Radial compression guided by mean artery pressure versus standard compression with a pneumatic device (RACOMAP).
BACKGROUND
Transradial access is the approach of choice in many laboratories for diagnostic coronariography or percutaneous coronary interventions (PCI) because of its lower vascular complication rate than the femoral approach. However, this approach has a higher rate (5-10%) of asymptomatic radial artery (RA) occlusion.


METHODS
We conducted a prospective, controlled, single-centre trial study. We investigated whether the pneumatic compression (using "TR Band of Terumo") of the radial artery guided by the mean artery pressure (MAP) after the procedure (group A) is efficient in reducing radial occlusion in patients under a coronary angiography by transradial access for diagnostic coronariography or PCI compared to use of standard procedure (group B, 15 cm(3) of air in the device).


RESULTS
The study was suspended after analyzing the results of 50% of the scheduled patients. An analysis of the results of 351 consecutive random patients in Group A showed significantly (P = 0.0001) lower rate (1.1%) of occlusion than Group B (12.0%) without significant differences in the rate of other complications. Other variables associated with RA occlusion in univariate analysis were previous or active smoker (P < 0.04), absence of anti-aggregant treatment (P < 0.04), and the presence of RA flow postprocedure (PFP, P < 0.001). Independent predictors with logistic regression analysis were PFP (HR = 0.06, 95% CI 0.01-0.2), presence of hematoma (HR = 3.7, 95% CI 1.2-11.0), and standard pneumatic compression in group B patients (HR = 18.8, 95% CI 3.8-92.2).


CONCLUSIONS
Use of pneumatic compression guided by MAP is safe and efficient, and it can significantly lower the incidence of radial artery occlusion.
Cubero
Jose M
JM
Cardiology Service, Valme University Hospital, Seville, Spain. josucubero@yahoo.es
Lombardo
Juan
J
Pedrosa
Carmela
C
Diaz-Bejarano
Dolores
D
Sanchez
Blanca
B
Fernandez
Vicente
V
Gomez
Coral
C
Vazquez
Rafael
R
Molano
Francisco J
FJ
Pastor
Luis F
LF
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D001794:Blood Pressure; D006328:Cardiac Catheterization / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D004867:Equipment Design; D005260:Female; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D010991:Plethysmography; D011312:Pressure; D011446:Prospective Studies; D017534:Radial Artery / Q000503:physiopathology*; D012039:Regional Blood Flow; D018570:Risk Assessment; D012307:Risk Factors; D016037:Single-Blind Method; D018608:Ultrasonography, Doppler