부산대학교 도서관

Coronary artery disease is the first cause of death in our environment. Contrast angiography and coronariography was performed in more than 140.000 cases in Spain last year, in more than 70.000 cases an interventional coronary procedure was also done to treat coronary flow disturbances. The initial arterial access to the coronary ostia was historically through femoral or brachial access but recent material development and improvement in quality Rx image has helped to switch to radial artery access in more than 90% of the cases done in our hospital. Rapid and progressive adoption of radial access has been boosted in the medical community due to the better clinical results published in patients in whom radial access is used. The study that we have conducted to analyze the incidence of radial artery occlusion after transradial catheterization aimed to detect the influence of the compression method used to achieve homeostasis in artery occlusion and also studied the potential functional impairment of the patient’s hand affected. We know from previous studies that type of compression influences thrombosis and artery occlusion after catheterization. We also know that percutaneous closure devices contribute to faster patient mobilization but do not avoid arterial access typical complications. We designed a study with three different methods to explore radial artery permeability (Allen Clinical Test, Pulsioximetric Test and Eco Doppler exploration) at basal, 1 week after and 3 month after catheterization and the compression method being randomized to pneumatic force (Terumo®) or elastic compression (Tensoplast®) between all the patients treated consecutively in our center during a 18 month period time. We did a functional test of hand strength following two different protocols: one to test maintained strenght and the other to test Rapid Exchange repetitions with two interval specified tests. We analized 274 patients, 124 submitted finally to the elastic compression method Tensoplast® and 150 patients treated with a pneumatic compression method Terumo®. Despite there were not statistically significant differences in basal characteristics between both groups our study showed higher radial artery occlusion rate at one week in the Terumo ® group. This was consistently confirmed with the three different methods of radial artery occlusion used. The difference in the occlusion rate lost statistical significance at the analysis performed at 3 month due to a higher rate of recanalization of the radial artery occluded in the pneumatic group, being more than double of the one raised with the elastic method. Incidence of late occlusion detected only at 3 month period was equivalent in both groups while persistent occlusion was clearly higher in the Terumo® patients. Functional strength analysis with all the prespecified tests did not show any differences between methods of compression nor between patients that suffered radial occlusion against those whose radial was kept permeable. By the other hand anatomic analysis showed variation between arterial diameters related to radial occlusion: if these was present ulnar diameter was bigger at 1 week and also at 3 month time. Arterial blood flow increased at one week if radial was occluded specifically at its systolic phase, not at all the other possible situations. In summary pneumatic compression is associated with a higher incidence of radial artery occlusion at 1 week. This phenomenon has not functional impact in the patient’s hand strenght but an adaptive anatomic change is found in the contralateral vessel: the ulnar artery.