Outcomes of a modified technique for deflation of distal radial artery occlusion device on radial artery patency after percutaneous coronary intervention

Objective This study aimed to compare two protocols of deflation with increased intervals versus late deflation with smaller intervals for distal radial artery occlusion device (DROAD) removal to assess for radial artery occlusion (RAO). Methods All patients who underwent PCI with distal radial access were enrolled in the study. The DROAD was applied using an occlusive hemostasis method. Patients were assigned to either protocol 1 or protocol 2 at the primary physician's discretion. Protocol 1 involved the removal of 2 ml of air starting 1 hour after the sheath removal and then the removal of 2 ml every 30 minutes until the band came off. Protocol 2 involved the removal of 4 ml of air 2 hours after the sheath removal and then a further 4 ml of air every 15 minutes until the band came off. Results A total of 446 patients were enrolled in this study (mean age; 61 ± 6 (Group 1) and 60 ± 5 (Group 2); females 45.83% (Group 1) and 46.34% (Group 2)). The baseline characteristics were the same, including mean hemostasis time (256 ± 25 minutes (Group 1) and 254 ± 28 minutes (Group 2), P-value = 0.611). Primary and secondary endpoints did not reach significance in either group (RAO; 21 (8.71) Group 1 and 18 (8.78) Group 2 (P-value = 0.932)). Age (OR (95%CI): 1.07 (0.57 - 1.45); P-value = 0.031), female gender (OR (95%CI): 1.42 (0.93 - 1.74); P-value = 0.012), distal artery diameter (OR (95%CI): 0.57 (0.21 - 0.93); P-value = 0.005), procedure time (OR (95%CI): 2.64 (0.95 - 4.32); P-value = 0.001), and sheath size (OR (95%CI): 2.47 (1.43 - 3.76); P-value = 0.044) were predictors of RAO in our cohort. Conclusion This investigation shows no difference in the incidence of RAO with the standard versus accelerated deflation protocol after PCI. However, local vascular complications, including hematoma were increased with the accelerated protocol.