P6518Radial artery dilatation to improve access and lower complication rates during coronary angiography (RADIAL): a randomized controlled trial

Abstract

Background Transradial catheterization has become the preferred access site for coronary angiography. The transradial approach is however not without challenges and complications. Cannulation is technically challenging and may require multiple cannulation attempts or access may fail. Local access site complications may occur postprocedurally. Purpose To explore the use of prolonged occlusion flow mediated dilatation (PO-FMD) to dilate the radial artery prior to cannulation to reduce puncture attempts, increase cannulation success and reduce access site complications in transradial coronary angiography. Methods 1156 patients undergoing transradial coronary angiography were randomized into PO-FMD and sham PO-FMD groups. PO-FMD was achieved by a 10 minute inflation of a blood pressure cuff on the arm to above systolic pressure, followed by deflation with resultant radial artery dilation. In the sham PO-FMD group the cuff was not inflated. The operators were blinded to the intervention. Results 580 patients were randomized to the sham PO-FMD group and 576 to the PO-FMD group. The number of puncture attempts were reduced with the use of PO-FMD, with a median number of attempts of 1 in the PO-FMD group and 2 in the sham PO-FMD group (p<0.001). Cannulation failure was reduced with PO-FMD FMD with cannulation failure rates of 2.7% in the PO-FMD group and 5.8% in the sham PO-FMD group (p=0.01). Radial artery pulsation loss (RAPL) was reduced with PO-FMD with 1.4% in the PO-FMD group and 3.8% in the sham PO-FMD group (p=0.02). Conclusion PO-FMD decreases puncture attempts, reduces cannulation failure rates and decreases RAPL during transradial coronary angiography.

Vascular Complications of Transradial Access for Cardiac Catheterization

“…3 However, 60-70% of these occluded cases later have spontaneous recanalization of their radial artery. 35,36 At 6 months postprocedure, radial artery occlusion diagnosed by Doppler was 5.1%; this incidence is consistent with other studies that report radial artery occlusion in 3.9-8.1% of patients 8,14,16,35 Nonetheless, only 0.2% of radial access patients developed symptomatic radial occlusion needing medical attention. 1 The symptoms of radial artery occlusion include hand or finger pain or discoloration, weakness, cold, or sensory deficit.…”

“…12,13 The incidence of radial artery spasm is 4-5% in large randomized control trials (RADIAL and RIVAL trials). 1,[14][15][16] Younger age, female sex, diabetes, and lower BMI are independent predictors of radial artery spasm, as are small radial artery diameter, large sheath:artery size ratio, and multiple catheter exchanges. 12 Most radial artery spasm is mild, and multiple techniques can be used to prevent and treat it.…”