Abstract 14370: Randomized Trial of Short vs Ultra Short Radial Artery Clamp Time Post Trans-radial Cardiac Catheterization
Introduction: Radial artery occlusion (RAO) is a known complication following transradial cardiac catheterization. A shorter duration of radial clamp time post procedure may reduce this risk. However, rapid clamp release may be associated with more bleeding.
Hypothesis: Shorter duration of clamp placement is associated with reduction in RAO without increase in bleeding.
Methods: We randomized 568 patients undergoing diagnostic cardiac catheterization or percutaneous coronary intervention (PCI) via the radial approach to 2 groups: 20 minutes and 60 minutes of clamp duration. Patients had the clamp placed for maximal pressure that allowed patent hemostasis. After 20 or 60 minutes, pressure was reduced gradually over 20 minutes. The primary endpoint was proportion of patients with RAO post clamp removal. Secondary outcome was bleeding. Patients who lived within a reasonable driving distance were requested to come for 1 week follow-up.
Results: Baseline characteristics were comparable in both groups. Age 64.3±11.1 years, 29.8% female. PCI was performed on 161 patients, and 407 underwent diagnostic catherization. Unfractionated heparin was used in 99.6%, clopidogrel in 42.3%, and ticagrelor or prasugrel in 8.8%. The primary outcome (RAO immediately post clamp removal) occurred in 14 patients (4.9%) and in 8 patients (2.8%) of the 20 and 60 minutes groups, respectively (p=0.19). Large hematoma (more than 5 cm), or any bleeding (oozing, small or large hematoma) where not different between groups. There was also no difference in the incidence of RAO after 1 week (Figure). In the 20 minutes group, there was more frequently a need to retighten the clamp (20.5% vs 12.3%, p<0.01).
Conclusions: Rapid clamp release within 20 or 60 minutes post transradial cardiac catheterization is safe. Ultra short duration of 20 minutes was not associated with reduction in RAO.
Author Disclosures: S. Lavi: Research Grant; Modest; Astra Zeneca. A. Yadegari: None. A. Cheema: None. R. Bagur: None. N. AbuRomeh: None. Y. Levi: None. Y. Parviz: None. Z. Israeli: None. K. Awan: None. M. Alemayehu: None. D. Murariu: None. S. Wall: None. T. McPherson: None. J. Syed: None.
- © 2016 by American Heart Association, Inc.