The Impact of Using a Larger Forearm Artery for Percutaneous Coronary Interventions on Hand Strength: A Randomized Controlled Trial

Abstract

(1) Background: The exact mechanism underlying hand strength reduction (HSR) after coronary angiography with transradial access (TRA) or transulnar access (TUA) remains unknown. (2) Methods: This study aimed to assess the impact of using a larger or smaller forearm artery access on the incidence of HSR at 30-day follow-up. This was a prospective randomized trial including patients referred for elective coronary angiography or percutaneous coronary intervention. Based on the pre-procedural ultrasound examination, the larger artery was identified. Patients were randomized to larger radial artery (RA) or ulnar artery (UA) or a group with smaller RA/UA. The primary endpoint was the incidence of HSR, while the secondary endpoint was the incidence of subjective HSR, paresthesia, and any hand pain. (3) Results: We enrolled 200 patients (107 men and 93 women; mean age 68 ± 8 years) between 2017 and 2018. Due to crossover between TRA and TUA, there were 57% (n = 115) patients in larger RA/UA and 43% (n = 85) patients in smaller RA/UA. HSR occurred in 29% (n = 33) patients in larger RA/UA and 47% (n = 40) patients in smaller RA/UA (p = 0.008). Subjective HSR was observed in 10% (n = 12) patients in larger RA/UA and 21% (n = 18) patients in smaller RA/UA (p = 0.03). Finally, paresthesia was noted in 7% (n = 8) patients in larger RA/UA and 22% (n = 15) in smaller RA/UA (p = 002). Independent factors of HSR were larger RA/UA (OR 0.45; 95% CI, 0.24–0.82; p < 0.01) and the use of TRA (OR 1.87; 95% CI, 1.01–34; p < 0.05). (4) Conclusions: The use of a larger artery as vascular access was associated with a lower incidence of HSR at 30-day follow-up.

Platelet reactivity and activated clotting time predict hemorrhagic site complications in patients with chronic coronary syndromes undergoing percutaneous coronary interventions

“…The follow-up was short but consistent with the short duration of the hospital stay. All of the procedures were performed from the radial artery, and we did not assess the ulnar artery in order to choose the dominant one, which might have influenced the outcomes [36,37].…”

The Effectiveness of Hand Exercise on Limb Function in Patient Coronary Artery Disease Posttransradial Artery Catheterization: Systematic Review

“…Previous research shows that hand exercises can guide patients to perform functional exercises that can improve blood circulation in the upper limbs and increase blood flow in the radial artery and cephalic vein (Lewandowski et al, 2021). In the hand grip test after transradial study (HANGAR), a hand dynamometer applied to patients undergoing transradial PCI improved the recovery of hand strength and helped improve blood circulation in the limbs.…”

Comparison of the effects of three kinds of hand exercises on improving limb function in patients after transradial cardiac catheterization

“…Previous research indicated that handgrip exercise with a dynamometer as a medium could guide patients to perform functional exercise and promote blood circulation in the upper limbs [ 12 ]. Furthermore, a previous study reported that handgrip dynamometers could promote blood circulation and increase the blood flow of the radial artery and cephalic vein [ 13 ]. In the Hand Grip test After Transradial (HANGAR) study, the hand dynamometer applied in patients who underwent transradial PCI promoted the recovery of hand strength [ 14 ].…”

“…In the Hand Grip test After Transradial (HANGAR) study, the hand dynamometer applied in patients who underwent transradial PCI promoted the recovery of hand strength [ 14 ]. In addition, another study demonstrated that low-intensity, short-duration handgrip exercise produces significant elevations in blood pressure [ 13 , 15 ]. Furthermore, such isometric handgrip exercise can mobilize the muscles of hand exercise, which has been found to be beneficial for reducing resting arterial pressure in hypertensive individuals [ 16 ].…”