Development and Evaluation of a Dynamic, Precise Decompression-Hemostasis Strategy after Surgery via the Distal Radial Artery Approach Based on Multimodal Monitoring Indicators

Background: This study aimed to develop and assess a dynamic, precise decompression-hemostasis strategy based on multimodal monitoring indicators, and to investigate the effectiveness and safety of this strategy in hemostasis management after surgery via the distal radial artery approach. Methods: In this single-center prospective cohort study, 224 patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) (January 2024 to June 2025) were consecutively assigned to a dynamic precise decompression group or a conventional compression group (n = 112 each). The dynamic strategy used individualized decompression guided by indicators such as activated clotting time (ACT) and perfusion index, whereas the control group followed conventional empirical fixed procedures. Hemostasis outcomes, patient comfort, and vascular complications were compared. Logistic regression identified risk factors for hemostasis failure, and a predictive model was constructed. Results: No significant differences were observed in initial hemostasis success, rebleeding, or hematoma rates (p > 0.05). The dynamic group showed significantly shorter compression time and higher first-attempt hemostat removal success (p < 0.05). Pain scores, local discomfort, and overall satisfaction were more favorable in the dynamic precise decompression group (p < 0.05). The 30-day distal radial artery occlusion rate was numerically lower in the dynamic precise decompression group, but the difference was not statistically significant (p > 0.05). ACT, body mass index (BMI), and sheath type were independent risk factors for hemostasis failure, while the dynamic strategy was independently associated with lower odds of hemostasis failure. The model showed acceptable discrimination, and exploratory subgroup analyses suggested possible heterogeneity according to ACT and BMI. Conclusions: Multimodal monitoring-guided dynamic decompression was associated with shorter compression time and more favorable comfort-related outcomes without an observed increase in bleeding complications. The 30-day distal radial artery occlusion (RAO) rate showed only a nonsignificant numerical trend toward reduction. These findings support further evaluation of this individualized hemostasis strategy in randomized controlled trials or externally validated studies.