麻豆传媒

With transradial access for coronary angiography, complication rates were the same whether patients got subsequent manual or mechanical compression, though it took longer to get to hemostasis with the latter, according to the MEMORY investigators.

Radial artery occlusion at 24 hours was no more likely for patients randomized to either manual or mechanical compression with the Vitatech Pressure Bandage, an inflatable air-filled wrist bracelet (12% versus 8%, P=0.176), reported Antonios Ziakas, MD, PhD, of Greece's AHEPA General Hospital, Aristotle University of Thessaloniki, and colleagues.

Comparing the access-site bleeding complication rates of hematoma (17% versus 18%, P=0.749) and bleeding (3% for both, P=1.000) also put neither strategy at a disadvantage, they wrote . Time to hemostasis, however, was markedly reduced with manual radial artery compression (22 versus 119 min, P<0.001).

The MEMORY trial included 589 patients undergoing diagnostic coronary angiography at five cardiac catheterization laboratories across Greece. All procedures were performed via transradial access with a 5-F sheath and radial artery patency assessed by ultrasound 24 hours after angiography.

"In the United States, mechanical compression is used most widely, though the two approaches have not previously been comparatively evaluated," commented Frederic Resnic, MD, , and Arjun Majithia, MD, both of Lahey Hospital and Medical Center in Burlington, Massachusetts. "Overall, accounting for clinical and procedural variables, limitations in study size, and event rates, the analysis did not show a definitive benefit with either manual or mechanical compression."

Even so, the trial highlights several important clinical insights regarding outcomes after transradial access, Resnic and Majithia said in an accompanying editorial comment.

"First, radial artery occlusion is an important complication following transradial access that can be significantly underrecognized in the clinical setting," they noted. "Second, the study findings support the conclusion that mechanical compression appears to be safe compared with meticulous manual compression. Despite a drastic reduction in time to hemostasis, the process of meticulous manual compression is more resource intensive viewed from the standpoint of personnel time, such that the incremental cost of a compression band would be negligible in comparison."

The third point they emphasized was the importance of patent hemostasis in post-transradial access management. "In this study, patent hemostasis was associated with an astounding 92% reduction in odds for radial artery occlusion. Approximately 10% of patients did not achieve patent hemostasis despite meticulous technique, such as intermittent ulnar compression and continuous plethysmography to assess arterial patency," according to the duo.

MEMORY investigators acknowledged a "statistically borderline higher" heparin dose in the mechanical compression group in their trial, though they noted that adjusting for this (among other factors in their multivariable analysis) still yielded comparable rates of radial artery occlusion between groups.

Another potential limitation were that the investigators did not test newer mechanical compression methods, such as ulnar artery compression and pneumatic control device compression.

"Of note, the present study excluded percutaneous coronary intervention procedures, and it is therefore unknown whether manual compression would significantly reduce time to hemostasis after such procedures, which require significant additional anticoagulation and frequently larger sheath sizes," Resnic and Majithia also pointed out.