Retrospective Analysis of Angiographic Radial Artery Spasm Predictors

Background: Radial artery spasm remains a frequent complication during transradial coronary and peripheral angiography. Despite its impact on procedural success and patient discomfort, consistent predictors remain elusive, as does a standard definition. Objectives: This study aimed to identify independent clinical, hemodynamic, and anatomical predictors of radial artery spasm using data from a single-operator, real-world cohort of patients undergoing both elective and emergency procedures, utilizing an angiographic definition of radial artery spasm. Methods: A retrospective observational analysis was conducted on 96 patients with successful radial artery access. Radial artery spasm was objectively defined as >50% luminal narrowing on radial angiography. Patient demographics, procedural characteristics, comorbidities, and arterial parameters were analyzed. Univariate and multivariate logistic regression models were used to identify significant predictors. Results: Radial artery spasm occurred in 62.5% of patients. Univariate analysis identified lower height, weight, smaller radial artery diameter, higher pain scores, and lower diastolic blood pressure as associated with radial artery spasm. In multivariate analysis, only lower body weight (β = −0.043, p = 0.0307) and smaller radial artery diameter (β = −1.352, p = 0.0200) remained independent predictors. Age, sex, and most comorbidities, including diabetes, chronic kidney disease, and peripheral artery disease, showed no significant association. Clinically, these findings suggest that simple pre-procedural assessment of patient weight and radial artery diameter may help operators identify individuals at higher risk of radial spasm, allowing for tailored preventive strategies and potentially improving procedural comfort and success. Conclusions: Our findings suggest that low body weight and small radial artery diameter are significant independent predictors of angiographic radial artery spasm, highlighting the importance of anatomical considerations over demographic or clinical factors. Preprocedural assessment of radial artery size may enhance risk stratification and guide preventive strategies. Further multicenter validation is warranted. Incorporating routine evaluation of radial artery size and body habitus into pre-procedural assessment may help identify patients who could benefit from tailored preventive approaches—such as smaller sheath sizes, increased vasodilator use, or ultrasound-guided puncture—to optimize procedural success and patient comfort.