Does smaller sheath size allow transradial coronary angiography without heparin administration?

Abstract

Radial artery occlusion is the most common complication after coronary angiography performed by transradial access. It has been shown that heparin administration decreases the rate of radial artery occlusion but most of these studies were performed using 6 F arterial sheaths. There are few data regarding the radial artery occlusion rate after 4 French coronary angiography performed without heparin and with a reduced compression time. To assess radial artery patency after diagnostic coronary angiography performed through a 4 F sheath without heparin administration and with a short hemostasis time by manual compression. In this observational study, patients referred for diagnostic coronary angiography from February 2017 to May 2017 underwent the procedure either using a 4 French arterial sheath, no heparin administration and a short manual compression time (Group 1) or using a 5 French arterial sheath, heparin administration and prolonged hemostasis by a compression wristband (Group 2). We assessed radial artery patency by continuous Doppler ultrasound after removal of the radial compression band, if any. Three hundred and eight patients were included, 51 (16.5%) in Group 1. Eleven cases of radial artery occlusion (3.57% of the study population) were diagnosed by Doppler, asymptomatic in all. Radial artery occlusion was more frequent in Group 1 (9.8% vs. 2.3%, P = 0.006). Lower weight ( P = 0.04) and lower heparin dose ( P = 0.005) were associated with an increased risk of radial occlusion. Four French transradial coronary angiography without heparin led to an increased risk of radial artery occlusion compared to a strategy of 5 French coronary angiography with heparin administration.