032 Impact of length and hydrophilic coating of the introducer sheath on radial artery spasm during transradial coronary intervention: a randomised study

Introduction: Sheathless transradial access, by decreasing the profile of hardware, is expected to lower the incidence of radial artery occlusion (RAO). Hypothesis: We sought to compare the risk of RAO in patients undergoing coronary intervention with introducer sheath (SG) or without introducer sheath (SLG). Methods: 1251 consecutive patients undergoing 6 French percutaneous coronary intervention (PCI) between January 1, 2009 and December 31, 2013 in Scranton, PA, formed the study cohort. Radial artery patency was assessed using reverse Barbeau’s test and RAO was confirmed by ultrasonography. Unadjusted, adjusted and propensity matched association between type of radial access (SG vs SLG) and RAO were assessed using logistic regression analysis. Results: Mean age was 65 years, 63% were men 37% were diabetics. 78% attained patent hemostasis (PH). Patients in SG had lower pre-discharge RAO [unadjusted (OR: 0.31, 95% CI: 0.21 - 0.46, P < 0.001), adjusted (OR: 0.10, 95% CI: 0.05 - 0.20, P < 0.001) and propensity matched (OR: 0.20, 95% CI: 0.13 - 0.32, P < 0.001)], 24 hours RAO [unadjusted (OR: 0.20, 95% CI: 0.12 - 0.34, P < 0.001), adjusted (OR: 0.12, 95% CI: 0.06 - 0.24, P < 0.001) and propensity matched (OR: 0.13, 95% CI: 0.07 - 0.25, P < 0.001)] and 30 day RAO [unadjusted (OR: 0.28, 95% CI: 0.14 - 0.54, P < 0.001), adjusted (OR: 0.22, 95% CI: 0.10 - 0.50, P < 0.001) and propensity matched (OR: 0.18, 95% CI: 0.10 - 0.40, P < 0.001)], compared to those in SLG. Spontaneous recanalization rates were significantly higher in SG compared to SLG at 24 hours (62% Vs 38%, P = 0.007) but similar at 30 days (38% Vs 50%, P = 0.338) post PCI. Diabetes diagnosis was an effect modifier for RAO at pre-discharge, 24 hours and 30 days post PCI. Conclusions: Sheath use during radial access for PCI, despite diametrically increasing hardware profile, is associated with less RAO, likely by reducing friction induced intimal trauma. Diabetes is an effect modifier in this association.

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Infected chronic sinus secondary to a retained fragment of radial artery introducer sheath following percutaneous coronary intervention (PCI)

BMJ Case Reports ◽

10.1136/bcr-2018-227136 ◽

2019 ◽

Vol 12 (3) ◽

pp. e227136

Author(s):

Christopher George Ghazala ◽

Benjamin Alexander Marrow ◽

Dermot Kearney ◽

John William Kenneth Harrison

Keyword(s):

Percutaneous Coronary Intervention ◽

Radial Artery ◽

Rare Complication ◽

Coronary Intervention ◽

Introducer Sheath ◽

Percutaneous Coronary ◽

Cannulation Site ◽

The Uk ◽

Developed World

Coronary angiography and percutaneous coronary intervention (PCI) are frequently performed procedures in the UK and the developed world, with the radial artery becoming the preferred route of access. A chronically retained macroscopic fragment of radial artery introducer sheath is a very rare complication that has not, to our knowledge, been reported. We report the case of a 62-year-old woman who underwent PCI and developed a persisting infected sinus and abscess at the cannulation site despite multiple courses of antibiotics. Surgical exploration of the forearm recovered a foreign body that was found in the brachioradialis muscle and resembled a fragment of hydrophilic sheath. In conclusion, this case highlights that it is possible to leave macroscopic fragments of hydrophilic sheaths in situ. This is likely to be encountered during difficult access, especially during arterial spasm, and it is advised that the sheath and any other vascular access device is thoroughly inspected following removal.

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Combination of InnoSEAL plus TR band compared with TR band alone for radial artery outcomes in patients undergoing transradial coronary intervention (InnoSEAL-II): an open-label randomised controlled trial (protocol)

BMJ Open ◽

10.1136/bmjopen-2020-042101 ◽

2020 ◽

Vol 10 (12) ◽

pp. e042101

Author(s):

Saba Aijaz ◽

Sana Sheikh ◽

Asad Pathan

Keyword(s):

Randomised Controlled Trial ◽

Radial Artery ◽

Controlled Trial ◽

Coronary Intervention ◽

Ease Of Use ◽

P Value ◽

Radial Compression ◽

Open Label ◽

Scientific Publications ◽

Randomised Controlled

IntroductionAbout 2%–30% of cardiac catheterisation procedures get complicated by radial artery occlusion (RAO). Ensuring patent haemostasis appears to be an important factor in reducing RAO. Currently employed method is a radial compression device (RCD) such as transradial band (TRB) that take hours to achieve haemostasis and cause discomfort to the patients. Haemostatic pads offer an alternative to RCD with reduced time to achieve haemostasis. Our trial aims to determine the non-inferiority of the catecholamine chitosan-based pad (InnoSEAL haemostatic pad) used in conjunction with TRB (InnoSEAL +TRB) when compared with the TRB alone in reducing composite adverse access site outcomes.Methods and analysisIt will be an open-label, parallel, randomised controlled trial on 714 adult patients (325 in each arm) undergoing coronary procedure using transradial approach at a cardiac health facility over 7 months duration. InnoSEAL patch along with TRB will be used to control bleeding in intervention arm and TRB alone in control arm, which is the standard practice. Study primary outcomes include RAO and haematoma; secondary outcomes are compression time, patient discomfort, time to discharge and ease of use of the intervention technique by the healthcare staff. χ2 test will be used to compare the categorical outcomes between two arms and student’s t-test for continuous outcomes. A p value of <0.05 will be considered significant.Ethics and disseminationEthical approval for the study has been obtained from the Institutional Review Board of Tabba Heart Institute number IORG0007863. Findings will be disseminated through seminars and scientific publications.Trial registration numberNCT04380883; Pre-results.

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Feasibility and Outcomes of Percutaneous Coronary Intervention to Radial Artery Bypass Graft Stenoses and General Characteristics of Radial Graft Failure: Insights From a Multicentre PCI Registry

Heart Lung and Circulation ◽

10.1016/j.hlc.2021.06.478 ◽

2021 ◽

Vol 30 ◽

pp. S307-S308

Author(s):

G. Hamilton ◽

D. Dinh ◽

O. Farouque ◽

J. Raman ◽

J. Yeoh ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Radial Artery ◽

Graft Failure ◽

Artery Bypass ◽

Bypass Graft ◽

Coronary Intervention ◽

Artery Bypass Graft ◽

Percutaneous Coronary

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Varıatıons Encountered With Increasıng Transradıal Approach for Coronary Interventıon: Accesory Radial Artery

The American Journal of Cardiology ◽

10.1016/j.amjcard.2018.03.281 ◽

2018 ◽

Vol 121 (8) ◽

pp. e121-e122

Author(s):

Çağlar Kaya ◽

Servet Altay

Keyword(s):

Radial Artery ◽

Coronary Intervention ◽

Transradial Approach

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Low-molecular-weight-heparin in radial artery occlusion treatment: the LOW-RAO randomized study

Future Cardiology ◽

10.2217/fca-2021-0067 ◽

2021 ◽

Author(s):

Matthaios Didagelos ◽

Areti Pagiantza ◽

Thomas Zegkos ◽

Christos Papanastasiou ◽

Konstantina Zarra ◽

...

Keyword(s):

Molecular Weight ◽

Radial Artery ◽

Low Molecular Weight Heparin ◽

Controlled Trial ◽

Randomized Study ◽

Coronary Intervention ◽

Artery Occlusion ◽

Low Molecular Weight ◽

Open Label ◽

Radial Artery Occlusion

Radial artery occlusion (RAO) is the commonest complication of transradial catheterization. There is no evidence-based therapy, in the frame of a randomized control study, for the treatment of RAO. The purpose of the LOW-RAO study is to question the hypothesis if low-molecular-weight heparin is effective in the treatment of RAO after transradial coronary catheterization (both angiography and percutaneous coronary intervention). It is a prospective, open label, randomized controlled trial that will randomize 60 patients with RAO, irrespective of symptoms, into two groups, one receiving anticoagulation with low-molecular-weight heparin and the other receiving no treatment. The primary end point is improvement in radial artery patency rate at 4 weeks after the procedure. Trial registration number: NCT04196309 (ClinicalTrials.gov)

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Abstract 366: Procedure Change To Reduce Radial Artery Compression Device Bleeding Following Radial-approach Angiography: A Single Centre’s Preliminary Results.

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.366 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Vanessa Lee ◽

Toni Davey ◽

Ellen Kenny ◽

Kath Cowie ◽

Nicholas Cox

Keyword(s):

Radial Artery ◽

Coronary Intervention ◽

Puncture Site ◽

Compression Device ◽

Radial Access ◽

Initial Volume ◽

Post Procedure ◽

Retrospective Audit ◽

Percutaneous Coronary ◽

Prolonged Recovery

Background: Radial access is an increasingly common approach to coronary angiography whereby a radial artery compression device (RACD) is applied to achieve haemostasis following sheath removal. Current procedure recommends the removal of 5mL of air at 5-minutely intervals from the RACD; 45 minutes post angiogram sheath removal and 2 hours post PCI (Percutaneous Coronary Intervention) sheath removal. Haemostasis failure at the puncture site however was frequently reported and required re-insertion of air. Patients reported increased discomfort and, in 44% of elective cases, post-procedure stay was increased and discharge delayed by 30-180 minutes as a result of prolonged recovery time. Methods: Hospital procedure was revised to remove 3mL volume (air) at 5-minutely intervals from the RACD instead of 5mL. The RACD was also to remain untouched for 60 minutes post angiogram sheath removal and remained at 2 hours untouched post PCI sheath removal. A retrospective audit was conducted pre- and post-procedure change and included patients undergoing radial-access angiogram or PCI Results: A total of 258 cases were reviewed; 158 angiogram and 100 PCI. Initial volume of air used to achieve haemostasis was 10-18mLs and heparin dose administered was 2000-10,000units. Prior to procedure change, 5mL (air) was removed from the RACD and subsequently haemostasis failure occurred in 43.8% (35) of angiogram patients and 55.1% (27) of PCI patients. Following implementation of the 3mL procedure, haemostasis failure was reported in 12.8% (10) of angiogram patients and 19.6% (10) of PCI patients. Conclusion: Whilst total time taken to remove the RACD marginally increased, decreasing the volume of air removed from 5mL to 3mL significantly reduced the incidence of haemostasis failure. This effect was achieved without adjustment of anticoagulation dose or initial volume of air inserted into the RACD.

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