Use of Various Types of Introducers in Conventional Radial Access (TIRE)

The purpose of this intervention study is to compare different types of radial introducers used in traditional radial access in terms of the incidence of complications.

The main questions it aims to answer are:

1. Does a smaller outer diameter of the introducer reduce the risk of complications associated with radial access?
2. Does the presence of an outer hydrophilic coating on the introducer reduce the risk of complications associated with radial access?
3. Does the use of an introducer with a smaller outer diameter and an outer hydrophilic coating reduce the risk of complications associated with radial access? The researchers will compare the number of complications associated with radial access when using conventional diameter, uncoated radial introducers, conventional diameter introducers with an outer hydrophilic coating, or reduced outer diameter introducers with an outer hydrophilic coating.

During the scheduled revascularization procedure, the participants will undergo radial artery catheterization using one of the types of introducers. Complications from the radiation access will be recorded by doctors within 72 hours after the intervention.

Study Overview

• Status: Completed
• Conditions: Radial Artery Occlusion; Percutaneous Coronary Intervention (PCI); Radial Artery Spasm
• Intervention / Treatment: Procedure: catheterization of the radial artery using an classic introducer; Procedure: catheterization of the radial artery using an introducer with a standard outer diameter and an outer hydrophilic coating; Procedure: catheterization of the radial artery using an introducer with a reduced outer diameter and an outer hydrophilic coating

Detailed Description

Objective: to compare different types of radial introducers used in conventional radial access by the frequency of complications.

Scientific hypotheses:

1. The risk of acute radial artery occlusion depends on the outer diameter of the introducer.
2. The risk of acute radial artery occlusion depends on the presence of an outer hydrophilic coating on the introducer.
3. The risk of persistent radial artery spasm depends on the presence of an outer hydrophilic coating on the introducer.
4. The risk of persistent radial artery spasm depends on the outer diameter of the introducer.

Patients were enrolled by endovascular specialists with experience of at least 250 radial-access procedures per year.

Inclusion criteria: clear pulsation of the right radial artery, indications for percutaneous coronary intervention.

Exclusion criteria: previous unsuccessful radial artery catheterization; concomitant pathology limiting patient survival; disorders of the blood coagulation system (hemophilia, thrombocytopathy, etc.); previous coronary artery bypass grafting; occlusion of the right radial artery.

The required sample size was calculated using the method of M. Bland for a high-precision study. The required significance level (α) was 0.001 and the statistical power was 95%. The expected rate of radial artery occlusion in the Rad, Rad polymer, and Rad slender groups was assumed to be 12%, 8%, and 8%, respectively. Under these conditions, the calculated sample size was 2723 patients. The planned loss during the study was 20%. Thus, the minimum sample size was 3268 patients.

The study had an experimental design and complied with the CONSORT protocol. A simple randomization method using a random-number generator was chosen. The type of randomization was permuted block randomization. The total block size was 3000, and the allocation ratio between the groups was 1:1:0.7.

Puncture of the right radial artery was performed after local anesthesia with a 2% lidocaine solution. The radial artery was punctured at the typical site using the puncture needle included in the introducer set, with only the anterior wall being punctured. The type of introducer was selected by randomization using a random-number method, and depending on this assignment the patient was allocated to one of the groups.

All patients underwent percutaneous coronary angioplasty with coronary artery stenting via the right radial artery. The radial artery catheterization technique did not differ between groups. The type of introducer was selected by randomization using a random-number method, and depending on this assignment the patient was allocated to one of the groups. In the Rad group , introducers without a hydrophilic coating were used; in the Rad polymer group , introducers with a hydrophilic coating were used; and in the Rad slender group , thin-walled introducers with a hydrophilic coating were used. The access site was examined within 3 hours after the intervention and then, in the absence of complaints, again at bandage removal. After bandage removal, patients underwent ultrasound examination to confirm radial artery patency. Complications from the radiation access will be recorded by doctors within 72 hours after the intervention.

• Study Type: Interventional
• Enrollment (Actual): 3307
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Russia
  • Kostroma Oblast
    • Kostroma, Kostroma Oblast, Russia, 156013
      • E.I. Korolev Kostroma Regional Clinical Hospital
  • Moscow
    • Moscow, Moscow, Russia, 119071
      • Central Clinical Hospital of St. Alexy Metropolitan of Moscow of the Moscow Patriarchate of the Russian Orthodox Church

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• clear pulsation of the right radial artery
• indications for percutaneous coronary intervention

Exclusion Criteria:

• previous unsuccessful radial artery catheterization
• concomitant pathology limiting patient survival
• disorders of the blood coagulation system (hemophilia, thrombocytopathy, etc.)
• previous coronary artery bypass grafting
• occlusion of the right radial artery

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Rad classic; Introducer with a standard outer diameter and no external hydrophilic coating	Procedure: catheterization of the radial artery using an classic introducer; The right radial artery was punctured under local anesthesia with a 2% lidocaine solution. The radial artery was punctured at a typical location using a puncture needle included in the catheterization kit, puncturing only the anterior wall. An introducer with a standard outer diameter and no external hydrophilic coating was inserted. 5,000 IU of heparin in saline solution was injected into the catheterized artery. All injected solutions, including radiocontrast agents, had a temperature of 36.5-36.7 °C. Hemostasis was achieved by applying a pressure bandage. The access site was examined 3 hours after the intervention, and then, if there were no complaints, it was examined again when the bandage was removed. After the bandage was removed, patients underwent an ultrasound examination to confirm the patency of the radial artery. Complications were recorded within 3 days after the intervention.
Experimental: Rad polymer; Introducer with a standard outer diameter and an outer hydrophilic coating	Procedure: catheterization of the radial artery using an introducer with a standard outer diameter and an outer hydrophilic coating; Description: The right radial artery was punctured under local anesthesia with a 2% lidocaine solution. The radial artery was punctured at a typical location using a puncture needle included in the catheterization kit, puncturing only the anterior wall. An introducer with a standard outer diameter and an outer hydrophilic coating was using. 5,000 IU of heparin in saline solution was injected into the catheterized artery. All injected solutions, including radiocontrast agents, had a temperature of 36.5-36.7 °C. Hemostasis was achieved by applying a pressure bandage. The access site was examined 3 hours after the intervention, and then, if there were no complaints, it was examined again when the bandage was removed. After the bandage was removed, patients underwent an ultrasound examination to confirm the patency of the radial artery. Complications were recorded within 3 days after the intervention.
Experimental: Rad slender; Introducer with a reduced outer diameter and an outer hydrophilic coating	Procedure: catheterization of the radial artery using an introducer with a reduced outer diameter and an outer hydrophilic coating; Description: The right radial artery was punctured under local anesthesia with a 2% lidocaine solution. The radial artery was punctured at a typical location using a puncture needle included in the catheterization kit, puncturing only the anterior wall. An introducer with a reduced outer diameter and an outer hydrophilic coating was using. 5,000 IU of heparin in saline solution was injected into the catheterized artery. All injected solutions, including radiocontrast agents, had a temperature of 36.5-36.7 °C. Hemostasis was achieved by applying a pressure bandage. The access site was examined 3 hours after the intervention, and then, if there were no complaints, it was examined again when the bandage was removed. After the bandage was removed, patients underwent an ultrasound examination to confirm the patency of the radial artery. Complications were recorded within 3 days after the intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Acute radial artery occlusion after catheterization	Acute radial artery occlusion was confirmed by ultrasound examination	Within 72 hours after radial artery catheterization
Radial artery perforation	Angiography-confirmed perforation of the radial artery	Perioperative/Periprocedural
Radial artery false aneurysm	A false aneurysm of the radial artery was confirmed by ultrasound examination	Within 72 hours after radial artery catheterization
Hematoma by classification EASY Grade II	Hematoma by classification EASY Grade II was confirmed by ultrasound examination	Within 72 hours after radial artery catheterization
Persistent radial artery spasm	Persistent radial artery spasm confirmed by angiography	Perioperative/Periprocedural

Collaborators and Investigators

• Sponsor: Pirogov Russian National Research Medical University
• Collaborators: I.M. Sechenov First Moscow State Medical University

Study record dates

Study Major Dates

• Study Start (Actual): January 28, 2019
• Primary Completion (Actual): December 16, 2025
• Study Completion (Actual): December 19, 2025

Study Registration Dates

• First Submitted: April 22, 2026
• First Submitted That Met QC Criteria: May 6, 2026
• First Posted (Actual): May 7, 2026

Study Record Updates

• Last Update Posted (Actual): May 13, 2026
• Last Update Submitted That Met QC Criteria: May 8, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Radial artery occlusion; Randomized study; Percutaneous Coronary Intervention (PCI); Radial Artery Spasm; radial access; types of radial introducers
• Additional Relevant MeSH Terms: Vascular Diseases; Cardiovascular Diseases; Arterial Occlusive Diseases
• Other Study ID Numbers: 260/1

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: all personal data underlying the publication results
• IPD Sharing Time Frame: Beginning 6 months and ending 1 years after the publication of results
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No