Author + information
- Vincent Dangoisse,
- Antoine Guédès,
- Claude Hanet,
- Laurence Gabriel,
- Benoit Bihin,
- Valerie Robin,
- Olivier Piraux,
- Karine Jourdan and
- Erwin Shroeder
Minimizing injury related to the local compression after transradial access (TRA) reduces the radial artery occlusion (RAO) rate. RAO limits future use of this access.
To assess the benefit of reducing both intensity and duration of the compression.
From 2009 to 2011, Crasoc I randomized 1937 patients into a normal-low intensity (TR Band 13 ± 2 cc of air) versus an ultra-low (10 ± 2 cc) compression group. The same degree of compression was maintained for 4h. Ward nurses were blinded about the final volume of compression used. During 2014, Crasoc II randomized 942 patients into 2 versus 3 hours of compression, using the ultra-low (10 cc) volume. Patients were followed for 24 hours with attention to bleeding or vascular problems. The 24 hours patency was assessed by pulse oximetry of the hand when compressing the ulnar artery. In case of no or doubtful signals, a Doppler exam was performed. 24h RAO defined as negative pulse by oximetry (RAO-Nurse) and by Doppler (RAO-D) was analyzed.
All groups were well balanced. Except for re-bleeding (external), vascular problems were equivalent and benign. The combination of reducing the degree and the duration of compression lessens the RAO rate (RAO-Nurse and RAO-D), the 10cc-2h gives a less than 1% of RAO-D (figure). To avoid one RAO, 15 patients need to be treated (RAO-N) with the 10cc-2hrs protocol versus 13cc-4h, at the expense of re bleeding requiring prolonged compression for 5.5%.
Multivariate analysis found following variables of patency: groups 10 cc-4h<3h<2h, patient height, GP IIb/IIIa treatment, HTN, Diabetes.
A low RAO rate (less than 1%) can be achieved with a compression protocol of low intensity/low duration, at the expense of a prolonged compression for 5.5% of the patients. Small body size, diabetes, IIb/IIIa GP inhibitor are associated with a higher RAO rate.