Radial compression guided by mean artery pressure versus standard compression with a pneumatic device (RACOMAP)

Cubero, José M.; Lombardo, Juan; Pedrosa, Carmela; Diaz-Bejarano, Dolores; Sánchez, Blanca de Vega; Fernández, V. Martínez de Vega; Gómez, C Javier Almeida; Vázquez, Rafael; Molano, Francisco; Pastor, Luis

doi:10.1002/ccd.21900

Cited by 137 publications

(80 citation statements)

References 22 publications

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“…Another speculation might be that the arterial stiffness in hypertension may preclude the total interruption of flow during manual compression, thus providing adequate maintenance of perfusion. In other words, patent hemostasis, which has been shown to decrease the rate of RAO [26,27], might be the mechanism in our hypertensive patients.…”

Section: Discussionmentioning

confidence: 84%

The long-term incidence and predictors of radial artery occlusion following a transradial coronary procedure

et al. 2014

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Section: Discussionmentioning

confidence: 84%

The long-term incidence and predictors of radial artery occlusion following a transradial coronary procedure

et al. 2014

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“…10,12 Furthermore, rates of RAO are higher with prolonged cannulation times, 20 -22 whereas RAO is reduced with anticoagulation 23 and nonocclusive hemostasis. 11,24,25 Direct support for the thrombotic hypothesis has come from recent studies that have confirmed the presence of radial artery thrombus on vascular ultrasound, 26 angiography, 27 and pathology. 28 Transradial catheterization can also negatively affect radial artery structure and function.…”

Section: Pathophysiologymentioning

confidence: 99%

“…The intervention group had significantly less RAO than the control group, both at 24 hours (5% versus 12%, PϽ0.05) and at 1 month (1.8% versus 7.0%, PϽ0.05). The importance of patent hemostasis was confirmed in the Radial Compression Guided by Mean Artery Pressure Versus Standard Compression with a Pneumatic Device Trial (RACOMAP), 24 which tested the concept using the TR Band (Terumo Medical Corporation, Somerset, NJ), a device with an inflatable bladder that is used to apply differential amounts of pressure to the artery. Patients were randomly assigned to compression guided by mean arterial pressure (the TR Band bladder was inflated to mean arterial pressure) versus a control group that received a standard 15 cc of air in the bladder.…”

Section: Sheath Sizementioning

confidence: 99%

Radial Artery Patency After Transradial Catheterization

Kotowycz

Džavík

2012

Circ: Cardiovascular Interventions

176

133

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T he transradial approach to cardiac catheterization has many advantages over the transfemoral approach and is increasingly being used for both diagnostic coronary angiography and percutaneous coronary intervention (PCI). The technique is associated with fewer vascular access complications [1][2][3] and has been shown to reduce major bleeding when compared with the femoral approach. 4 Patients prefer the radial approach and score higher on quality-of-life questionnaires after transradial catheterization. 3,5 Radial access allows for earlier patient ambulation and same-day hospital discharge in PCI patients 4 -6 and is associated with decreased cost. 5,7,8 Radial artery occlusion (RAO) is a complication of transradial catheterization that can lead to permanent occlusion of the radial artery. Estimated to occur in 1-10% of cases, 9 -14 it has been described as the "Achilles' heel" of the transradial technique. 15 RAO is usually clinically silent because of the dual blood supply to the hand, and for this reason it is often overlooked. In fact, more than 50% of transradial operators do not routinely assess radial artery patency before hospital discharge. 16 However, the complication is not benign, as hand ischemia resulting from RAO has been reported. [17][18][19] Furthermore, once the artery is occluded, it cannot be used as an access site for future catheterization or as an arterial conduit for bypass surgery. RAO renders the ipsilateral ulnar artery unusable as well, because instrumenting and cannulating the ulnar would put the patient's hand at risk of ischemia. In this report, we review the pathophysiology, clinical presentation, and risk factors for RAO, discuss prevention and treatment options, and suggest directions for future research aimed at minimizing this complication. PathophysiologyAcute loss of radial artery patency after cardiac catheterization is thought to be due to a thrombotic process. Sheath insertion leads to local endothelial injury and cessation of blood flow in the radial artery, creating an environment conducive to thrombosis. Many observations about RAO provide indirect evidence to support this hypothesis. RAO tends to occur early after transradial catheterization, and roughly 50% of patients have spontaneous recanalization of the artery within 1-3 months. 10,12 Furthermore, rates of RAO are higher with prolonged cannulation times, 20 -22 whereas RAO is reduced with anticoagulation 23 and nonocclusive hemostasis. 11,24,25 Direct support for the thrombotic hypothesis has come from recent studies that have confirmed the presence of radial artery thrombus on vascular ultrasound, 26 angiography, 27 and pathology. 28 Transradial catheterization can also negatively affect radial artery structure and function. A study using optical coherence tomography found that 67% of radial arteries had intimal tears and 36% had medial dissections immediately after transradial PCI. 29 Other studies have found that minimal lumen diameter and minimal lumen area are smaller in repeat transradial patients than i...

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“…5000 IU heparin (or 70 IU/kg) is recommended, and most operators use an intraarterial route. Other potential predictive factors of RAO are procedural time, operators in their learning curve, arterial diameter ratio to the sheath and compression time and pressure [8,9]. Anatomical variations: a wire can be introduced into a remnant artery with a small arterial diameter (type 3) but failure to advance any catheter is the rule and the incidence of spasm is very high in such anatomy.…”

Section: Prevention Of Radial Artery Occlusion (Rao)mentioning

confidence: 99%

“…The amount of air inflated in the TR-band usually varies between 13 to 18 ml. A Spanish study [9] showed that when the amount of air inflated was guided by mean arterial pressure (mean air volume of 8.8 ml), significantly fewer RAO were observed than…”

Section: Figurementioning

confidence: 99%

How to transform you into a radialist (Part II): tips and tricks

Frangos¹,

Noble²

2011

Cardiovasc Med

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SummaryThe transradial approach increases patient comfort and reduces vascular complications and major bleeding. Although modern equipment has been improved and catheter sizes reduced, there remain specific technical challenges in the practice of the transradial approach. Indeed, the transradial approach requires a longer learning curve than transfemoral access, but the transradial challenges are usually overcome with experience. Nowadays, in view of its benefits, there is no longer any justification for ignoring the transradial approach, the patient's preferred access route for percutaneous coronary interventions. In this paper we highlight five rules which will transform you into a radialist and provide valuable tips and tricks.

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Radial compression guided by mean artery pressure versus standard compression with a pneumatic device (RACOMAP)

Abstract: Use of pneumatic compression guided by MAP is safe and efficient, and it can significantly lower the incidence of radial artery occlusion.

Cited by 137 publications

References 22 publications

The long-term incidence and predictors of radial artery occlusion following a transradial coronary procedure

The long-term incidence and predictors of radial artery occlusion following a transradial coronary procedure

Radial Artery Patency After Transradial Catheterization

How to transform you into a radialist (Part II): tips and tricks

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