Randomized comparison of rapid versus oximetry guided deflation of the transradial-band after coronary angiography or angioplasty

Christel Gry Aagren Nielsen; Martin Bøhme Rasmussen; Pernille Thordahl Rhode; Dorte Vitt Bagner; Rebekka Vibjerg Jensen; Lars Jakobsen; Nicolaj Brejnholt Støttrup; Karsten Tange Veien; Ellen Nyholm Larsen; Mette Gitz Charlot; Anne Elisabeth Boesgaard; Christian Juhl Terkelsen

doi:10.1016/j.ijcard.2024.132708

Randomized comparison of rapid versus oximetry guided deflation of the transradial-band after coronary angiography or angioplasty

Christel Gry Aagren Nielsen, Martin Bøhme Rasmussen, Pernille Thordahl Rhode, Dorte Vitt Bagner, Rebekka Vibjerg Jensen, Lars Jakobsen, Nicolaj Brejnholt Støttrup, Karsten Tange Veien, Ellen Nyholm Larsen, Mette Gitz Charlot, Anne Elisabeth Boesgaard, Christian Juhl Terkelsen

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Background: Transradial access is recommended for coronary angiography and angioplasty, and is associated with fewer complications when compared to femoral access. Nevertheless, there is a risk of hematoma and radial artery occlusion (RAO), and substantial time may elapse until hemostasis is achieved. Aims: We aimed to evaluate if an oximetry-guided deflation technique compared to a traditional rapid deflation technique was associated with earlier removal of the transradial band (TR-band) and lower rates of RAO following radial coronary intervention. Methods: Between October 2018 and December 2021, we randomized 3600 patients to either traditional rapid deflation where 1/3 of volume in the TR-band was removed every 20 min and reinflated if bleeding, or oximetry-guided deflation aiming at patent hemostasis and full deflation of the TR-band after 60 min, with cross-over to traditional deflation if bleeding at the time of deflation. Results: A TR-band was applied in 3540 patients, and data on time to removal was available in 3288 (93 %) of these. The time to full deflation of the TR-band was 92 versus 74 min, P < 0.01 and the time to removal of the TR-band was 112 versus 100 min, P < 0.01 in patients randomized to traditional rapid (n = 1767) versus oximetry-guided deflation (n = 1773). The rate of RAO or sub- occlusion evaluated by oximetry after TR-band removal was 1.2 % versus 1.8 %, P = 0.16. Conclusion: Traditional rapid deflation of the TR-band with the first deflation attempt after 20 min is associated with re-bleeding and prolonged time to removal of the TR-band, as compared to a strategy where the first deflation attempt is performed after 60 min. Oximetry-guided deflation, however, was not associated with lower rates of RAO or subocclusion.

Original language	English
Article number	132708
Journal	International Journal of Cardiology
Volume	419
Pages (from-to)	132708
ISSN	0167-5273
DOIs	https://doi.org/10.1016/j.ijcard.2024.132708
Publication status	Published - 15 Jan 2025

Keywords

Access site
Hemostasis time
Radial
Radial artery occlusion
Vascular closure device

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10.1016/j.ijcard.2024.132708

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Aagren Nielsen, C. G., Rasmussen, M. B., Rhode, P. T., Bagner, D. V., Jensen, R. V., Jakobsen, L., Støttrup, N. B., Veien, K. T., Larsen, E. N., Charlot, M. G., Boesgaard, A. E., & Terkelsen, C. J. (2025). Randomized comparison of rapid versus oximetry guided deflation of the transradial-band after coronary angiography or angioplasty. International Journal of Cardiology, 419, 132708. Article 132708. https://doi.org/10.1016/j.ijcard.2024.132708

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title = "Randomized comparison of rapid versus oximetry guided deflation of the transradial-band after coronary angiography or angioplasty",

abstract = "Background: Transradial access is recommended for coronary angiography and angioplasty, and is associated with fewer complications when compared to femoral access. Nevertheless, there is a risk of hematoma and radial artery occlusion (RAO), and substantial time may elapse until hemostasis is achieved. Aims: We aimed to evaluate if an oximetry-guided deflation technique compared to a traditional rapid deflation technique was associated with earlier removal of the transradial band (TR-band) and lower rates of RAO following radial coronary intervention. Methods: Between October 2018 and December 2021, we randomized 3600 patients to either traditional rapid deflation where 1/3 of volume in the TR-band was removed every 20 min and reinflated if bleeding, or oximetry-guided deflation aiming at patent hemostasis and full deflation of the TR-band after 60 min, with cross-over to traditional deflation if bleeding at the time of deflation. Results: A TR-band was applied in 3540 patients, and data on time to removal was available in 3288 (93 %) of these. The time to full deflation of the TR-band was 92 versus 74 min, P < 0.01 and the time to removal of the TR-band was 112 versus 100 min, P < 0.01 in patients randomized to traditional rapid (n = 1767) versus oximetry-guided deflation (n = 1773). The rate of RAO or sub- occlusion evaluated by oximetry after TR-band removal was 1.2 % versus 1.8 %, P = 0.16. Conclusion: Traditional rapid deflation of the TR-band with the first deflation attempt after 20 min is associated with re-bleeding and prolonged time to removal of the TR-band, as compared to a strategy where the first deflation attempt is performed after 60 min. Oximetry-guided deflation, however, was not associated with lower rates of RAO or subocclusion.",

keywords = "Access site, Hemostasis time, Radial, Radial artery occlusion, Vascular closure device",

author = "{Aagren Nielsen}, {Christel Gry} and Rasmussen, {Martin B{\o}hme} and Rhode, {Pernille Thordahl} and Bagner, {Dorte Vitt} and Jensen, {Rebekka Vibjerg} and Lars Jakobsen and St{\o}ttrup, {Nicolaj Brejnholt} and Veien, {Karsten Tange} and Larsen, {Ellen Nyholm} and Charlot, {Mette Gitz} and Boesgaard, {Anne Elisabeth} and Terkelsen, {Christian Juhl}",

year = "2025",

month = jan,

day = "15",

doi = "10.1016/j.ijcard.2024.132708",

language = "English",

volume = "419",

pages = "132708",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

}

Aagren Nielsen, CG , Rasmussen, MB, Rhode, PT, Bagner, DV, Jensen, RV , Jakobsen, L , Støttrup, NB, Veien, KT, Larsen, EN, Charlot, MG, Boesgaard, AE & Terkelsen, CJ 2025, 'Randomized comparison of rapid versus oximetry guided deflation of the transradial-band after coronary angiography or angioplasty', International Journal of Cardiology, vol. 419, 132708, pp. 132708. https://doi.org/10.1016/j.ijcard.2024.132708

Randomized comparison of rapid versus oximetry guided deflation of the transradial-band after coronary angiography or angioplasty. / Aagren Nielsen, Christel Gry ; Rasmussen, Martin Bøhme; Rhode, Pernille Thordahl et al.
In: International Journal of Cardiology, Vol. 419, 132708, 15.01.2025, p. 132708.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Randomized comparison of rapid versus oximetry guided deflation of the transradial-band after coronary angiography or angioplasty

AU - Aagren Nielsen, Christel Gry

AU - Rasmussen, Martin Bøhme

AU - Rhode, Pernille Thordahl

AU - Bagner, Dorte Vitt

AU - Jensen, Rebekka Vibjerg

AU - Jakobsen, Lars

AU - Støttrup, Nicolaj Brejnholt

AU - Veien, Karsten Tange

AU - Larsen, Ellen Nyholm

AU - Charlot, Mette Gitz

AU - Boesgaard, Anne Elisabeth

AU - Terkelsen, Christian Juhl

PY - 2025/1/15

Y1 - 2025/1/15

N2 - Background: Transradial access is recommended for coronary angiography and angioplasty, and is associated with fewer complications when compared to femoral access. Nevertheless, there is a risk of hematoma and radial artery occlusion (RAO), and substantial time may elapse until hemostasis is achieved. Aims: We aimed to evaluate if an oximetry-guided deflation technique compared to a traditional rapid deflation technique was associated with earlier removal of the transradial band (TR-band) and lower rates of RAO following radial coronary intervention. Methods: Between October 2018 and December 2021, we randomized 3600 patients to either traditional rapid deflation where 1/3 of volume in the TR-band was removed every 20 min and reinflated if bleeding, or oximetry-guided deflation aiming at patent hemostasis and full deflation of the TR-band after 60 min, with cross-over to traditional deflation if bleeding at the time of deflation. Results: A TR-band was applied in 3540 patients, and data on time to removal was available in 3288 (93 %) of these. The time to full deflation of the TR-band was 92 versus 74 min, P < 0.01 and the time to removal of the TR-band was 112 versus 100 min, P < 0.01 in patients randomized to traditional rapid (n = 1767) versus oximetry-guided deflation (n = 1773). The rate of RAO or sub- occlusion evaluated by oximetry after TR-band removal was 1.2 % versus 1.8 %, P = 0.16. Conclusion: Traditional rapid deflation of the TR-band with the first deflation attempt after 20 min is associated with re-bleeding and prolonged time to removal of the TR-band, as compared to a strategy where the first deflation attempt is performed after 60 min. Oximetry-guided deflation, however, was not associated with lower rates of RAO or subocclusion.

AB - Background: Transradial access is recommended for coronary angiography and angioplasty, and is associated with fewer complications when compared to femoral access. Nevertheless, there is a risk of hematoma and radial artery occlusion (RAO), and substantial time may elapse until hemostasis is achieved. Aims: We aimed to evaluate if an oximetry-guided deflation technique compared to a traditional rapid deflation technique was associated with earlier removal of the transradial band (TR-band) and lower rates of RAO following radial coronary intervention. Methods: Between October 2018 and December 2021, we randomized 3600 patients to either traditional rapid deflation where 1/3 of volume in the TR-band was removed every 20 min and reinflated if bleeding, or oximetry-guided deflation aiming at patent hemostasis and full deflation of the TR-band after 60 min, with cross-over to traditional deflation if bleeding at the time of deflation. Results: A TR-band was applied in 3540 patients, and data on time to removal was available in 3288 (93 %) of these. The time to full deflation of the TR-band was 92 versus 74 min, P < 0.01 and the time to removal of the TR-band was 112 versus 100 min, P < 0.01 in patients randomized to traditional rapid (n = 1767) versus oximetry-guided deflation (n = 1773). The rate of RAO or sub- occlusion evaluated by oximetry after TR-band removal was 1.2 % versus 1.8 %, P = 0.16. Conclusion: Traditional rapid deflation of the TR-band with the first deflation attempt after 20 min is associated with re-bleeding and prolonged time to removal of the TR-band, as compared to a strategy where the first deflation attempt is performed after 60 min. Oximetry-guided deflation, however, was not associated with lower rates of RAO or subocclusion.

KW - Access site

KW - Hemostasis time

KW - Radial

KW - Radial artery occlusion

KW - Vascular closure device

UR - http://www.scopus.com/inward/record.url?scp=85208538183&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2024.132708

DO - 10.1016/j.ijcard.2024.132708

M3 - Journal article

C2 - 39532256

SN - 0167-5273

VL - 419

SP - 132708

JO - International Journal of Cardiology

JF - International Journal of Cardiology

M1 - 132708

ER -

Randomized comparison of rapid versus oximetry guided deflation of the transradial-band after coronary angiography or angioplasty

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Keywords

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