Abstract Background The transradial approach (TRA) is a widely adopted, minimally invasive strategy for cardiac catheterization and intervention. Radial artery hemostasis is typically achieved using dedicated compression devices (e.g., TR Band®), yet specific protocols vary by institution due to limited evidence. Reducing compression time may improve patient comfort, preserve long-term radial artery patency, and enhance the overall management of ischemic heart disease. Purpose This study aimed to determine whether a novel hemostasis protocol could minimize radial artery compression time following percutaneous coronary intervention (PCI) without compromising safety, compared to the conventional protocol. Methods From July 2024 to January 2025, participants undergoing PCI via the transradial approach were randomly assigned to either the conventional or the novel hemostasis protocol. For both protocols, a TR Band® was applied with an initial 16 mL of air before sheath removal. The conventional protocol employed scheduled deflations at set times (2 mL immediately after sheath removal, 4 mL at 4 hours, and 10 mL at 5 hours), with reinflation if bleeding recurred. In the novel protocol, 2 mL of air was deflated immediately after sheath removal, followed by stepwise deflations every 30 minutes until all the air was removed. The primary endpoints were hemostasis duration and the incidence of radial artery occlusion (RAO), which was assessed by ultrasound on the day after the intervention. Results A total of 249 patients (mean age, 73.0 ± 11.1 years; 25.5% female; mean radial artery diameter, 2.33 ± 0.49 mm) were randomly assigned to the conventional (n = 122) or the novel (n = 125) group, with baseline characteristics well balanced between groups. Hemostasis duration was significantly shorter in the novel protocol group (112 ± 58 min vs. 308 ± 22 min, p 0.001). The incidence of RAO was also significantly lower in the novel group (2.4% vs. 9.8%, p = 0.014). There was no significant difference in subcutaneous bleeding or hematoma between the two groups (13.6% vs. 9.9%, p = 0.371). Patient satisfaction, evaluated via a Likert scale-based questionnaire, was significantly better in terms of pain (p = 0.001) and time constraints (p 0.001) in the novel protocol group. Conclusions A novel hemostasis protocol effectively reduces compression time and the incidence of RAO following transradial PCI without increasing bleeding complications. These findings highlight the potential benefits of a systematic approach to optimizing hemostasis protocols, warranting further validation in larger and more diverse clinical settings.
Takamatsu et al. (Sat,) studied this question.