A novel approach to reduce radial artery occlusion after transradial catheterization: Postprocedural/prehemostasis intra‐arterial nitroglycerin

Dharma, Surya; Kedev, Saško; Patel, Tejas; Kiemeneij, Ferdinand; Gilchrist, Ian C.

doi:10.1002/ccd.25661

Cited by 89 publications

(91 citation statements)

References 18 publications

(25 reference statements)

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“…The first finding was expected and is consistent with previous results [1]. On the contrary, few previous studies focused on the hemostasis time, showing the importance of an adequate and careful management of hemostasis after the procedure [17]. Dharma et al [17], in a multicenter study in which all patients received 50–100 IU/kg of heparin, found that the duration of the hemostasis was the strongest predictor of RAO.…”

Section: Discussionsupporting

confidence: 80%

“…On the contrary, few previous studies focused on the hemostasis time, showing the importance of an adequate and careful management of hemostasis after the procedure [17]. Dharma et al [17], in a multicenter study in which all patients received 50–100 IU/kg of heparin, found that the duration of the hemostasis was the strongest predictor of RAO. We have confirmed this observation in a different population and without default local administration of heparin.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Verapamil versus Heparin as Adjunctive Treatment for Transradial Coronary Procedures: The VERMUT Study

et al. 2018

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Objective: We sought to demonstrate that the combination of a local vasodilator (verapamil), modern materials, patent hemostasis, and intravenous anticoagulant only in the case of percutaneous coronary intervention, as compared to default heparin administration after sheath insertion, may optimize a combined endpoint, including radial artery occlusion (RAO), radial artery spasm (RAS), and access site complication. Methods: This is a prospective, single-center, double-blind randomized trial. Overall, 418 patients undergoing a transradial approach (TRA) for coronary procedures were randomized 1: 1 to receive intraradial verapamil (5 mg) or heparin (5,000 IU) after a 6-Fr sheath insertion. The primary outcome was the 24-h occurrence of RAO (ultrasound confirmation), access site complication, and RAS requiring the bailout administration of vasodilators. Results: The combined primary outcome occurred in 127 (30%) patients. It was significantly lower in patients randomized to verapamil as compared to others (26 vs. 35%, p = 0.03). This was mainly due to a significant reduction in RAS (3 vs. 10%, p = 0.006). The 24-h and 30-day occurrence of RAO did not differ between the study groups. Conclusion: Local administration of verapamil versus heparin reduces RAS, without increasing RAO, which appears to be strictly related to radial artery diameter and hemostasis time.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Comparison of Verapamil versus Heparin as Adjunctive Treatment for Transradial Coronary Procedures: The VERMUT Study

et al. 2018

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“…The rate of RAO in the standard deflation group was higher than expected from previous data. Prior trials have reported RAO rates at 24 hours between 4.3% and 12% 9–12,15,16 . However, the majority of these trials used 5 Fr sheaths; a higher rate of RAO has been established with the use of a larger sheath size 17 .…”

Section: Discussionmentioning

confidence: 99%

Facilitated patent haemostasis after transradial catheterisation to reduce radial artery occlusion

Edris¹,

Gordin²,

Sallam³

et al. 2015

EuroIntervention

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Aims This study sought to evaluate the feasibility of a rapid deflation technique (RDT) after transradial catheterisation to achieve patent haemostasis and to assess whether this could reduce radial artery occlusion (RAO). Ensuring patent haemostasis is the most important factor in reducing RAO. The use of larger sheath sizes and antiplatelet and antithrombotic agents limits achieving patent haemostasis immediately after transradial intervention. Methods and results A feasibility assessment was first performed in 105 patients to assess whether RDT could be performed safely and consistently achieve patent haemostasis after transradial catheterisation. Prospective data were then collected on 201 patients who underwent either rapid or standard deflation technique and had RAO assessment at 24 hours. Acute coronary syndrome was the indication for transradial catheterisation in 62.7% of patients. Baseline patent haemostasis increased from 40% to 95% after RDT. RAO at 24 hours was seen in two (2.0%) patients in the RDT group and 15 (14.9%) in the standard deflation group (OR 0.117; 95% CI: 0.026 to 0.526, p=0.005). Other independent predictors of RAO included body surface area (OR 0.022; 95% CI: 0.002 to 0.273, p=0.003) and male sex (OR 0.298; 95% CI: 0.108 to 0.824, p=0.020). No significant difference was found in safety outcomes: need to re-inflate compression band (2% versus 1.8%) or haematoma (0% versus 0.9%). Conclusions Rapid deflation of the compression band after transradial catheterisation is a safe and effective method of achieving patent haemostasis that reduces RAO.

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“…It should be highlighted, however, that among patients who had a standard deflation protocol, patent hemostasis was not assessed and the TR Band was maintained for 2 hours until removal . In this regard, Dharma and colleagues showed that the duration of hemostasis was found to be a strong predictor of RAO, increasing the risk by 3‐fold.…”

Section: Discussionmentioning

confidence: 99%

“…Such instructions regarding duration are not available for all devices. Nevertheless, the concept of early release is likely applicable to all devices, and it seems that the compression clamp starts to be released only after 2 to 4 hours at most institutions …”

Section: Discussionmentioning

confidence: 99%

Randomized Trial of Compression Duration After Transradial Cardiac Catheterization and Intervention

Lavi

Cheema

Yadegari

et al. 2017

JAHA

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Background Radial artery occlusion is a known complication following transradial cardiac catheterization. A shorter duration of postprocedural radial clamp time may reduce radial artery occlusion ( RAO ) but might be associated with incomplete hemostasis. Methods and Results In total, 568 patients undergoing transradial diagnostic cardiac catheterization were randomly assigned to either 20 minutes (ultrashort) or 60 minutes (short) hemostatic compression time using patent hemostasis. Subsequently, clamp pressure was reduced gradually over 20 minutes. Access site hemostasis and RAO were assessed after clamp removal. Repeated assessment of RAO was determined at 1 week in 210 (37%) patients. Mean age was 64±11 years, and 30% were female. Percutaneous coronary intervention was performed in 161 patients. RAO immediately after clamp removal was documented in 14 (4.9%) and 8 (2.8%) patients in the 20‐ and 60‐minute clamp application groups, respectively ( P =0.19). The incidence of grade 1 hematoma was higher in the 20‐minute group (6.7% versus 2.5%, P =0.015). RAO at 1 week after the procedure was 2.9% and 0.9% in the 20‐ and 60‐minute groups, respectively ( P =0.36). Requirement for clamp retightening (36% versus 16%, P =0.01) was higher among patients who had RAO . Need for clamp retightening was the only independent predictor of RAO ( P =0.04). Conclusions Ultrashort radial clamp application of 20 minutes is not preferable to a short duration of 60 minutes. The 60‐minute clamp duration is safe and provides good access site hemostasis with low RAO rates. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 02269722.

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A novel approach to reduce radial artery occlusion after transradial catheterization: Postprocedural/prehemostasis intra‐arterial nitroglycerin

Abstract: The administration of nitroglycerin at the end of a transradial catheterization, reduced the incidence of RAO, examined 1 day after the radial procedure by ultrasound. Postprocedural/prehemostasis pharmacologic regimens may represent a novel target for further investigation to reduce RAO.

Cited by 89 publications

References 18 publications

Comparison of Verapamil versus Heparin as Adjunctive Treatment for Transradial Coronary Procedures: The VERMUT Study

Comparison of Verapamil versus Heparin as Adjunctive Treatment for Transradial Coronary Procedures: The VERMUT Study

Facilitated patent haemostasis after transradial catheterisation to reduce radial artery occlusion

Randomized Trial of Compression Duration After Transradial Cardiac Catheterization and Intervention

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