Usefulness of a Gentle and Short Hemostasis Using the Transradial Band Device after Transradial Access for Percutaneous Coronary Angiography and Interventions to Reduce the Radial Artery Occlusion Rate (from the Prospective and Randomized CRASOC I, II, and III Studies)

Abstract

The study sought to evaluate the benefit of the reduction in intensity and duration of the hemostasis obtained with the transradial (TR) Band compression device on the radial artery occlusion (RAO) rate. RAO is the most frequent complication of TR access for cardiac catheterization and limits future use of this safe route. Its occurrence must be minimized. Between 2009 and 2016, 3,616 TR accesses were randomized to TR Band hemostasis during 3consecutive protocols: CRASOC I (Compression of Radial ArterieS without Occlusion): 13 versus 10cc of air into the TR Band and for 4hours of continuous compression; CRASOC II: 10cc of air for 3 hours versus 2hours of compression; and CRASOC III: 10cc of air for 2 hours versus 1.5hours of compression and virtual 4F introducer as default sheath (both arms). Radial artery patency was assessed by plethysmography at 24 hours, using Doppler for doubtful or negative plethysmography. The primary end point, 24 hours of RAO, was markedly reduced when hemostasis was soft (10cc of air) and short (1.5hours) and resulted in a 2.3% rate of RAO versus 9.4% for 13 cc, 4hours. Hemostasis was obtained in 89% of patients with only 10cc of air and in 97% of patients with less than the recommended 13cc. About 8% of patients required more than the 1.5hours of hemostasis time. In conclusion, short and soft hemostasis with the TR Band device leads to a low RAO rate.