Randomized comparison of rapid versus oximetry guided deflation of the transradial-band after coronary angiography or angioplasty.

Background: Transradial access is recommended for coronary angiography and angioplasty, and is associated with fewer complications when compared to femoral access. Nevertheless, there is a risk of hematoma and radial artery occlusion (RAO), and substantial time may elapse until hemostasis is achieved.

Aims: We aimed to evaluate if an oximetry-guided deflation technique compared to a traditional rapid deflation technique was associated with earlier removal of the transradial band (TR-band) and lower rates of RAO following radial coronary intervention.

Methods: Between October 2018 and December 2021, we randomized 3600 patients to either traditional rapid deflation where 1/3 of volume in the TR-band was removed every 20 min and reinflated if bleeding, or oximetry-guided deflation aiming at patent hemostasis and full deflation of the TR-band after 60 min, with cross-over to traditional deflation if bleeding at the time of deflation.

Results: A TR-band was applied in 3540 patients, and data on time to removal was available in 3288 (93 %) of these. The time to full deflation of the TR-band was 92 versus 74 min, P < 0.01 and the time to removal of the TR-band was 112 versus 100 min, P < 0.01 in patients randomized to traditional rapid (n = 1767) versus oximetry-guided deflation (n = 1773). The rate of RAO or sub- occlusion evaluated by oximetry after TR-band removal was 1.2 % versus 1.8 %, P = 0.16.

Conclusion: Traditional rapid deflation of the TR-band with the first deflation attempt after 20 min is associated with re-bleeding and prolonged time to removal of the TR-band, as compared to a strategy where the first deflation attempt is performed after 60 min. Oximetry-guided deflation, however, was not associated with lower rates of RAO or subocclusion.