1. Hemostasis after Trans Radial Intervention Division of Cardiology, Department of Internal Medicine Dongguk University Gyeongju Hospital Deuk-Young Nah, MD, PhD

2. Hamon M, et al. AHA 2006

3. The primary goals of TRI Easy Hemostasis and Early Ambulation

4. Two methods of hemostasis after TRI 1. Conventional compression 2. Patent hemostasis

5. Hemostasis Manual Compression / Gauze / Coban

6. Hemostasis HemoBand pressure pad

7. The ideal hemostasis after TRI Ensure adequate hemostasis without compromising the integrity of radial artery circulation

8. The ideal hemostasis after TRI

13. Hemostasis Radistop™ Compression Assist Device

14. Hemostasis RadStat® Radial Artery Compression Device (Merit Medical)

15. Hemostasis Terumo TR Band™

16. Hemostasis HEMO-STOP Transradial Transradial Compression Bracelet Aids Hemostasis This bracelet is designed to obtain a stable compression of the radial artery, which will allow an uninterrupted flow of blood sufficient to protect the vascular system, while assuring adequate compression to avoid hematoma and encouraging prompt hemostasis. The device will be released in April 2010. For more information: www.zoomco-medic.com

17. Hemostasis

18. Midforearm Hematoma

19. Radial artery occlusion (=RAO) 1.Incidence is 1-5% 2.95% of RAO occlusion are asymptomatic

20. Factors in RAO 1.Vasospasm 2.Inadequate anticoagulation 3.Prolonged occlusive pressure 4.Radial Artery damage Access, Prolonged canulation Sheath-to-artery ratio > 1 Excessive compression pressure

21. Radial artery occlusion 1.Thrombosis initiated by flow abnormality during the procedure. 2.Thrombosis propagated by occlusive hemostatic pressure 3.Organizing thrombosis leading to fibrotic obliteration

22. Radial artery occlusion J INVASIVE CARDIOL 2009;21:101–104

23. Radial artery occlusion

25. Conclusions 1.Hemostasis after TRI is effective, cheap, and easier compared to hemostasis after femoral or brachial intervention. 2.Patent hemostasis to prevent radial artery occlusion is very important.