Hydrophilic-coated sheaths for reducing radial artery spasm during transradial procedures: A systematic review and meta-analysis

Background Transradial access for interventional procedures has become increasingly favored over the transfemoral approach. However, radial artery spasm (RAS) and radial artery occlusion (RAO) pose challenges to this approach. Aims This study aims to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing hydrophilic coated (HC) introducer sheaths with non-coated (NC) introducer sheaths during transradial procedures. The impact on RAS, RAO, periprocedural pain, and complications is evaluated. Methods PubMed, Embase, and the Cochrane Library were searched for RCTs utilizing HC sheaths in their intervention arm and NC sheaths in the control arm for patients undergoing transradial procedures. Outcomes included incidence of RAS, RAO, pain or discomfort during the procedure, procedure duration, pseudoaneurysm, and hematoma. RevMan 5.4 software was used to analyze pooled risk ratios and mean differences with 95% confidence intervals. Results Eight RCTs were included in this study. HC sheaths significantly reduced the risk of RAS and periprocedural pain or discomfort compared to NC sheaths (RR = 0.38, 95% CI [0.24, 0.60], I 2  = 19% and RR = 0.47, 95% CI [0.37, 0.59], I 2  = 1%, respectively). The use of HC sheaths had no significant effect on the risk of RAO, hematoma, or pseudoaneurysm. Conclusion The use of HC sheaths can enhance the overall patient and operator experience by reducing the risk of RAS and pain during transradial procedures, with no significant effect on RAO, hematoma, or pseudoaneurysm. This study provides evidence supporting the superiority of HC introducer sheaths over NC sheaths during transradial interventions.