Manual heating of the radial artery (Balbay maneuver) to facilitate radial puncture prior to transradial coronary catheterization.

Objective: Transradial access is widely used for both diagnostic and interventional cardiac procedures. The use of transradial access offers several advantages, including decreased bleeding, fewer vascular complications, and reduced length of hospital stay and cost. However, the small size of the radial artery limits the size of the equipment that can be used via this approach. In this study we sought to investigate whether preprocedural manual heating of the radial artery facilitates radial artery puncture.

Methods: Patients undergoing transradial cardiac catheterization were randomized to subcutaneous nitroglycerin plus diltiazem or manual heating. The study endpoint was puncture score (score 1: easiest - puncture at first attempt; score 2: second attempt; score 3: third attempt; score 4: fourth attempt or more; score 5: puncture failed).

Results: Ninety consecutive patients were enrolled in the study, 45 allocated to the drug treatment group and 45 to the heating group. Patients underwent radial artery ultrasound before catheterization. Complications were rare: one hematoma (drug treatment group) and one radial artery occlusion (heating group). Baseline demographic and clinical characteristics were similar. Baseline radial artery diameter was similar in both groups (2.41±0.46 mm and 2.29±0.48 mm in the heating and drug treatment groups, respectively). However, the median puncture score was lower in the heating group (1; interquartile range 1-2) compared to the drug treatment group (2; interquartile range 1-3; p=0.001).

Conclusions: Preprocedural manual heating of the radial artery facilitates radial artery puncture in patients undergoing transradial cardiac catheterization.