Abstract Body: Background: Transradial access has become increasingly favored over the traditional transfemoral approach for neurointerventional procedures, however radial artery spasm (RAS) and radial artery occlusion (RAO) pose challenges to this approach. RAS is one of the most common complications associated with the transradial approach that can impede procedural success and cause significant pain to patients. A promising strategy to mitigate RAS is the use of hydrophilic-coated (HC) introducer sheaths. The lubricious surface facilitates smoother insertion and manipulation within the radial artery, potentially reducing friction that contributes to RAS. Prior studies have reported conflicting results regarding the utility of HC sheaths in reducing the risk of RAS. Thus, the clinical benefit of HC sheaths is not fully understood.
Objective: The purpose of this study is to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing HC introducer sheaths with non-coated (NC) introducer sheaths during transradial procedures and their impact on RAS, RAO, periprocedural pain, and complications.
Methods: PubMed, Embase, and Cochrane Library were searched for RCTs utilizing HC sheaths in their intervention arm and NC sheaths in their control arm in patients undergoing a transradial procedure. Outcomes included incidence of RAS, RAO, pain/discomfort during the procedure, pseudoaneurysm, and hematoma. RevMan 5.4 software was used to calculate pooled risk ratios and mean differences with 95% confidence intervals.
Results: Seven RCTs were included in this study. HC sheaths were associated with a significant reduction in the risk of RAS and periprocedural pain/discomfort compared to NC sheaths (RR = 0.38, 95% CI [0.24, 0.60], I² = 19% and RR = 0.45, 95% CI [0.34, 0.60], I² = 14%, respectively). The use of HC sheaths had no significant effect on the risk of RAO, hematoma, or pseudoaneurysm.
Conclusion: The use of HC sheaths is associated with a reduced risk of RAS and periprocedural pain/discomfort compared to NC sheaths with no significant effect on RAO, procedure duration, hematoma, or pseudoaneurysm. HC sheaths improve the overall patient experience and reduce the risk of spasm. These findings may provide valuable insights for neurointerventionalists seeking to optimize transradial techniques and improve patient care.