Arterial Occlusion, Angina Pectoris, Cardiovascular Diseases, Atherosclerosis, Hematoma, Anticoagulant-Induced Bleeding, Coronary Artery Disease
Conditions
Keywords
radial artery occlusion, time to hemostasis, radial artery, transradial catheterization, TR band, Statseal, hemostasis band, potassium ferrate, percutaneous coronary intervention
Brief summary
The primary objectives of this study are to evaluate the performance of StatSeal Advanced used in conjunction with the TR Band (SSA) as compared to the TR Band without SSA (TRB) relative to: the incidence of peri-procedural radial artery occlusion (RAO) at discharge or 24 hours, whichever occurs first, and the Time to Hemostasis (TTH).
Detailed description
This study is a physician initiated, prospective, observational, two arm, randomized study to be performed at up to four experienced 'Radial First' centers (UCSD, UCLA. Arkansas Heart Hospital and LBVA). A maximum of 180 patients having undergone successful radial catheterization will be enrolled in the study, 60 in each arm. 60 patients will be enrolled at the LBVA. Enrollment will continue at each site on discretion of the investigators until each center enrolls a minimum of 30 patients, or a maximum of 180 patients are enrolled. Clinicians will perform the catheterization in accordance with local standard practice, with a minimum of 5,000 units of unfractionated heparin for anticoagulation. At the start of the TRA procedure, prior to radial artery cannulation, a baseline Pleth-ox exam will be performed for all patients and recorded on the CRF. Ulnar compression will be applied to confirm that the radial artery is patent. Patients with a type D pattern exam will be excluded from the study. At the conclusion of a successful transradial procedure, the patient will be randomized to either SSA or TRB, each device applied per protocol & IFU. It is hypothesized that if radial artery compression time can be shortened to 40 minutes or less, the following could result: improved catheterization lab efficiency, greater patient satisfaction and lower complication rates, including RAO, may be improved.
Interventions
DEVICEStatSeal
Patients randomly assigned to the experimental group will have a Statseal Advance (SSA) disc applied after withdrawing the radial sheath 2-4 cm. A Tegaderm dressing will be applied to secure the disc position. The TR band will be applied over the SSA disc with the center of the balloon (the green dot) over the center of the SSA disc. The TR band will be inflated with 8cc of air (which is typically occlusive pressure), and the sheath removed. No deflation will occur immediately. After 20 minutes of pressure, 3 cc of air will be removed from the TR band. After an additional 20 minutes (40 minutes after procedure), the TR band will be completely deflated, and the TR band left in place. After an additional 20 minutes (60 minutes after procedure) the TR band will be removed.
DEVICETR Band
Patients randomly assigned to the control group will have a TR band applied over the arteriotomy site and inflated with 15-18ml of air. After aspirating and clearing the contents of the sheath, the radial sheath will be removed. The TR band will be deflated until bleeding occurs, and 2 ml of air will be reintroduced to provide hemostasis. Patent hemostasis will be documented with plethysmography and oximetry as described below within 5 minutes after band application and removal, and within 30 min of discharge or after 24 hours. The TR band will be left inflated and in place for 2 hours following the procedure for all patients (regardless of diagnostic or PCI procedure), after which deflation attempts will commence.
Sponsors
VA Long Beach Healthcare System
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patient undergoing diagnostic angiography or PCI via the radial artery * Patients with a Barbeau test prior to the procedure showing pattern A,B,or
Exclusion criteria
* Use of a radial sheath larger than 6 Fr (a 7Fr-in-6 Glidesheath Slender ® is allowed). * Use of an anticoagulant other than unfractionated heparin or bivalirudin. * Any anticipated need for continued anticoagulation post-catheterization. Glycoprotein inhibitors are acceptable. * Any active treatment with oral anticoagulants continued during course of procedure. * Presence of arteriovenous dialysis fistula in the ipsilateral arm. * Any physical deformity or trauma / injury of either wrist that would prevent proper placement or function of the hemostasis band. * Raynaud's syndrome or known peripheral vascular disease of the forearm. * Mental incompetence or inability to follow the instructions to complete the study. * History or presence of Radial Artery Occlusion. * Barbeau test showing Pattern D. * Patients undergoing catheterization from the femoral or ulnar artery approach. * Cardiogenic shock or any clinical instability as assessed by the physician performing the procedure.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to Hemostasis Using the Hemostasis Management System (HMS) | within 30 min of discharge or after 24 hours | Time to deflation for removal of the TR Band (or TR Band and Statseal) for each group was measured in minutes. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percent of Patients With Radial Artery Occlusion(RAO) | within 30 min of discharge or after 24 hours | Radial artery occlusion was monitored for all participants using Barbeau's test and pulse oximetry. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| TR Band Only TR Band: Patients randomly assigned to the control group will have a TR band applied over the arteriotomy site and inflated with 15-18ml of air. After aspirating and clearing the contents of the sheath, the radial sheath will be removed. The TR band will be deflated until bleeding occurs, and 2 ml of air will be reintroduced to provide hemostasis. Patent hemostasis will be documented with plethysmography and oximetry as described below within 5 minutes after band application and removal, and within 30 min of discharge or after 24 hours. The TR band will be left inflated and in place for 2 hours following the procedure for all patients (regardless of diagnostic or PCI procedure), after which deflation attempts will commence. | 87 |
| Statseal With TR Band StatSeal: Patients randomly assigned to the experimental group will have a Statseal Advance (SSA) disc applied after withdrawing the radial sheath 2-4 cm. A Tegaderm dressing will be applied to secure the disc position. The TR band will be applied over the SSA disc with the center of the balloon (the green dot) over the center of the SSA disc. The TR band will be inflated with 8cc of air (which is typically occlusive pressure), and the sheath removed. No deflation will occur immediately. After 20 minutes of pressure, 3 cc of air will be removed from the TR band. After an additional 20 minutes (40 minutes after procedure), the TR band will be completely deflated, and the TR band left in place. After an additional 20 minutes (60 minutes after procedure) the TR band will be removed. | 93 |
| Total | 180 |
Baseline characteristics
| Characteristic | TR Band Only | Statseal With TR Band | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 52 Participants | 55 Participants | 107 Participants |
| Age, Categorical Between 18 and 65 years | 35 Participants | 38 Participants | 73 Participants |
| Age, Continuous | 66.5 years STANDARD_DEVIATION 9.8 | 65.8 years STANDARD_DEVIATION 11.8 | 66.15 years STANDARD_DEVIATION 10.8 |
| Barbeau Class A | 76 Participants | 79 Participants | 155 Participants |
| Race and Ethnicity Not Collected | — | — | 0 Participants |
| Region of Enrollment United States | 87 participants | 93 participants | 180 participants |
| Sex: Female, Male Female | 18 Participants | 22 Participants | 40 Participants |
| Sex: Female, Male Male | 69 Participants | 71 Participants | 140 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 87 | 0 / 93 |
| other Total, other adverse events | 9 / 87 | 18 / 93 |
| serious Total, serious adverse events | 0 / 87 | 0 / 93 |
Outcome results
Primary
Time to Hemostasis Using the Hemostasis Management System (HMS)
Time to deflation for removal of the TR Band (or TR Band and Statseal) for each group was measured in minutes.
Time frame: within 30 min of discharge or after 24 hours
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| TR Band Only | Time to Hemostasis Using the Hemostasis Management System (HMS) | 160 minutes | Standard Deviation 42.75 |
| Statseal With TR Band | Time to Hemostasis Using the Hemostasis Management System (HMS) | 42.95 minutes | Standard Deviation 13.91 |
Secondary
Percent of Patients With Radial Artery Occlusion(RAO)
Radial artery occlusion was monitored for all participants using Barbeau's test and pulse oximetry.
Time frame: within 30 min of discharge or after 24 hours
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| TR Band Only | Percent of Patients With Radial Artery Occlusion(RAO) | 0 Participants |
| Statseal With TR Band | Percent of Patients With Radial Artery Occlusion(RAO) | 2 Participants |