Post-procedural radial artery patency and occlusion detection, I Bernat

1. Post-procedural RAP and RAO
detection
Ivo Bernat MD, PhD.
University Hospital and Faculty of Medicine Pilsen, Charles University
Czech Republic

2. Disclosure
I have no conflict of interests to disclose

3. Kanei et al. Catheter Cardiovasc Interv 2011;78:840-6

4. - Palpation - no
- Allen test - no
• reverse Barbeau test - yes
• DUSG - yes
• Laser doppler - new - probably yes
Postprocedural RA patency control in 2016

5. • pulse oximeter
• ulnar artery compression
• display and plethysmo curve
• Barbeau test (AHJ 2004)
Reverse Barbeau test

6. • RA diameter
• color and pulse
Doppler
DUSG

8. Background
• Diagnosis of radial artery patency (RAP) and soon
detection of radial artery occlusion (RAO) after
transradial catheterization and intervention is an
important part of successful radial program. The aim
of our study was to compare two diagnostic
methods of RAP and RAO - reverse Barbeau test and
duplex ultrasound.

9. Before our study results
- few slides about RA and sheaths …

10. • usually asymtomatic
• 50% spontaneous recanalizations in
few months
• Risk of RAO:
– sheath - artery diameter >1
– oclusive RA compression
– prolong RA compression
– ↓ anticoagulation
– prolong cannulation
– diabetes, female … BMI
Radial artery occlusion (RAO)

12. What is important …
• sheath - artery diameter > 1 (Saito et al. 1999)
• usually we use sheath inner diameter for GC in F (6F … 0,33x6=2,0mm)
• but this is sheath outer diameter vs inner artery diameter >1

13. IID a OD 5F - 7F : sheath vs. guiding catheter
Kotowycz M, Džavík V. Circ Cardiovasc Interv 2012;5:127-133

15. 6F sheaths outer diameters - for 6F GC (1,98mm) !!
7,42 F 7,97 F 8,15 F 8,27 F 8,3 F 8,57 F 8,72 F 8,72 F …!!!

16. … that is why „Slender“ is better for radial arteries
Dahm JB et al CCI 2002

17. Spasm in 5F is not 0 % and rarely can be diffuse ….

18. Example of diffuse spasm from our SDD program 2.

19. Example of diffuse spasm from our SDD program 3.

20. Small radial arteries in our routine practice …

21. Wrist arteries …

22. Slender in Japan … vs .... Slender in Europe

23. Aminian et al. CCI 2013

24. Last and very good news - 5F Glide Sheath Slender
Yoshimachi et al. Cardiovasc Interv and Ther 2016;31:38-41

25. Radial artery is usually smaller than treated coronary artery …
We should think more about RA protection and soon RAO detection
…

26. • 260 consecutive patients from our SDD program
• Glidesheath 5,2F a 5F
• compression with TR Band
Reverse Barbeau test vs. DUSG

27. • RA compression by TR Band was followed by:
- reverse Barbeau test - nurse from our Lounge
- DUSG a. radialis - physician (cardiologist)
• We evaluated :
- RAP and RAO by both methods
- compression time
- other local complications including hematomas (EASY)
Reverse Barbeau test vs. DUSG

28. Baseline characteristics (n=260)
males 74% (191)
age (y) 64±9
BMI 30,6 ±17,3
hypertension 72% (187)
hyperlipidemia 66% (172)
diabetes 19% (49)
smoking 19% (48)
exsmoking 26% (68)
previous MI 17% (45)
previous PCI 20% (53)
previous CABG 5% (12)
previous TR same approach 21% (55)

29. CAG 100% (n=260)
PCI 25,4% (66)
FFR 7,7% (20)
LVG 11,5% (30)
UFH 5000 j 92%
aspirin 76% (197)
clopidogrel 33% (85)
ticagrelor 1,2% (3)
warfarin (INR 2,0-2,5) 6,5% (17)
NOAC 1,5% (4)
Procedures

30. Indication
28,5%
28,1%
15,8%
6,9%
6,9%
6,5%
5,8%
1,5%
stable angina
chest pain
dyspnoe
systolic dysfunction
silent ischemia
post MI
elective PCI/FFR
others

31. 89,1%
6,2%
3,1% 0,8% 0,8%
1
2
3
≥4
conversion
Number of punctions

32. Results - RBT vs. DUSG
99,2%
0,8%
reverse Barbeau test
patent
RAO 99,2%
0,8%
DUSG
patent
RAO
• Both methods are comparable in detection of RAP and RAO
• 99,2% (n=258) RAP and 0,8% RAO by DUSG and reverse Barbeau test

33. Results - RA compression time
• 103±38 min
0
60
120
180
240
300
0 50 100 150 200 250 300
time (min)

34. 80,4%
14,2%
5,4%
I.st. (>5cm) n=37
II.st. (5-10cm) n=14
III.st. (>10cm) n=0
IV.st. (po loket) n=0
V.st. (compartment
syndrom) n=0
Results - hematomas in cm (EASY)

35. • Both methods are comparable in detection of
RAP and RAO
• Reverse Barbeau test is easier in our routine daily
practice
• Reverse Barbeau test should be perfomed in all
patients after transradial catheterizations and
interventions for its simplicity (optimally immediately after
compression)
Conclusions