PROPHET II Studies Prevention of Radial Artery Occlusion After Transradial Catheterization

October 4, 2016—The PROPHET II randomized trial sought to evaluate whether prophylactic ipsilateral ulnar artery compression during radial artery hemostasis could reduce the risk of radial artery occlusion (RAO), which is a structural complication of transradial access. Samir B. Pancholy, MD, et al published the PROPHET II findings in the Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2016;9:1992–1999).

According to the investigators, the background of the study is that RAO limits future ipsilateral TRA and may cause transient pain. Maintaining radial artery flow during hemostasis reduces the incidence of acute RAO. Ipsilateral ulnar compression increases radial artery flow and could impact the incidence of RAO.

As summarized in JACC: Cardiovascular Interventions, the PROPHET II study was composed of 3,000 patients undergoing diagnostic cardiac catheterization using TRA. The patients were randomized to receive either standard patent hemostasis protocol (group I) or prophylactic ipsilateral ulnar compression in addition to patent hemostasis (group II).

Using plethysmography, radial artery patency was evaluated at the time of removal of the compression device as well as at 24 hours and 30 days after the procedure. The primary study endpoint was 30-day RAO.

The investigators reported that the primary endpoint, 30-day RAO, was significantly reduced in patients with patent hemostasis and prophylactic ulnar compression compared with standard patent hemostasis (0.9% vs 3.0%; P = .0001). Baseline patient and procedural characteristics were similar between the two groups. RAO was significantly reduced by prophylactic ulnar compression at all time intervals (P < .0001).

Prophylactic ipsilateral ulnar compression during radial artery hemostasis is an effective, simple, and inexpensive technique that lowers the risk of RAO after TRA, concluded the PROPHET II investigators in JACC: Cardiovascular Interventions.