Evaluation of the incidence of radial artery occlusion using different introducer sheaths and hemostasis techniques

Abstract

Background: Radial artery occlusion (RAO) remains one of the most important complications of transradial access (TRA). Despite the identification of multiple predictors, the interaction between these predictors on the occurrence of RAO has not been evaluated.Methods: Consecutive patients undergoing TRA coronary angiography (CA) or percutaneous coronary intervention (PCI), were retrospectively analyzed to compare the effect of standard patent hemostasis using a one-bladder band versus twobladder band with simultaneous ipsilateral ulnar artery compression and two introducer sizes on the primary endpoint of RAO. Access was obtained using 6-Fr slender introducer sheath or 7-Fr slender introducer sheath and hemostasis with either a one-bladder band or a two-bladder band. The radial artery was evaluated using ultrasound.Results: Total of 2019 patients undergoing CA or PCI were included in the analysis.In the one-bladder band group, the incidence of RAO with a 6-Fr slender introducer sheath was 4.2%. In those receiving hemostasis with a two-bladder band, RAO occurred in 1% of patients receiving a 6-Fr slender introducer sheath versus 0.9% in those receiving a 7-Fr slender introducer sheath (p = 0.68). Larger radial artery diameter, larger body weight, and a two-bladder hemostasis band with ipsilateral ulnar compression were independently associated with a lower incidence of RAO. Conclusion:A two-bladder band with simultaneous ipsilateral ulnar artery compression when used for radial artery hemostasis, is associated with a lower incidence of RAO, and can mitigate the penalty for a larger catheter with reassuring implications for use of a 7-Fr capable system for complex transradial PCI.

Simultaneous Radial and Ipsilateral Ulnar Artery Compression versus Isolated Radial Artery Compression after Conventional Radial Access for Coronary Angiography and/or Intervention: A Systematic Review and Meta-Analysis

“…The PRISMA flow diagram for study search and selection is shown in Figure 1 . Of the 316 citations screened, a total of 6 studies, including 6793 patients, were identified and included in the final analysis [ 12 , 23 , 24 , 25 , 26 , 27 ]. Details on the search strategy are reported in the Supplementary Materials .…”

“…Coronary angiography alone was performed in one study [ 9 ], PCI following coronary angiography was performed in a variable proportion of patients ranging from 15.6% to 58.7% across 4 studies [ 23 , 25 , 26 , 27 ], while no information was available in one study [ 24 ]. Patients presenting with acute coronary syndrome were excluded in two studies [ 12 , 26 ], data regarding the clinical syndrome were reported in two studies [ 23 , 25 ], with the proportion of acute coronary syndrome ranging from 30.2% to 88.7%, and no information was available in 2 studies [ 24 , 27 ]. The best recommendations for the detection and prevention of RAO were followed in all included studies [ 10 ].…”

“…For instance, 5 French (Fr) access site sheath was used in 2 studies [ 12 , 24 ], 6 Fr access size sheath in 2 studies [ 26 , 27 ] and in the majority of cases (from 95.1% to 96.3%) in two studies [ 23 , 25 ]. Compression of the ulnar artery was achieved with a dedicated ulnar artery compression device comprising a double-balloon band system [ 23 , 24 ], a second radial band device adapted to the ulnar artery [ 26 , 27 ], or by compressing a cylindrical composite of gauze or the barrel of a plastic syringe at the Guyon’s canal with a Hemoband (Hemoband Corporation, Portland, Oregon) [ 12 , 25 ]. Transient ulnar artery compression (1 h) was performed in all studies but one [ 12 ], in which continuous compression following the radial artery compression time was applied.…”

2 bladder, or not 2 bladder? That is the question

“…Patel et al report that the incidence of RAO after 6 French radial access was less in the two‐bladder band with simultaneous ipsilateral ulnar compression (1.0%) versus the one‐bladder band group (4.2%, p = 0.009) 3 . Of those that received the two‐bladder band, the incidence of RAO was similar with the use of the 6 French versus 7 French slender introducers (1.0% vs. 0.9%, p = 0.9).…”

“…In this issue of Catheterization and Cardiovascular Interventions , Patel et al report a study comparing patent hemostasis with a one‐bladder compression band (TR band) versus a novel two‐bladder compression band (Vasoband, VASOInnovations Inc.) that provides simultaneous ipsilateral ulnar artery compression. They observed sequential cohorts of 1592 patients treated with the single‐bladder band over 16 months and 427 patients treated with the two‐bladder band over the next 8 months 3 The investigators further compared results with the two‐band device when radial access employed 6 French versus 7 French Terumo Slender introducer sheaths.…”