Forearm approach for percutaneous coronary procedures

Safety analysis of brachial artery sheath removal after heparin reversal with a half dose of protamine after percutaneous coronary intervention: a single-center experience

Aim

To evaluate the safety of brachial artery (BA) sheath removal after heparin neutralization with a half dose of protamine immediately after percutaneous coronary intervention (PCI).

Methods

The clinical data of 209 consecutive patients who underwent PCI through the BA at Fu Wai Hospital between September 2019 and June 2024 were retrospectively collected. In group I, the brachial sheath was removed 4 h after the PCI procedure. In group II, circulating heparin was neutralized with a half dose of protamine sulfate, and the brachial sheath was removed immediately after the procedure.

Results

There were no cases of acute stent thrombosis, nonfatal myocardial infarction or in-hospital mortality in either group. In group II, there were two cases of pseudoaneurysm, one of which was transfer to surgery and the other was manually compressed. No severe puncture site-related bleeding occurred. The levels of hemoglobin were similar between the two groups before and after the PCI procedure (p > 0.05).

Conclusions

The BA sheath can be safely removed immediately after PCI by neutralizing heparin with a half dose of protamine. But we still need to be vigilant about the occurrence of pseudoaneurysms.

Comparison of the Efficacy of Two Elastic Bandages for Forearm Hematoma After Transradial Coronary Intervention

Background: This study compares the efficacy of two elastic bandages in treating forearm hematoma after transradial coronary intervention.

Methods: A total of 60 patients with moderate or severe forearm hematoma following transradial coronary intervention were enrolled in this study. They were randomly divided into two groups, as follows: an Idealast-haft elastic bandage group (the observation group) and a control group. The patients in the Idealast-haft elastic bandage group received compression bandaging with Idealast-haft elastic bandages and the patients in the control group received compression bandaging with Nylexorgrip elastic bandages. Observation indexes related to, for example, forearm pain, arterial pulsation, blistering, skin color, and hemostasis time were compared between the two groups.

Results: The results revealed that the times taken for pain disappearance, arterial pulse recovery, blister disappearance, skin color recovery, and compression hemostasis were significantly shorter in the Idealast-haft elastic bandage group than in the control group, and the differences were statistically significant (P < 0.05). The hematoma range and the arm circumference at the severest part of the hematoma decreased faster in the observation group than in the control group, and the differences were statistically significant (P < 0.05).

Conclusion: The Idealast-haft elastic bandage is more effective than the Nylexorgrip elastic bandage in patients with forearm hematoma following transradial coronary intervention and should therefore be used in such cases.