This study compared radial artery clamp times of 20 minutes versus 60 minutes after transradial cardiac catheterization. The primary outcome was radial artery occlusion (RAO) on the same day. Secondary outcomes included hemostasis and RAO at 1 week. The study found no difference in same day or 1 week RAO between groups. However, the 20 minute clamp time required more retightening and was associated with more bleeding and hematomas. Thus, the investigators concluded that a 60 minute clamp duration is preferable to an ultra-short 20 minute duration following transradial cardiac catheterization.

1. Postcath Radial Arterial
Clamp Time In the Cath Lab
S. Lavi, A. Cheema, A. Yadegari, J. Syed, Z. Israeli, Y. Levi, S. Wall,
M. Alemayehu, Y. Parviz, B. Murariu, T. McPherson, R. Bagur
London Health Sciences Centre, Ontario, Canada

2. • I have nothing to disclose

3. Radial Artery Occlusion (RAO)
• Uncommon but not rare
• Usually clinically silent
• Potentially clinically significant
– Ischemic symptoms of hand
– Precludes use of artery for future procedures

4. Increased with:
- Large catheters
- No anticoagulation
- Prolonged compression
Reduced with:
- Patent hemostasis
- Vasodilators
Radial Artery Occlusion (RAO) RiskRISK

5. Radial Artery Clamp Duration
Bleed
RAO
Optimal compression duration
• Current practice variable
• Most start to release clamp after 2-4 h
• In our institution 15-180 mins
• No “standard” time exists

6. Aim
• Assess the safety and efficacy of ultra-short
duration of clamp application after TRA

7. Study Methods
• RCT
• 2 sites: LHSC and St. Mikes
• Inclusion criteria:
– Elective & ACS patients
– Patency of ulnopalmar circulation (Barbeau type A, B,
C)
• Exclusion criteria
– Urgent cath (STEMI)
– Barbeau type D
– Prior RAO
– Prior surgery close to access site

8. Protocol
• Standard techniques, diagnostic or PCI
• 5 or 6 F sheath
• Intra-arterial nitroglycerin 200 mcg and
Verapamil 2.5 mg
• UFH 50 units/kg for diagnostic. 70 units/kg &
according to ACT for PCI
• Procedure completed prior to randomization
• Patent hemostasis

9. Hemostatic Clamp (RadARTM)
• Clamp at full pressure
– 20 vs. 60 mins
– Patent hemostasis
• 5 min timer

10. Clamp Removal
Clamp
Applied
Clamp
Removed1
Releases
20 5
2
5
3
5
4
5
Clamp
Applied
60
Clamp
Removed1
Releases
5
2
5
3
5
4
5

11. Clamp Removal
• Document bleeding during/after release
– Retighten x 10 mins
– Restart 20 min release procedure (q 5 mins x 4)

12. Study endpoints
• Primary : RAO same day (pulse-oximeter and a
reverse Barbeau ± US)
• Hemostasis- EASY scale
• RAO at 1 week

13. Results

14. Baseline Clinical Characteristics
20 minutes (n=283) 60 minutes (n=285)
Age 64.7±12 63.8±10.1
Females 28.6 % 30.9 %
BMI (kg/m2) 32.2±18.2 30.4±8.96
Hypertension 73.5 % 73 %
Diabetes 29.3 % 27 %
Creatinine (µmol/L) 84.5±32.8 87.2±43.2
Prior PCI 16.3 % 18.9 %
Prior radial approach 9.2 % 13.7 %
Barbeau’s type
A / B 87.6 % 91.2 %
C 3.5% 1.8 %

15. Procedural characteristics
20 minutes (n=283) 60 minutes (n=285)
Sheath size 5/6 33 / 67 % 35 / 65 %
PCI 27.6 % 27.0 %
UFH 99.6 % 99.6 %
GP IIbIIIa 4.9 % 3.9 %
Bivalirudin 0 0
Clopidogrel 41.3 % 43.2 %
Ticagrelor / prasugrel 8.8 % 8.8%
Aspirin 92.2 % 89.8 %

16. Results - RAO
0
1
2
3
4
5
Same day 1 week
4.9
2.92.8
0.9
20 min
60 min
P=0.19
P=0.36
%

17. Hemostasis during clamp
0
1
2
3
Hematoma < 5 cm Hematoma > 5cm
1.4
0.4
2.5
1.4 20 min
60 min
P=0.37
P=0.37
%

18. Hemostasis following clamp removal
0
2
4
6
8
10
Hematoma < 5 cm Hematoma > 5cm
6.7
1.8
2.5
1.4
20 min
60 min
P=0.01 P=0.75
%

19. Hemostasis
0
2
4
6
8
10
12
14
16
18
20
22
Any bleeding Retightening
19.8 20.5
14
12.3
20 min
60 min
P=0.13 P<0.01
%

20. Summary
• Ultra-short clamp release after 20 minutes
post TRA is not associated with reduction in
the incidence of RAO
• Rapid release required more retightening of
the clamp
• Rapid release associated with more bleeding
or hematoma.
• Retightening was independent predictor for
RAO

21. Conclusion
• The short (60 min) clamp duration is
preferable compared to the ultra-short (20
min)