Abstract
Background Despite the enormous benefits of radial access, this route is associated with a risk of radial artery occlusion (RAO). Objective We compared the incidence of RAO in patients undergoing transradial coronary angiography and intervention after short versus prolonged hemostasis protocol. Also we assessed the efficacy of rescue 1-hour ipsilateral ulnar artery compression if RAO was observed after hemostasis. Material and Methods. Patients referred for elective transradial coronary procedures were eligible. After 6 F radial sheath removal, patients were randomized to short (3 hours) (n = 495) or prolonged (8 hours) (n = 503) hemostasis and a simple bandage was placed over the puncture site. After hemostasis was completed, oximetry plethysmography was used to assess the patency of the radial artery. Results One thousand patients were randomized. Baseline characteristics were similar between both groups with average age 61.4 ± 9.4 years (71% male) and PCI performed on half of the patients. The RAO rate immediately after hemostasis was 3.2% in the short hemostasis group and 10.1% in the prolonged group (p < 0.001). Rescue recanalization was successful only in the short group in 56.2% (11/19); at hospital discharge, RAO rates were 1.4% in the short group and 10.1% in the prolonged group (p < 0.001). Conclusion Shorter hemostasis was associated with significantly less RAO compared to prolonged hemostasis. Rescue radial artery recanalization was effective in > 50%, but only in the short hemostasis group.
Highlights
Radial access (RA) has become the gold standard for coronary angiography (CAG) and percutaneous coronary interventions (PCI) within the last decade. e use of this access is associated with reduced rates of access site complications, MACE, and improved clinical outcomes, including survival [1,2,3]
From 2015 to 2018, from 1284 all-comers patients screened, a total of 1000 patients undergoing diagnostic CAG or PCI were randomized with sealed envelopes in two groups
Patients in both groups were randomized before sheath removal to receive either short (n 495) or prolonged hemostasis (n 505)
Summary
Radial access (RA) has become the gold standard for coronary angiography (CAG) and percutaneous coronary interventions (PCI) within the last decade. e use of this access is associated with reduced rates of access site complications, MACE, and improved clinical outcomes, including survival [1,2,3]. We aimed to compare the incidence of RAO in patients undergoing both diagnostic CAG and PCI using 2 different regimens of radial artery hemostasis. We further compared the efficacy of ipsilateral ulnar artery compression for the treatment of early RAO in both groups. We compared the incidence of RAO in patients undergoing transradial coronary angiography and intervention after short versus prolonged hemostasis protocol. We assessed the efficacy of rescue 1-hour ipsilateral ulnar artery compression if RAO was observed after hemostasis. After 6 F radial sheath removal, patients were randomized to short (3 hours) (n 495) or prolonged (8 hours) (n 503) hemostasis and a simple bandage was placed over the puncture site. Rescue radial artery recanalization was effective in > 50%, but only in the short hemostasis group
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