Manual Radial Artery Compression After Transradial Coronary Procedures: Is It Safe to Go Bare-Handed?

Incidence and Prognostic Factors of Radial Artery Occlusion in Transradial Coronary Catheterization

Background/Objectives: Radial artery occlusion (RAO) is the most common complication of transradial coronary catheterization. In this study, we aimed to evaluate the incidence of RAO and identify the risk factors that predispose patients to it. Methods: We conducted an investigator-initiated, prospective, multicenter, open-label study involving 1357 patients who underwent cardiac catheterization via the transradial route for angiography and/or a percutaneous coronary intervention (PCI). Univariate and multivariate logistic regression analyses were performed to identify potential predictors of RAO occurrence. Additionally, a subgroup analysis only for patients undergoing PCIs was performed. Results: The incidence of RAO was 9.5% overall, 10.6% in the angiography-only group and 6.2% in the PCI group. Independent predictors of RAO were as follows: (i) the female gender (aOR = 1.72 (1.05-2.83)), (ii) access site cross-over (aOR = 4.33 (1.02-18.39)), (iii) increased total time of the sheath in the artery (aOR = 1.01 (1.00-1.02)), (iv) radial artery spasms (aOR = 2.47 (1.40-4.36)), (v) the presence of a hematoma (aOR = 2.28 (1.28-4.06)), (vi) post-catheterization dabigatran use (aOR = 5.15 (1.29-20.55)), (vii) manual hemostasis (aOR = 1.94 (1.01-3.72)) and (viii) numbness at radial artery ultrasound (aOR = 8.25 (1.70-40)). Contrariwise, two variables were independently associated with increased odds for radial artery patency (RAP): (i) PCI performance (aOR = 0.19 (0.06-0.63)), and (ii) a higher dosage of intravenous heparin per patient weight (aOR = 0.98 (0.96-0.99)), particularly, a dosage of >50 IU/kg (aOR = 0.56 (0.31-1.00)). In the PCI subgroup, independent predictors of RAO were as follows: (i) radial artery spasms (aOR = 4.48 (1.42-14.16)), (ii) the use of intra-arterial nitroglycerin as a vasodilator (aOR = 7.40 (1.67-32.79)) and (iii) the presence of symptoms at echo (aOR = 3.80 (1.46-9.87)), either pain (aOR = 2.93 (1.05-8.15)) or numbness (aOR = 4.66 (1.17-18.57)). On the other hand, the use of intra-arterial verapamil as a vasodilator (aOR = 0.17 (0.04-0.76)) was independently associated with a greater frequency of RAP. Conclusions: The incidence of RAO in an unselected, all-comers European population after transradial coronary catheterization for angiography and/or PCIs is similar to that reported in the international literature. Several RAO prognostic factors have been confirmed, and new ones are described. The female gender, radial artery trauma and manual hemostasis are the strongest predictors of RAO. Our results could help in the future identification of patients at higher risk of RAO, for whom less invasive diagnostic procedures maybe preferred, if possible.

Manual compression hemostasis using a hemostatic pad for the distal radial artery approach

BACKGROUND

The method of hemostasis for the distal radial approach has not been standardized, although this approach has become increasingly popular due to its advantages. In this study, we investigated the feasibility of manual compression hemostasis using a calcium alginate pad after coronary angiography via the distal radial approach.

METHODS

We retrospectively collected 150 consecutive patients (mean age, 74.9 ± 8.0 years; male, 75 %) who underwent coronary angiography via the distal radial artery with a predominantly 4 Fr sheath from April 2021 to December 2022 and were hemostatic according to the following methods. After sheath removal, hemostasis was achieved by manual compression for 10 min using a hemostatic pad containing calcium alginate. When hemostasis was confirmed, a small log-shaped gauze was placed over the pad and fixed using a self-adhesive elastic bandage for 2 h. All procedures were performed by four fellows just beginning the distal radial approach.

RESULTS

The mean compression time was 12.4 ± 4.8 min, and hemostasis was successfully achieved in all patients, allowing the release of the elastic bandage after 2 h, with only one patient oozing the next morning. There were no major complications, while one patient had a >10 cm hematoma. Compared to that of the first 15 patients, for each fellow, the compression time of the subsequent patients was significantly shorter (14.5 ± 6.7 vs 11.1 ± 2.1 min, p < 0.01).

CONCLUSIONS

Manual compression hemostasis using calcium alginate pads for the distal radial artery approach appears feasible with a simple learning.

The protective role of low-dose acetylsalicylic acid use and relation with inflammatory and thrombotic parameters on radial artery occlusion in patients undergoing elective transradial coronary angiography

Aim: Transradial angiography (TRA) is recommended in clinical practice; it is better than the transfemoral route to prevent site-related complications. Radial artery occlusion is one of the most seen significant complications after TRA. In the present study, the protective effect of low dose acetylsalicylic acid (ASA) use against the radial artery occlusion (RAO) and the predictive ability of some thrombotic and inflammatory factors for the development of RAO were investigated. Material and Method: One thousand two hundred fifty-four patients who planned for elective coronary angiography were screened to include transradial coronary angiography. The patients have grouped group I, who took ASA (100 mg) (n= 56), and group II (n= 51), who did not. Blood samples were taken immediately after sheath insertion and after the six hours of the sheath removal. The D-dimer and C-reactive protein values were analyzed between groups. In the first 24 hours after the procedure, the radial Doppler ultrasonography assessment was performed to detect RAO. Multivariable regression analysis was used to evaluate the independent risk factors for the TRA. Results: Eligible one hundred seven stable patients were included in the study. The demographic, laboratory and procedural characteristics were similar between the two groups (Table 2). TRA was statistically lower in Group I compared to Group II. (n=3 vs. n=22, p=.001). Multivariable regression analysis demonstrated that postprocedural higher D-dimer levels and non-ASA status were found to be the independent risk factors for RAO (OR (95% CI=1.235(1.014-1.582) p=.001, 5.534 (3.376-9.252), p .05). Conclusion: Preprocedural ASA use may have a protective role against the RAO. Pre- and post-procedural D-dimer levels can predict the thrombotic process in the early phase of the RAO.