Comparative analysis of two radial hemostasis strategies following percutaneous coronary intervention: a prospective, single-center, real-world cohort study

Abstract

Background Radial access is currently the approach of choice for coronary interventional procedures. However, puncture and hemostasis are not exempt from access site complications. This study evaluated the efficacy and safety of two radial hemostasis devices used after percutaneous coronary intervention (PCI) in routine clinical practice. Methods A prospective, single-center, real-world cohort study was carried out. Consecutive patients undergoing coronary angiography or PCI via radial access between February 2023 and October 2024 were included. Depending on the hemostasis technique used, the patients were assigned to TR-Closure band™ or a dedicated pad (VIRUNDA®). Access site complications were assessed at the time of device removal. Results A total of 597 patients were included (TR-Closure band™ n = 282; VIRUNDA® n = 315). The median age was 71 years (63–78); 409 (68.5%) were male. Compression time was shorter with VIRUNDA® [median 113 [90–133] vs. 148 [125–180] minutes; p < 0.001]. VIRUNDA® was associated with lower bleeding rates [Bleeding Academic Research Consortium (BARC) score 1: 9.8% vs. 58.2%], less pain during compression (10.5% vs. 19.9%) and after compression (5.4% vs. 13.8%), and less paresis (2.5% vs. 8.5%) (all p ≤ 0.001). Hematoma was more frequent with TR-Closure band™ (27.7% vs. 19.4%; p = 0.009). The immediate radial artery occlusion rates were similar (9.2% vs. 4.6%; p = 0.143). The multivariate analysis identified the use of VIRUNDA® as an independent protective factor (RR 0.171; 95%CI 0.119–0.245; p < 0.001). Conclusions Compared with TR-Closure band™, VIRUNDA® reduced bleeding, pain and paresis, and shortened compression time, without a significant increase in immediate radial occlusion. These findings support its use as a safe and efficient hemostatic alternative in routine practice.