Assessment of the efficacy of phentolamine to prevent radial artery spasm during cardiac catheterization procedures: A randomized study comparing phentolamine vs. verapamil

Abstract

The objective of this study was to evaluate phentolamine as radial artery spasmolytic in transradial catheterization procedures. Radial artery spasm is a relatively frequent complication during transradial approach, causing patient discomfort or even making it impossible to continue the procedure. As radial artery spasm is mediated by the stimulation of alpha-adrenoreceptors, the use of the alpha-blocker phentolamine could make sense as spasmolytic. We designed a randomized double-blind study to compare phentolamine vs. verapamil, the standard spasmolytic agent. Five hundred patients (250 in each arm) submitted to a transradial cardiac catheterization were consecutively included and randomly assigned to receive 2.5 mg of verapamil or 2.5 mg of phentolamine after sheath insertion. Both vasodilator agents induced a significant radial artery diameter increase (from 2.22 +/- 0.53 to 2.48 +/- 0.57 mm, P < 0.001 for verapamil, and from 2.20 +/- 0.53 to 2.45 +/- 0.53 mm, P < 0.001 for phentolamine). However, verapamil was more efficacious to prevent radial artery spasm (13.2% compared with 23.2% in phentolamine-treated patients; P = 0.004). Follow-up (20 +/- 18 days) evaluation of the radial artery patency by plestismography and pulse oximetry showed no differences between the two groups in the rate of radial occlusion (3.0% vs. 3.2% in verapamil and phentolamine treated patients, respectively). Phentolamine was an effective radial vasodilator agent, although it showed less ability to prevent radial artery spasm than verapamil. Radial artery occlusion rate was almost identical for both vasodilators. Thus, phentolamine could be a valid alternative to verapamil as a radial artery spasmolytic agent.

Comparação entre um cateter único dedicado e cateteres de Judkins na realização da cineangiocoronariografia pela via radial direita

“…[17][18][19] Dentre outros fatores de prevenção, a utilização de várias drogas com efeito vasodilatador tem se mostrado eficaz em vários estudos 7,8,[20][21][22] , além da utilização de introdutores hidrofílicos, que promovem menor reação inflamatória tecidual local por menor trauma mecânico à parede arterial. Em estudo randomizado recente, Rathore et al 14 avaliaram 790 pacientes submetidos a intervenção coronária percutânea que utilizaram introdutores hidrofílicos e não-hidrofílicos e encontraram diminuição de cerca de 50% da incidên-cia de espasmo com a utilização dos introdutores recobertos.…”

“…[3][4][5] O espasmo da artéria radial é uma das complicações mais comuns da técnica, causando significante desconforto para o paciente e reduzindo a taxa de sucesso do procedimento. [6][7][8][9] O tempo prolongado do exame, a utilização de cateteres de maior diâmetro, a maior manipulação no procedimento e o maior núme-ro de cateteres utilizados estão entre as principais causas. 10 O objetivo deste estudo é avaliar se a utilização de cateteres únicos dedicados ao acesso radial poderia minimizar tais ocorrências e, consequentemente, diminuir a incidência de espasmo.…”

Intra-arterial vasodilators to prevent radial artery spasm: a systematic review and pooled analysis of clinical studies

“…Rosencher 2013 SPASM 3 [27] No significant difference was found between the three groups in terms of severe pain, crossover and safety events. Ruiz-Salmeron 2005 [28] There were only two serious events related to the procedure: one patient presented an extensive hematoma in the right forearm produced by radial…”

Radial artery spasm: Should we worry?

“…16 Moreover, RAS has been shown to be effectively treated by intra-arterial injection of selective alpha-receptor antagonists. 17 Assuming that RAS is a reflex response to trauma, with a sympathetically mediated efferent limb, the afferent component remains to be elucidated. In addition, there is uncertainty as to which level in the central nervous system (or peripheral nervous system [sympathetic ganglion]) the reflex is organized.…”

“…16 Il a aussi été démontré que le SAR pouvait être efficacement traité par injection intra-artérielle d'un antagoniste sélectif des récepteurs alpha. 17 Si l'on suppose que le SAR est une réponse réflexe au traumatisme avec une composante efférente à médiation sympathique, la composante afférente reste à déterminer. On ignore aussi avec certitude à quel niveau du système nerveux central ou périphérique (ganglion sympathique) le réflexe s'intègre.…”