Usefulness of a Gentle and Short Hemostasis Using the TR Band Device After Transradial Access for Percutaneous Coronary Angiography and Interventions to Reduce the Radial Artery Occlusion Rate (From the Prospective and Randomized CRASOC I, II & III Studies)

Abstract The study sought to evaluate the benefit of the reduction in intensity and duration of the hemostasis obtained with the TR Band compression device on the radial artery occlusion (RAO) rate. RAO is the most frequent complication of transradial access (TRA) for cardiac catheterization and limits future use of this safe route. Its occurrence must be minimized. Between 2009 and 2016, 3616 TRA were randomized to TR Band hemostasis following 3 consecutive protocols: Crasoc I: 13 vs 10 cc of air into the TR Band and for 4 h of continuous compression; Crasoc II: 10 cc of air for 3 vs 2 h of compression; Crasoc III: 10 cc of air for 2 vs 1.5 h of compression and virtual 4F introducer as default sheath (both arms). Radial artery patency was assessed by plethysmography at 24h, using Doppler for doubtful or negative plethysmography. The primary endpoint, 24h RAO, was markedly reduced when hemostasis was soft (10 cc of air) and short (1.5h) and resulted in a 2.3 % rate of RAO vs 9.4% for 13 cc- 4 h. Hemostasis was obtained in 89% of patients with only 10 cc of air and in 97% of patients with less than the recommended 13 cc. About 8% of patients required more than the 1.5 h of hemostasis time. In conclusion, short and soft hemostasis with the TR Band device leads to a low RAO rate.