Radial artery dilatation to improve access and lower complications during coronary angiography: the RADIAL trial

Jacques Doubell, Charles Kyriakakis, Hellmuth Weich, Philip Herbst, Alfonso Pecoraro, Jane Moses, Bradley Griffiths, H W Snyman, Lorrita Kabwe, Rudolf Du Toit, Lloyd Joubert, Karim Hassan, Anton Doubell, Jacques Doubell, Charles Kyriakakis, Hellmuth Weich, Philip Herbst, Alfonso Pecoraro, Jane Moses, Bradley Griffiths, H W Snyman, Lorrita Kabwe, Rudolf Du Toit, Lloyd Joubert, Karim Hassan, Anton Doubell

Abstract

Aims: The aim of this study was to explore the use of prolonged occlusion flow-mediated dilatation (PO-FMD) to dilate the radial artery prior to cannulation to increase cannulation success, reduce puncture attempts and reduce access-site complications in transradial coronary angiography.

Methods and results: A total of 1,156 patients undergoing transradial coronary angiography were randomised into PO-FMD and sham PO-FMD groups. PO-FMD was achieved by a 10-minute inflation of a blood pressure cuff on the arm to above systolic pressure, followed by deflation with resultant radial artery dilation. In the sham PO-FMD group the cuff was not inflated. Operators were blinded to the intervention. Five hundred and eighty (580) patients were randomised to the sham PO-FMD group and 576 to the PO-FMD group. Cannulation failure was reduced with PO-FMD, with cannulation failure rates of 2.7% in the PO-FMD group and 5.8% in the sham PO-FMD group (p=0.01).The number of puncture attempts was reduced with the use of PO-FMD, with a median of one attempt in the PO-FMD group and two in the sham PO-FMD group (p<0.001). Radial artery pulsation loss (RAPL) was reduced with PO-FMD, with 1.4% in the PO-FMD group and 3.8% in the sham PO-FMD group (p=0.02).

Conclusions: PO-FMD reduces cannulation failure rates, decreases puncture attempts, and decreases RAPL during transradial coronary angiography.

Conflict of interest statement

The authors have no conflicts of interests to declare.

Figures

Figure 1
Figure 1
Flow chart illustrating the randomisation and exclusion of participants in the trial.
Figure 2
Figure 2
Cannulation failure rates.
Figure 3
Figure 3
Number of radial artery puncture attempts to cannulate the radial artery.
Figure 4
Figure 4
Correlation between the number of radial artery puncture attempts and radial artery diameter.
Figure 5
Figure 5
Number of puncture attempts in females and males.
Figure 6
Figure 6
Cannulation failure rates in females and males.

Source: PubMed

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