RADIAL PCI: NOT ALL HEMATOMAS ARE THE SAME
After transradial or transulnar PCI, a forearm hematoma should be recognized early and classified by how far it extends.
The classic EASY classification:
⬜ Grade I: local, superficial hematoma, ≤5 cm
🟧 Grade II: ≤10 cm with moderate muscular infiltration
🟩 Grade III: extends beyond the elbow with muscular infiltration
🟥 Grade IV: extends above the elbow
🟦 Grade V: signs of ischemia/compartment syndrome
The practical lesson:
1️⃣ Small hematoma: observe and compress.
2️⃣ Expanding hematoma: escalate compression and reassess frequently.
3️⃣ Extensive hematoma: urgent physician assessment.
4️⃣ Ischemic/compartment syndrome: emergency management.
Check the hand perfusion, pulses, sensation, motor function, pain and progression of swelling rather than judging severity by size alone.
Radial access remains preferred for PCI in ACS because it reduces bleeding and vascular complications compared with femoral access.
Reference: Bertrand OF et al. EASY hematoma classification; updated context from ACC/AHA/SCAI revascularization and ACS guidance.