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Role of trans-radial band protocols in radial artery occlusion: Randomized trial
Nasir Rahman1, Azmina Artani1, Farhala Baloch1
1Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
Insights
Local radial artery band deflation protocols are as effective as the Cohen and Alfonso method in preventing radial artery occlusion after coronary angiography. This study found no significant difference in complications between the two protocols.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Cardiology
Background:
- Radial artery occlusion is a frequent complication following coronary angiography, often linked to prolonged use of trans-radial compression bands.
- Existing literature indicates a lack of a standardized protocol for radial band deflation, leading to institutional variations.
- The Cohen and Alfonso protocol is a widely adopted global standard for radial band management.
Purpose of the Study:
- To evaluate if the hospital's current radial band deflation protocol (Protocol A) is non-inferior to the established Cohen and Alfonso protocol (Protocol B).
- To compare the incidence of radial artery occlusion and other complications between the two deflation protocols.
Main Methods:
- A prospective, outcome assessor-blinded, non-inferiority trial was conducted with 100 patients undergoing coronary angiography via radial access.
- Patients were randomized to either Protocol A (institutional protocol) or Protocol B (Cohen and Alfonso protocol).
- The primary endpoint was radial artery occlusion at 24 hours; secondary endpoints included hematoma and bleeding post-deflation.
Main Results:
- No significant difference in radial artery occlusion rates was observed between Protocol A (10%) and Protocol B (14%) (p=0.49).
- Hematoma and bleeding complications after radial band removal also showed no statistically significant difference between the two groups.
- Baseline characteristics of participants were similar across both intervention and control groups.
Conclusions:
- The institutional trans-radial band deflation protocol is non-inferior to the Cohen and Alfonso protocol regarding the incidence of radial artery occlusion post-coronary angiography.
- The findings support the adoption of the institutional protocol, potentially simplifying post-procedure care without compromising safety.
Background:
Radial artery occlusion is a common complication of coronary angiography via radial artery, attributed to the prolonged use of trans-radial band post procedure. Literature suggests there is no standard protocol for radial band deflation, and it varies across institutions. However, the protocol suggested by Cohen and Alfonso is widely used globally. This study aims to test whether our hospital's radial band deflation protocol is non-inferior to the protocol of Cohen and Alfonso, which affirms lesser complications.
Methods:
This is an outcome assessor blinded, non-inferiority trial conducted at a tertiary care hospital in Karachi. We enrolled 100 patients who underwent coronary angiography from radial access and gave written informed consent. The intervention group received protocol A, that is in practice at the institution, while the control group received protocol B, developed by Cohen and Alfonso. The primary outcome was occurrence of radial artery occlusion at 24 h. The secondary outcomes included hematoma and bleeding after radial band removal.
Results:
The mean age of the participants in the trial was 58.3 ± 11.5 years, while 63% of them were men. Participants in both the groups had similar baseline characteristics. Radial artery occlusion was not significantly different between protocol A and protocol B (10% vs. 14%, p = 0.49, respectively). Similarly, hematoma and bleeding after trans-radial band removal showed no statistical difference between the groups.
Conclusion:
Trans-radial band deflation practice at our institution was non-inferior to Cohen and Alfonso's protocol in the incidence of radial artery occlusion after coronary angiography.
Trial Registration Number:
This trial is registered at clinicaltrials.gov (https://clinicaltrials.gov) with registration number NCT03298126.
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