There is a paucity of data on acute radial artery (RA) injuries using optical coherence tomography (OCT) in patients undergoing coronary intervention via distal transradial coronary access (dTRA). To evaluate the incidence of acute RA injury following dTRA for coronary intervention using OCT. We retrospectively analyzed 200 consecutive patients with acute coronary syndrome (ACS) who underwent coronary intervention guided by OCT and RA-OCT after dTRA at our center between June 2021 and November 2022. Total length of RA was divided into three segments based on the sheath location during dTRA: no sheath protection portion (proximal RA segment) and sheath protection portion (divided into mid- and distal segments). Acute RA injuries, including tears, dissections, perforations, thrombi, and spasms, were analyzed. Radial artery occlusion (RAO) was assessed using ultrasonography 24 h after dTRA. Acute RA injury was observed in 45.5% of patients after dTRA. The incidence of tear, dissection, perforation, thrombi, and spasm in all the patients was 11.5%, 16.5%, 1.5%, 17.5%, and 17.5%, respectively. In segment-level analysis, dissection and spasm were significantly more frequent in the proximal segment, followed by the mid and distal segments (11.0% vs. 5.5% vs. 4.5%, P = 0.015
13.0% vs. 4.0% vs. 4.5%, P = 0.002). The rate of RAO at 24-h follow-up was 3.0%. Acute RA injuries were observed in nearly half of the patients using OCT via dTRA
dissection and spasm occurred more frequently in the proximal segment. Hydrophilic-coated sheaths have the potential advantage of preventing radial artery spasm and dissection.