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

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.