How to Make Radial Access Even Safer with Minimum Effort

Courtesy of Dr. Agustín Vecchia.

Since 1990, radial access has progressively gained ground, currently becoming the default technique in most endovascular intervention centers.

One of its few associated complications is radial artery occlusion. While most frequently clinically silent and non-serious, this complication could hinder the performance of future procedures in the patient and, in some cases, cause symptoms. Non-occlusive radial compression and ipsilateral ulnar compression are among the recommendations for its prevention.

The PROPHET II study sought to evaluate the effect of prophylactic ipsilateral ulnar artery compression of radial access on radial artery occlusion rates at 30 days of follow-up.

In order to accomplish that, 3000 patients were randomized to receive either standard care with non-occlusive radial compression or ipsilateral ulnar compression in addition to standard care.

For compression in the control group, an inflatable band (TR Band, Terumo Interventional Systems) was placed over the radial puncture site, removing the introducer, letting a small amount of blood flow out, and then inflating the band until hemostasis was achieved. Radial patency was verified through transient ulnar occlusion followed by pulse oximetry. In the absence of patency, the ulnar artery would be transiently occluded once again and the band would be progressively deflated to achieve radial patency. These steps were repeated for up to 15 minutes in order to achieve radial patency.

In the interventional group, ulnar compression (prior to the removal of the radial introducer) was carried out at Guyon’s canal. Removal of the device according to the aforementioned steps followed verification of proper ulnar occlusion through pulse oximetry. Logically, in the absence of plethysmographic signals in the radial artery in this group, ulnar compression would be removed. Additionally, radial artery patency was assessed at 24 hours and at 30 days.

The primary outcome, radial artery occlusion at 30 days, was significantly reduced in patients with prophylactic ulnar compression (0.9% vs. 3.0%; p = 0.0001). Baseline patient and procedural characteristics were similar among all patients. The outcome was reduced by prophylactic ulnar compression at all analyzed time intervals (p <0.0001).

Authors conclude that this is an effective, simple, and inexpensive technique that lowers radial artery occlusion after radial access.

Editorial

Radial access has become progressively relevant in the last years and the European Society of Cardiology (ESC) recommends it as the “default technique” even in patients with ST elevation myocardial infarction (STEMI). Its advantages, and the fact that coronary patients sometimes require multiple interventions throughout life, stress the importance of patency maintenance.

The method proposed by these authors is so simple that its implementation does not require much effort and should be considered in other centers, particularly after taking into account the fact that the radial occlusion rates reported in this study are the lowest to date.

Courtesy of Dr. Agustín Vecchia. Buenos Aires German Hospital, Argentina.

Original title: Prevention of Radial Artery Occlusion After Transradial Catheterization The PROPHET-II Randomized Trial.

Reference: Samir B. Pancholy et al. J Am Coll Cardiol Intv. 2016;9(19):1992-1999.

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.