Reverse Barbeau test accuracy in the diagnosis of radial artery occlusion after transradial coronary catheterization
A Keramas, S Tsokkou, A Pagiantza, A S Papazoglou, C Kakderis, S Daios, E Peteinidou, K Lekka, K C Theodoropoulos, A Kouparanis, T Papamitsou, V Kamperidis, G Kassimis, A Ziakas, M DidagelosAbstract
Background
Radial artery occlusion (RAO) is a relatively common consequence of transradial coronary procedures, yet it often goes unnoticed because patients remain asymptomatic. Despite its relevance for future access sites and potential graft use, routine evaluation of radial artery patency before hospital discharge is not consistently practiced.
Purpose
This study examined how accurately an early bedside reverse Barbeau test (pulse oximetry plethysmography) can identify RAO when compared with radial artery duplex ultrasound performed at the same time point.
Methods
A total of 769 patients undergoing transradial coronary angiography or angioplasty were enrolled. In the first 24 hours after successful hemostasis (T0), each participant underwent a reverse Barbeau test, categorized as either normal (types A, B, C) indicative of radial artery patency or abnormal (type D) indicative of RAO. Radial artery patency was simultaneously assessed with duplex ultrasound, which served as the reference standard. The primary outcome was the presence of RAO on ultrasound at T0. Diagnostic metrics, including sensitivity, specificity, positive and negative predictive values, and likelihood ratios, were calculated.
Results
Complete paired assessments were available for 724 individuals. Ultrasound confirmed RAO in 69 patients (9.5%). An abnormal reverse Barbeau test occurred in 70 cases (9.7%), 58 of which corresponded to true RAO. The test demonstrated a sensitivity of 84.1% and a specificity of 98.2%. The positive predictive value reached 82.9%, while the negative predictive value was 98.3%. The positive likelihood ratio was 45.9, and the negative likelihood ratio was 0.16. Among those with RAO at T0, spontaneous recanalization was observed in 12.3% at four weeks, and either full or partial improvement in patency occurred in 25.4%.
Conclusion
An early reverse Barbeau test performed at the bedside shows high specificity and an excellent ability to rule out RAO when compared with ultrasound. Implementing universal reverse Barbeau screening, followed by targeted ultrasound only in abnormal cases, may offer a practical and efficient strategy for early detection and follow-up of RAO after transradial coronary procedures.