P5519Radial artery dilatation to improve access and lower complication rates during coronary angiography (RADIAL): a randomized controlled trial

Abstract

Introduction: Trans‐radial access is preferred over trans‐femoral access during coronary angiography but poses a greater technical challenge and comes with its own set of complications. It may require multiple puncture attempts, has a higher cannulation failure rate and can be complicated by radial artery spasm (RAS), radial artery pulsation loss (RAPL) and radial artery occlusion (RAO). There is a paucity of data on measures to optimize successful radial access and to minimize complications. Purpose: We explored the use of prolonged occlusion flow mediated dilatation (PO‐FMD) to dilate the radial artery prior to cannulation to reduce puncture attempts and increase cannulation success. Methods: 350 patients undergoing trans‐radial coronary angiography were enrolled and randomized into PO‐FMD and sham‐PO‐FMD groups. PO‐FMD was achieved by a 10 minute inflation of a blood pressure cuff on the upper arm to a pressure above systolic pressure, followed by deflation with resultant radial artery dilation prior to cannulation. In the sham‐PO‐FMD group the blood pressure cuff on the upper arm was not inflated. The cardiologists performing the angiogram were blinded to the PO‐FMD intervention. Number of attempts, success of cannulation, time to cannulation and occurrence of complications were recorded. The radial artery was assessed by ultrasonography before and after the procedure. Results: 176 patients have been randomized to the sham‐PO‐FMD group and 174 to the PO‐FMD group. The radial artery diameter prior to cannulation was 2.27mm ± 0.45mm in the sham‐PO‐FMD group and 2.24mm ± 0.45mm in the PO‐FMD group. The number of puncture attempts needed was reduced with the use of PO‐FMD, with the median number attempts of 1 in the PO‐FMD group and 2 in the sham‐PO‐FMD (p=0.013). Cannulation failure was also reduced with POFMD with 65% of the failures occurring in the SHAM‐PO‐FMD group (p=0.014). The time to cannulation was 124s ± 129s in the sham‐PO‐FMD group and 98s ± 94s in the PO‐FMD group. Complication rates were low (RAS 8.4%, RAPL 3.8% and RAO 5.8%) with no significant difference between groups. Conclusion: PO‐FMD decreases puncture attempts and increases cannulation success during coronary angiography. The impact of this benefit on complication rates is the subject of an ongoing study.