Optimal TR-band weaning strategy while minimizing vascular access site complications
Gindi R, Shah S, Khandelwal A, Alqarqaz M, Zaidan M, Voeltz M, Koenig G, Kim H, O'Neill WW, Alaswad K. Optimal TR-band weaning strategy while minimizing vascular access site complications. J Am Coll Cardiol. 2018;71(11)
J Am Coll Cardiol
Background: Transradial cardiac catheterization is increasing in the United States due to the advantages of less access site complications and patient preference. A compression device is most commonly used to achieve hemostasis following sheath removal, however the optimalweaning strategy to expedite TR-band removal whileminimizing access site complications has yet to be defined. The purpose of this study was to develop an optimal TR-Band weaning strategy while minimizing vascular accesssite complications of hematoma or radial artery occlusion. Methods: The trial was a randomized, prospective, single center study of 129 patients who underwent cardiac catheterization via the radial artery. Group A was an accelerated protocol in which weaning was initiated 20 minutes after sheath removal. Group B was an adjusted protocol, in which weaning was dependent on the amount of anti-platelet or anti-coagulation used. All patients underwent radial artery ultrasound to demonstrate arterial patency. Results: Baseline characteristics were similar in both groups, and PCI was performed in 36.7% of patients in Group A and 37.7% of patients in Group B. RAO occurred in 7.7% of patients overall, with no statistical difference between groups (Group A 5% versus Group B 10.1%, p-value = 0.337). Hematoma formation greater than 5 cm in diameter occurred in 4.6% of patients in the overall cohort, without statistical difference between groups (Group A 5.0% versus Group B 4.3%, p-value = 1). The TR-Band duration was signifcantly shorter in Group A compared to Group B (112.9 ± 50.7 versus 130.7 ± 51.1 in minutes, respectively, p-value = 0.013). Conclusion: We have demonstrated an accelerated weaning protocol without increased vascularsite complications of radial artery occlusion or hematoma formation, which could potentially reduce hospital stay in same-day procedures.