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Outcomes of a Modified Technique for Deflation of Distal Radial Artery Occlusion Device on Radial Artery Patency
Aatika Habib1, Sahil Raj2, Ritesh Pahwani2
1Department of Cardiology, DHQ Hospital Nowshera, Nowshera, Pakistan.
Insights
Comparing two deflation protocols for the distal radial artery occlusion device (DROAD) after PCI showed no significant difference in radial artery occlusion (RAO) rates. However, the accelerated deflation protocol was associated with increased local vascular complications like hematoma.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Distal radial artery access is increasingly used for percutaneous coronary interventions (PCI).
- Ensuring adequate hemostasis after sheath removal is crucial to prevent radial artery occlusion (RAO).
- Different deflation protocols for the distal radial artery occlusion device (DROAD) exist, but their comparative efficacy and safety are not fully established.
Purpose of the Study:
- To compare the efficacy and safety of two DROAD deflation protocols in patients undergoing PCI with distal radial access.
- To assess the incidence of radial artery occlusion (RAO) between a standard increased-interval deflation protocol and an accelerated smaller-interval protocol.
- To identify predictors of RAO in the study cohort.
Main Methods:
- A total of 446 patients undergoing PCI with distal radial access were enrolled.
- Patients were assigned to either Protocol 1 (2 ml air removal every 30 min starting 1h post-sheath removal) or Protocol 2 (4 ml air removal every 15 min starting 2h post-sheath removal).
- The primary endpoint was the incidence of RAO, assessed after DROAD removal.
Main Results:
- No significant difference in RAO incidence was observed between Protocol 1 (8.71%) and Protocol 2 (8.78%) (P=0.932).
- Predictors of RAO included older age, female gender, smaller distal artery diameter, longer procedure time, and larger sheath size.
- Local vascular complications, such as hematoma, were more frequent in the accelerated deflation group (Protocol 2).
Conclusions:
- The standard and accelerated DROAD deflation protocols demonstrate comparable efficacy in preventing RAO after PCI.
- The accelerated deflation protocol is associated with a higher incidence of local vascular complications.
- Careful patient selection and monitoring are warranted, especially with accelerated deflation protocols.
Objective:
This study aimed to compare two protocols of deflation with increased intervals versus late deflation with smaller intervals for distal radial artery occlusion device (DROAD) removal to assess for radial artery occlusion (RAO).
Methods:
All patients who underwent PCI with distal radial access were enrolled in the study. The DROAD was applied using an occlusive hemostasis method. Patients were assigned to either protocol 1 or protocol 2 at the primary physician's discretion. Protocol 1 involved the removal of 2 ml of air starting 1 h after the sheath removal and then the removal of 2 ml every 30 min until the band came off. Protocol 2 involved the removal of 4 ml of air 2 h after the sheath removal and then a further 4 ml of air every 15 min until the band came off.
Results:
A total of 446 patients were enrolled in this study (mean age; 61 ± 6 (Group 1) and 60 ± 5 (Group 2); females 45.83% (Group 1) and 46.34% (Group 2)). The baseline characteristics were the same, including mean hemostasis time (256 ± 25 min (Group 1) and 254 ± 28 min (Group 2), P-value = 0.611). Primary and secondary endpoints did not reach significance in either group (RAO; 21 (8.71) Group 1 and 18 (8.78) Group 2 (P-value = 0.932)). Age (OR (95%CI): 1.07 (0.57-1.45); P-value = 0.031), female gender (OR (95%CI): 1.42 (0.93-1.74); P-value = 0.012), distal artery diameter (OR (95%CI): 0.57 (0.21-0.93); P-value = 0.005), procedure time (OR (95%CI): 2.64 (0.95-4.32); P-value = 0.001), and sheath size (OR (95%CI): 2.47 (1.43-3.76); P-value = 0.044) were predictors of RAO in our cohort.
Conclusion:
This investigation shows no difference in the incidence of RAO with the standard versus accelerated deflation protocol after PCI. However, local vascular complications, including hematoma were increased with the accelerated protocol.
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