A randomized trial comparing short vs prolonged hemostasis and rescue recanalization by ipsilateral ulnar artery compression - impact on radial artery occlusion

Author(s): D. Ognerubov

We aimed to compare the incidence of RAO in patients undergoing coronary angiography and intervention after short vs prolonged hemostasis protocol and tested following therapeutic ulna artery compression effect on early RAO.
Patients and Methods: Patients referred for elective transradial coronary procedures were enrolled. After 6F radial sheath removal, patients were randomized to short (group I, n=495) or prolonged (group II, n=503) hemostasis and a simple bandage was placed over the puncture site.

After compression reverse oximetry-plethysmograph was used to check the patency of the radial artery and one hour ipsilateral ulnar artery compression was applied in case of RAO, oximetry was repeated one more time after ulnar compression.
Results: Baseline characteristics were similar between both groups with average age 61.4 ± 9.4 years (71% male) and PCI was performed in half of all patients. Hemostatic bandage in group I was removed after 3 hours and after 8 hours in group II. The initial RAO rate was 3,2% in group I and 10.2% in group II (p<0.001). Successful recanalization after ulnar artery compression was found only in group I (56.25% vs 0%, p<0.001). Final early RAO was 1,4% in group I and 10,2% in group II (p<0.001).

Conclusion: Shorter hemostasis was associated with significantly less RAO compared to prolonged hemostasis. Rescue radial artery recanalization by one-hour ipsilateral ulnar artery compression was effective only in in 56,25% cases, but only in the short hemostasis group.