A Randomized Trial Comparing Short versus Prolonged Hemostasis with Rescue Recanalization by Ipsilateral Ulnar Artery Compression: Impact on Radial Artery Occlusion—The RESCUE-RAO Trial

Abstract

Background. Despite the enormous benefits of radial access, this route is associated with a risk of radial artery occlusion (RAO). Objective. We compared the incidence of RAO in patients undergoing transradial coronary angiography and intervention after short versus prolonged hemostasis protocol. Also we assessed the efficacy of rescue 1-hour ipsilateral ulnar artery compression if RAO was observed after hemostasis. Material and Methods. Patients referred for elective transradial coronary procedures were eligible. After 6 F radial sheath removal, patients were randomized to short (3 hours) (n = 495) or prolonged (8 hours) (n = 503) hemostasis and a simple bandage was placed over the puncture site. After hemostasis was completed, oximetry plethysmography was used to assess the patency of the radial artery. Results. One thousand patients were randomized. Baseline characteristics were similar between both groups with average age 61.4 ± 9.4 years (71% male) and PCI performed on half of the patients. The RAO rate immediately after hemostasis was 3.2% in the short hemostasis group and 10.1% in the prolonged group ( p < 0.001 ). Rescue recanalization was successful only in the short group in 56.2% (11/19); at hospital discharge, RAO rates were 1.4% in the short group and 10.1% in the prolonged group ( p < 0.001 ). Conclusion. Shorter hemostasis was associated with significantly less RAO compared to prolonged hemostasis. Rescue radial artery recanalization was effective in > 50%, but only in the short hemostasis group.

Hemostasis after transradial coronary intervention by rotary compression device with sterile gauze is associated with more adverse events: a retrospective study

“…A study reported that while hand swelling and radial artery hemorrhage fully resolve after medical treatment and sheath removal, RAO is the most common postprocedural complication, and approximately half of the cases eventually experience spontaneous recanalization [24]. Larger forearm artery [25], shorter compression time, small sheath size, higher dose of anticoagulation, vasorelaxing regimen, and distal radial artery approach have been recognized in several studies as an effective way to prevent RAO [26][27][28]. However, recent research indicated that sheath size and compression time do not affect short-term or long-term incidences of RAO following TRA [29,30].…”

Analysis of radial artery occlusion causes and methods of its prevention after interventions using radial access. Results of the APRIORI study

“…Частота ОЛА при коротком гемостазе была 1,4%, при пролонгированном 10,2%, в общей популяции 21,8% (p<0,001). Аналогичные результаты были получены авторами других исследований, в которых в зависимости от методики гемостаза час тота ОЛА варьировалась от 1,1 до 33% [1,3,[8][9][10]. Высокая частота ОЛА в ретроспективном исследовании хорошо соотносится с 30% частотой у Uhlemann M, et al, которые показали реальную клиническую практику, включив всех врачей и пациентов в исследование [11].…”

“…В отличие от других исследований, наша работа включает всех пациентов, подлежащих чрескожному вмешательству, без рафинированных выборок. Кроме этого, высокую частоту окклюзии можно объяснить частым использованием УЗИ для подтверждения ОЛА, в сравнении с предыдущими работами, в которых УЗИ используется спорадически или не используется вовсе [1,3,[8][9][10]. Клиническая значимость ОЛА требует достоверного её определения с помощью УЗИ или теста Барбо с пульсоксиметром.…”

“…Наши результаты схожи c другими работами. Наибольшей склонностью к возникновению ОЛА обладают: пациенты женского пола [9], с низким ИМТ [10,14], страдающие сахарным диабетом [12,14,16].…”

Double-blind, single-center, randomized study evaluating the effectiveness of Isosorbide Mononitrate in preventing radial artery occlusion compared to placebo in patients undergoing elective percutaneous coronary procedure: study protocol

“…O fato de a via radial ter se transformado na via de escolha para os PCP e seu potencial risco para OAR após procedimento incentivaram a busca de estratégias para sua prevenção. Entre as estratégias mecânicas cientificamente comprovadas estão o tempo de compressão hemostática mais curto 27 , a hemostasia patente 28 , e a compressão conjunta da artéria ulnar com a hemostasia patente 29 . Entre as estratégias farmacológicas citam-se o uso intrarterial na artéria radial de heparina não fracionada, de baixo peso molecular e inibidores diretos da trombina (bivalirudina) 22 , assim como a injeção subcutânea de nitroglicerina (NTG) 19 .…”