The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Radial artery dilatation to improve access and lower complication rates during coronary angiography (RADIAL): A Randomized Controlled Trial

DOI: 10.4244/EIJ-D-19-00207

1. Division of Cardiology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa

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Aims: 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:1156 patients undergoing transradial coronary angiography were 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 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. 580 patients were randomized 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 were reduced with the use of PO-FMD, with a median of 1 attempt in the PO-FMD group and 2 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.

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