Objective To assess the impact of length and hydrophilic coating of the introducer sheath on radial artery spasm, radial artery occlusion and local vascular complications in patients undergoing transradial coronary procedures.

Patients and Methods Seven hundred and ninety patients scheduled for a six Fr transradial coronary procedures were randomly assigned to different length (23 cm and 13 cm) and hydrophilic coated introducer sheaths (coated and uncoated) for transradial procedure. The primary outcome was clinical evidence of radial artery spasm and secondary end points were patient discomfort, and local vascular complications.

Results Procedural success was achieved in 96% of the cases and the radial artery spasm accounted for 17/33 failed cases. There was significantly less clinical radial artery spasm (19.0% vs 39.9%, OR 2.87; 95% CI, 2.07 to 3.97, p<0.0001) and patient reported discomfort (15.1% vs 28.5%, OR 2.27; 95% CI, 1.59 to 3.23) observed in patients receiving a hydrophilic sheath. No difference was observed between long and short sheaths. Radial artery occlusion was observed in 9.5% of the patients and was not influenced by sheath length or coating. A local large haematoma or arterial dissection was seen in 2.6% of the patients with no difference in groups allocated at randomisation. Younger age (OR 0.96, 95% CI: 0.95 to 0.98, p<0.001), female sex (OR 2.01, 95% CI: 1.31 to 3.09, p=0.001), diabetes (OR 1.84, 95% CI: 1.22 to 2.76, p=0.003) and lower body mass index (OR 0.96, 95% CI: 0.92 to 1.00, p=0.05) were identified as independent predictors of clinical radial artery spasm.

Conclusions Hydrophilic coating of the introducer sheath reduces the incidence of radial artery spasm during transradial coronary procedures. Sheath length did not influence this effect.