Abstract
Introduction: Sheathless transradial access, by decreasing the profile of hardware, is expected to lower the incidence of radial artery occlusion (RAO). Hypothesis: We sought to compare the risk of RAO in patients undergoing coronary intervention with introducer sheath (SG) or without introducer sheath (SLG). Methods: 1251 consecutive patients undergoing 6 French percutaneous coronary intervention (PCI) between January 1, 2009 and December 31, 2013 in Scranton, PA, formed the study cohort. Radial artery patency was assessed using reverse Barbeau’s test and RAO was confirmed by ultrasonography. Unadjusted, adjusted and propensity matched association between type of radial access (SG vs SLG) and RAO were assessed using logistic regression analysis. Results: Mean age was 65 years, 63% were men 37% were diabetics. 78% attained patent hemostasis (PH). Patients in SG had lower pre-discharge RAO [unadjusted (OR: 0.31, 95% CI: 0.21 - 0.46, P < 0.001), adjusted (OR: 0.10, 95% CI: 0.05 - 0.20, P < 0.001) and propensity matched (OR: 0.20, 95% CI: 0.13 - 0.32, P < 0.001)], 24 hours RAO [unadjusted (OR: 0.20, 95% CI: 0.12 - 0.34, P < 0.001), adjusted (OR: 0.12, 95% CI: 0.06 - 0.24, P < 0.001) and propensity matched (OR: 0.13, 95% CI: 0.07 - 0.25, P < 0.001)] and 30 day RAO [unadjusted (OR: 0.28, 95% CI: 0.14 - 0.54, P < 0.001), adjusted (OR: 0.22, 95% CI: 0.10 - 0.50, P < 0.001) and propensity matched (OR: 0.18, 95% CI: 0.10 - 0.40, P < 0.001)], compared to those in SLG. Spontaneous recanalization rates were significantly higher in SG compared to SLG at 24 hours (62% Vs 38%, P = 0.007) but similar at 30 days (38% Vs 50%, P = 0.338) post PCI. Diabetes diagnosis was an effect modifier for RAO at pre-discharge, 24 hours and 30 days post PCI. Conclusions: Sheath use during radial access for PCI, despite diametrically increasing hardware profile, is associated with less RAO, likely by reducing friction induced intimal trauma. Diabetes is an effect modifier in this association.
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