Prevention of radial artery occlusion-patent hemostasis evaluation trial (PROPHET study): a randomized comparison of traditional versus patency documented hemostasis after transradial catheterization.
OBJECTIVE
The objective of this study was to evaluate the efficacy of hemostasis with patency in avoiding radial artery occlusion after transradial catheterization.


BACKGROUND
Radial artery occlusion is an infrequent but discouraging complication of transradial access. It is related to factors such as sheath to artery ratio and is less common in patients receiving heparin. Despite being clinically silent in most cases, it limits future transradial access.


METHODS
Four hundred thirty-six consecutive patients undergoing transradial catheterization were prospectively enrolled in the study. Two hundred nineteen patients were randomized to group I, and underwent conventional pressure application for hemostasis. Two hundred seventeen patients were randomized to group II and underwent pressure application confirming radial artery patency using Barbeau's test. Radial artery patency was studied at 24 hr and 30 days using Barbeau's test.


RESULTS
Thirty-eight patients had evidence of radial artery occlusion at 24 hr. Twenty patients had persistent evidence of radial artery occlusion at 1 month. Group II, with documented patency during hemostatic compression, had a statistically and clinically lower incidence of radial artery occlusion (59% decrease at 24 hr and 75% decrease at 30 days, P < 0.05), compared with patients in group I. Low body weight patients were at significantly higher risk of radial artery occlusion. No procedural variables were found to be associated with radial artery occlusion.


CONCLUSIONS
Patent hemostasis is highly effective in reducing radial artery occlusion after radial access and guided compression should be performed to maintain radial artery patency at the time of hemostasis, to prevent future radial artery occlusion.
Pancholy
Samir
S
Department of Cardiology, Mercy Hospital and Community Medical Center, Scranton, PA.
Coppola
John
J
Chief, Department of Cardiology, St. Vincents Catholic Medical Center of New York, New York, NY.
Patel
Tejas
T
Chief, Department of Cardiology, Seth N.H.L. Municipal Medical College, Ahmedabad, India.
Roke-Thomas
Marie
M
Department of Biostatistics, Wilkes University, Wilkes-Barre, PA.
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D010991:Plethysmography; D011312:Pressure; D011446:Prospective Studies; D011677:Punctures / Q000009:adverse effects; D017534:Radial Artery / Q000503:physiopathology*; D012039:Regional Blood Flow; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency