{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:40:46Z","timestamp":1760060446620,"version":"build-2065373602"},"reference-count":18,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Radial artery access (RAA) is widely used for catheter-based procedures due to its safety and convenience, but complex regional pain syndrome (CRPS) remains a rare, underrecognized complication\u2014particularly in women. CRPS manifests as prolonged, severe pain and autonomic symptoms, often associated with nerve irritation near the carpal tunnel. This study aimed to evaluate whether modifying the puncture site to a high radial artery puncture (HRAP) reduces the risk of CRPS in patients undergoing transarterial micro-embolization (TAME) for frozen shoulder. Methods: We retrospectively reviewed 97 patients (47 women and 50 men) who underwent transarterial micro-embolization (TAME) via conventional RAA for frozen shoulder between February and June 2019. The occurrence of CRPS and vascular complications was recorded. All punctures were ultrasound-guided. Results: Among women treated via conventional RAA, five developed CRPS and one had radial artery occlusion. CRPS symptoms included intense puncture site pain (mean duration was 47 days), which severely impaired daily function. No complications occurred in men. Following the adoption of HRAP, no cases of CRPS, prolonged pain, or vascular complications were observed in the consecutive 101 women treated. Conclusions: Our findings suggest HRAP reduces CRPS risk by avoiding superficial nerve branches and targeting deeper arterial segments with fewer sensory structures. This ultrasound-guided modification is simple, does not require additional training, and may be widely applicable in both musculoskeletal and cardiovascular interventions. HRAP may help minimize neuropathic complications in broader patient populations.<\/jats:p>","DOI":"10.3390\/jcm14175937","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T11:50:31Z","timestamp":1755863431000},"page":"5937","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["High Radial Artery Puncture Reduces CRPS Risk for Women: A Retrospective Case Series"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9633-1303","authenticated-orcid":false,"given":"Takehiro","family":"Hashikata","sequence":"first","affiliation":[{"name":"Department of Radiology, Musculoskeletal Intervention Center, Okuno Clinic, Tokyo 106-0032, Japan"},{"name":"Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara 252-0324, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiko","family":"Shibuya","sequence":"additional","affiliation":[{"name":"Department of Radiology, Musculoskeletal Intervention Center, Okuno Clinic, Tokyo 106-0032, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshiaki","family":"Shintani","sequence":"additional","affiliation":[{"name":"Department of Radiology, Musculoskeletal Intervention Center, Okuno Clinic, Tokyo 106-0032, Japan"},{"name":"Department of Cardiology, Ageo Central General Hospital, Ageo 362-8588, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichi","family":"Miyazaki","sequence":"additional","affiliation":[{"name":"Department of Radiology, Musculoskeletal Intervention Center, Okuno Clinic, Tokyo 106-0032, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuji","family":"Okuno","sequence":"additional","affiliation":[{"name":"Department of Radiology, Musculoskeletal Intervention Center, Okuno Clinic, Tokyo 106-0032, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1007\/s00392-022-02094-z","article-title":"Incidence and predictors of radial artery occlusion following transradial coronary angiography: The proRadial trial","volume":"112","author":"Schlosser","year":"2023","journal-title":"Clin. Res. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e005430","DOI":"10.1161\/JAHA.116.005430","article-title":"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","volume":"6","author":"Hahalis","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e04","DOI":"10.15420\/usc.2020.23","article-title":"Vascular complications of transradial access for cardiac catheterization","volume":"15","author":"Riangwiwat","year":"2021","journal-title":"US Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1024\/0301-1526\/a000529","article-title":"Radial artery pseudoaneurysms after transradial cardiac catheterisation","volume":"45","author":"Din","year":"2016","journal-title":"Vasa"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e422","DOI":"10.1097\/MD.0000000000000422","article-title":"Complex regional pain syndrome and acute carpal tunnel syndrome following radial artery cannulation: A neurological perspective and review of the literature","volume":"94","author":"Lazaro","year":"2015","journal-title":"Medicine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1007\/s00540-004-0266-0","article-title":"A case of complex regional pain syndrome type II after transradial coronary intervention","volume":"18","author":"Sasano","year":"2004","journal-title":"J. Anesth."},{"key":"ref_7","unstructured":"Guthmiller, K.B., Dua, A., Dey, S., and Varacallo, M.A. (2025, July 18). Complex Regional Pain Syndrome [Updated 4 May 2025], StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK430719\/."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1468","DOI":"10.1016\/j.jvir.2022.08.016","article-title":"Transarterial embolization of neovascularity for refractory nighttime shoulder pain: A multicenter, open-label, feasibility trial","volume":"33","author":"Okuno","year":"2022","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1097\/AJP.0000000000001070","article-title":"Autonomic nervous system function and central pain processing in people with frozen shoulder: A case-control study","volume":"38","author":"Mertens","year":"2022","journal-title":"Clin. J. Pain"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1016\/S0140-6736(11)60404-2","article-title":"Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): A randomised, parallel group, multicentre trial","volume":"377","author":"Jolly","year":"2011","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1016\/S0140-6736(15)60292-6","article-title":"Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: A randomised multicentre trial","volume":"385","author":"Valgimigli","year":"2015","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1136\/neurintsurg-2019-015604","article-title":"Distal radial access in the anatomical snuffbox for neurointerventions: A feasibility, safety, and proof-of-concept study","volume":"12","author":"Singh","year":"2020","journal-title":"J. Neurointerv. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Roh, J.W., Kim, Y., Lee, O.H., Im, E., Cho, D.K., Choi, D., and Jeong, M.H. (2021). The learning curve of the distal radial access for coronary intervention. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-92742-7"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1097\/00003086-199411000-00034","article-title":"The radial sensory nerve: An anatomic study","volume":"308","author":"Auerbach","year":"1994","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1161\/CIRCULATIONAHA.116.024534","article-title":"Ischemia and no obstructive coronary artery disease (INOCA): Developing evidence-based therapies and research agenda for the next decade","volume":"135","author":"Pepine","year":"2017","journal-title":"Circulation"},{"key":"ref_16","first-page":"1611","article-title":"INOCA and MINOCA: Are Women\u2019s Heart Centres the Answer to Understanding and Management of These Increasing Populations of Women (and Men)?","volume":"38","author":"Pacheco","year":"2022","journal-title":"Can. J. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e37","DOI":"10.15420\/ecr.2021.20","article-title":"The Role of Mental Stress in Ischaemia with No Obstructive Coronary Artery Disease and Coronary Vasomotor Disorders","volume":"16","author":"Roos","year":"2021","journal-title":"Eur. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3415","DOI":"10.1093\/eurheartj\/ehae177","article-title":"2024 ESC Guidelines for the management of chronic coronary syndromes","volume":"45","author":"Vrints","year":"2024","journal-title":"Eur. Heart J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/17\/5937\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:33:51Z","timestamp":1760034831000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/17\/5937"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,22]]},"references-count":18,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14175937"],"URL":"https:\/\/doi.org\/10.3390\/jcm14175937","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,8,22]]}}}