Miller\n              JM,\n            \n            \n              Hasan\n              RK.\n            \n          \n          Influence of radial versus femoral access site on coronary angiography and intervention outcomes: a systematic review and meta-analysis.\n\t\t\t\t\tCatheter Cardiovasc Interv2017;90(7):1093\u2013104."},{"issue":"24","key":"i1526-6702-47-4-319-b4","series-title":"J Am Coll Cardiol","first-page":"2481","article-title":"Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study","volume":"60","year":"2012","unstructured":"Romagnoli\n              E,\n            \n            \n              Biondi-Zoccai\n              G,\n            \n            \n              Sciahbasi\n              A,\n            \n            \n              Politi\n              L,\n            \n            \n              Rigattieri\n              S,\n            \n            \n              Pendenza\n              G,\n            \n          \n          .\n\t\t\t\t\tRadial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study.\n\t\t\t\t\tJ Am Coll Cardiol2012;60(24):2481\u20139."},{"issue":"6","key":"i1526-6702-47-4-319-b5","series-title":"Rev Esp Cardiol","first-page":"581","article-title":"Vascular complications associated with radial artery access for cardiac catheterization [in Spanish]","volume":"57","year":"2004","unstructured":"Sanmartin\n              M,\n            \n            \n              Cuevas\n              D,\n            \n            \n              Goicolea\n              J,\n            \n            \n              Ruiz-Salmeron\n              R,\n            \n            \n              Gomez\n              M,\n            \n            \n              Argibay\n              V.\n            \n          \n          Vascular complications associated with radial artery access for cardiac catheterization [in Spanish].\n\t\t\t\t\tRev Esp Cardiol2004;57(6):581\u20134."},{"issue":"11","key":"i1526-6702-47-4-319-b6","series-title":"J Am Coll Cardiol","first-page":"1427","article-title":"Trends in U.S. cardiovascular care: 2016 report from 4 ACC national cardiovascular data registries","volume":"69","year":"2017","unstructured":"Masoudi\n              FA,\n            \n            \n              Ponirakis\n              A,\n            \n            \n              de Lemos\n              JA,\n            \n            \n              Jollis\n              JG,\n            \n            \n              Kremers\n              M,\n            \n            \n              Messenger\n              JC,\n            \n          \n          .\n\t\t\t\t\tTrends in U.S. cardiovascular care: 2016 report from 4 ACC national cardiovascular data registries.\n\t\t\t\t\tJ Am Coll Cardiol2017;69(11):1427\u201350."},{"issue":"2","key":"i1526-6702-47-4-319-b7","series-title":"Cathet Cardiovas Diagn","first-page":"156","article-title":"Incidence and outcome of radial artery occlusion following transradial artery coronary angioplasty","volume":"40","year":"1997","unstructured":"Stella\n              PR,\n            \n            \n              Kiemeneij\n              F,\n            \n            \n              Laarman\n              GJ,\n            \n            \n              Odekerken\n              D,\n            \n            \n              Slagboom\n              T,\n            \n            \n              van der Wieken\n              R.\n            \n          \n          Incidence and outcome of radial artery occlusion following transradial artery coronary angioplasty.\n\t\t\t\t\tCathet Cardiovas Diagn1997;40(2):156\u20138."},{"issue":"12","key":"i1526-6702-47-4-319-b8","series-title":"Clin Res Cardiol","first-page":"841","article-title":"Radial artery thrombosis following transradial coronary angiography: incidence and rationale for treatment of symptomatic patients with low-molecular-weight heparins","volume":"99","year":"2010","unstructured":"Zankl\n              AR,\n            \n            \n              Andrassy\n              M,\n            \n            \n              Volz\n              C,\n            \n            \n              Ivandic\n              B,\n            \n            \n              Krumsdorf\n              U,\n            \n            \n              Katus\n              HA,\n            \n            \n              Blessing\n              E.\n            \n          \n          Radial artery thrombosis following transradial coronary angiography: incidence and rationale for treatment of symptomatic patients with low-molecular-weight heparins.\n\t\t\t\t\tClin Res Cardiol2010;99(12):841\u20137."},{"issue":"2","key":"i1526-6702-47-4-319-b9","series-title":"J Invasive Cardiol","first-page":"106","article-title":"Incidence and predictors of radial artery occlusion after transradial coronary angioplasty: Doppler-guided follow-up study","volume":"27","year":"2015","unstructured":"Garg\n              N,\n            \n            \n              Madan\n              BK,\n            \n            \n              Khanna\n              R,\n            \n            \n              Sinha\n              A,\n            \n            \n              Kapoor\n              A,\n            \n            \n              Tewari\n              S,\n            \n          \n          .\n\t\t\t\t\tIncidence and predictors of radial artery occlusion after transradial coronary angioplasty: Doppler-guided follow-up study.\n\t\t\t\t\tJ Invasive Cardiol2015;27(2):106\u201312."},{"issue":"3","key":"i1526-6702-47-4-319-b10","series-title":"Catheter Cardiovasc Interv","first-page":"335","article-title":"Prevention of radial artery occlusion\u2013patent hemostasis evaluation trial (PROPHET study): a randomized comparison of traditional versus patency documented hemostasis after transradial catheterization","volume":"72","year":"2008","unstructured":"Pancholy\n              S,\n            \n            \n              Coppola\n              J,\n            \n            \n              Patel\n              T,\n            \n            \n              Roke-Thomas\n              M.\n            \n          \n          Prevention of radial artery occlusion\u2013patent hemostasis evaluation trial (PROPHET study): a randomized comparison of traditional versus patency documented hemostasis after transradial catheterization.\n\t\t\t\t\tCatheter Cardiovasc Interv2008;72(3):335\u201340."},{"issue":"3","key":"i1526-6702-47-4-319-b11","series-title":"Catheter Cardiovasc Interv","first-page":"383","article-title":"Hand ischemia resulting from a transradial intervention: successful management with radial artery angioplasty","volume":"76","year":"2010","unstructured":"Rhyne\n              D,\n            \n            \n              Mann\n              T.\n            \n          \n          Hand ischemia resulting from a transradial intervention: successful management with radial artery angioplasty.\n\t\t\t\t\tCatheter Cardiovasc Interv2010;76(3):383\u20136."},{"issue":"9","key":"i1526-6702-47-4-319-b12","series-title":"Circ Cardiovasc Interv","first-page":"e000035","article-title":"An update on radial access and best practices for transradial coronary angiography and intervention in acute coronary syndrome: a scientific statement from the American Heart Association","volume":"11","year":"2018","unstructured":"Mason\n              PJ,\n            \n            \n              Shah\n              B,\n            \n            \n              Tamis-Holland\n              JE,\n            \n            \n              Bittl\n              JA,\n            \n            \n              Cohen\n              MG,\n            \n            \n              Safirstein\n              J,\n            \n          \n          .\n\t\t\t\t\tAn update on radial access and best practices for transradial coronary angiography and intervention in acute coronary syndrome: a scientific statement from the American Heart Association.\n\t\t\t\t\tCirc Cardiovasc Interv2018;11(9):e000035."},{"issue":"22","key":"i1526-6702-47-4-319-b13","series-title":"JACC Cardiovasc Interv","first-page":"2241","article-title":"Multicenter randomized evaluation of high versus standard heparin dose on incident radial arterial occlusion after transradial coronary angiography: the SPIRIT OF ARTEMIS Study","volume":"11","year":"2018","unstructured":"Hahalis\n              GN,\n            \n            \n              Leopoulou\n              M,\n            \n            \n              Tsigkas\n              G,\n            \n            \n              Xanthopoulou\n              I,\n            \n            \n              Patsilinakos\n              S,\n            \n            \n              Patsourakos\n              NG,\n            \n          \n          .\n\t\t\t\t\tMulticenter randomized evaluation of high versus standard heparin dose on incident radial arterial occlusion after transradial coronary angiography: the SPIRIT OF ARTEMIS Study.\n\t\t\t\t\tJACC Cardiovasc Interv2018;11(22):2241\u201350."},{"key":"i1526-6702-47-4-319-b14","series-title":"Pol J Radiol","first-page":"19","article-title":"Critical hand ischemia after radial access for coronary angiography \u2013 case report","volume":"82","year":"2017","unstructured":"Bojakowski\n              K,\n            \n            \n              Zawadzki\n              M,\n            \n            \n              Mruk\n              B,\n            \n            \n              Andziak\n              P,\n            \n            \n              Walecki\n              J.\n            \n          \n          Critical hand ischemia after radial access for coronary angiography \u2013 case report.\n\t\t\t\t\tPol J Radiol2017;82:19\u201323."},{"issue":"1","key":"i1526-6702-47-4-319-b15","series-title":"J Am Coll Surg","first-page":"18","article-title":"Hand ischemia after radial artery cannulation","volume":"201","year":"2005","unstructured":"Valentine\n              RJ,\n            \n            \n              Modrall\n              JG,\n            \n            \n              Claggett\n              GP.\n            \n          \n          Hand ischemia after radial artery cannulation.\n\t\t\t\t\tJ Am Coll Surg2005;201(1):18\u201322."},{"issue":"9","key":"i1526-6702-47-4-319-b16","series-title":"Neth Heart J","first-page":"372","article-title":"Critical hand ischemia after transradial cardiac catheterisation: an uncommon complication of a common procedure","volume":"20","year":"2012","unstructured":"Rademakers\n              LM,\n            \n            \n              Laarman\n              GJ.\n            \n          \n          Critical hand ischemia after transradial cardiac catheterisation: an uncommon complication of a common procedure.\n\t\t\t\t\tNeth Heart J2012;20(9):372\u20135."},{"issue":"2","key":"i1526-6702-47-4-319-b17","series-title":"J Invasive Cardiol","first-page":"89","article-title":"Acute hand ischemia after radial intervention in patient with CREST-associated pulmonary hypertension: successful treatment with manual thromboaspiration","volume":"25","year":"2013","unstructured":"Taglieri\n              N,\n            \n            \n              Galie\n              N,\n            \n            \n              Marzocchi\n              A.\n            \n          \n          Acute hand ischemia after radial intervention in patient with CREST-associated pulmonary hypertension: successful treatment with manual thromboaspiration.\n\t\t\t\t\tJ Invasive Cardiol2013;25(2):89\u201391."},{"issue":"2","key":"i1526-6702-47-4-319-b18","series-title":"JACC Cardiovasc Interv","first-page":"e21","article-title":"Digital gangrene following transradial coronary angiogram","volume":"9","year":"2016","unstructured":"Singh\n              K,\n            \n            \n              Abunassar\n              J,\n            \n            \n              So\n              DY.\n            \n          \n          Digital gangrene following transradial coronary angiogram.\n\t\t\t\t\tJACC Cardiovasc Interv2016;9(2):e21\u20132."}],"container-title":["Texas Heart Institute 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