Evaluation of a spasmolytic cocktail to prevent radial artery spasm during coronary procedures

Kiemeneij, Ferdinand; Vajifdar, Bhavesh; Eccleshall, Simon; Laarman, Gert Jan; Slagboom, Ton; Wieken, Ron van der

doi:10.1002/ccd.10445

Cited by 140 publications

(117 citation statements)

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“…[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.…”

Section: Discussionunclassified

“…[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.…”

Section: Comparison Of a Single Dedicated Catheter And The Judkins Caunclassified

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

Tebet¹,

Andrade²,

Andrade³

et al. 2010

Rev. Bras. Cardiol. Invasiva

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RESUMOIntrodução: O espasmo radial é considerado um dos principais fatores de insucesso na via radial. O tempo prolongado de exame, a utilização de cateteres de maior diâme-tro, as fricções do cateter durante a manipulação e o número de cateteres utilizados estão entre as principais causas. A utilização de cateteres únicos dedicados a esse acesso poderia minimizar tais fatores, com consequente diminuição da incidência de espasmo. Método: Registro prospectivo de pacientes consecutivos com suspeita de doença coronária, submetidos a coronariografia pelo acesso radial direito, com introdutores 5 F. (grupo I) foram incluídos e comparados a um grupo controle com mesmo número de pacientes, que utilizaram cateteres de Judkins (grupo II). Houve maior taxa de sucesso do procedimento no grupo I (100% vs. 98%; P = 0,03) e não houve diferença na taxa de sucesso da estratégia escolhida (93,7% vs. 95%; P = 0,59). Houve diminuição estatisticamente significante da duração do procedimento (13,6 + 6 min vs. 15 + 6,4 min; P = 0,007), do tempo de fluoroscopia (2,5 + 1,6 min vs. 3,1 + 2,2 min; P = 0,0009) e do número de cateteres (1,1 + 0,3 vs. 2,1 + 0,6; P < 0,0001) no grupo I. Não houve diferença na ocorrên-cia de espasmo (4,7% vs. 5,7%; P > 0,99). Conclusão: A utilização de cateter dedicado ao acesso radial mostrouse eficaz, segura, com diminuição significativa do tempo de fluoroscopia, do exame e do número de cateteres, com ABSTRACT Comparison of a Single Dedicated Catheter and the Judkins Catheter for Coronary Angiography Using the Right Transradial AccessBackground: Radial spasm is considered one of the main reasons of failure in the transradial approach. The prolonged procedure time, use of large diameter catheters, catheter frictions during manipulation and number of catheters used are among the main causes of radial spasm. The use of catheters dedicated to radial access could minimize such factors, with a consequent reduction in the incidence of spasm. Method: Prospective registry of consecutive patients with suspected coronary artery disease undergoing coronary angiography using the right radial access, with 5 F sheaths. We compared the procedural success, the strategy success, duration of the procedure, fluoroscopy time and the number of catheters used among patients who used the dedicated catheter (Optitorque TM TIG) with those using the Judkins catheter (JL/JR). Results: From September 2009 to July 2010, 300 patients using the dedicated catheter (group I) were included and compared with a control group with the same number of patients whose procedure was performed using Judkins catheters (group II). There was a higher procedure success rate in group I (100% vs. 98%; P = 0.03) and no difference in the chosen strategy success (93.7% vs. 95%; P = 0.59). There was a statistically significant decrease in the duration of the procedure (13.6 + 6 min vs. 15 + 6.4 min; P = 0.007), in fluoroscopy time (2.5 + 1.6 min vs. 3.1 + 2.2 min; P = 0.0009) and number of catheters (1.1 + 0.3 vs. 2.1 + 0.6 min; P < 0.0001) in group I. There...

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Section: Discussionunclassified

Section: Comparison Of a Single Dedicated Catheter And The Judkins Caunclassified

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

Tebet¹,

Andrade²,

Andrade³

et al. 2010

Rev. Bras. Cardiol. Invasiva

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“…The incidence of RAS is not negligible and implies the need for risk factor determination before the procedure. Although previous studies have reported several RAS associated factors, radial artery pulse grading has not been investigated yet [7][8][9][10]. We hypothesised that radial artery pulse grading may predict RAS.…”

Section: Introductionmentioning

confidence: 92%

“…However, one of the major and well-defined disadvantages of the transradial approach is radial artery spasm (RAS), which causes severe discomfort and access site crossover [6][7][8]. The incidence of RAS is not negligible and implies the need for risk factor determination before the procedure.…”

Section: Introductionmentioning

confidence: 99%

Can radial artery pulse grading predict radial artery spasm during transradial approach?

Zencirci

Değirmencioğlu

2017

Kardiol Pol

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A b s t r a c tBackground: Radial artery spasm (RAS) has been defined as one of the major disadvantage of transradial approach. Aim:The aim of this study was to investigate the predictive value of radial artery pulse grading on RAS during transradial approach. Methods:The present study prospectively included 115 consecutive patients who underwent transradial coronary catheterisation at a single centre. Patients were divided into two groups: those with RAS and those without. Results:The incidence of RAS was 16.5% (n = 19). Multivariate logistic regression analysis demonstrated that female sex, guiding catheter usage, and radial artery pulse grading ≤ 2 independently predicted RAS (odds ratio [OR] 8, 95% confidence interval [CI] 1.8-36.2, p = 0.007, OR 10.6, 95% CI 2.2-51.2, p = 0.03 and OR 25.8, 95% CI 6.1-108.5, p < 0.001, respectively). These three variables were weighted proportionally to their respective OR for RAS (female sex [1.5 points], guiding catheter usage [2 points], and radial artery pulse grading ≤ 2 [5 points]). Two risk strata were defined (low risk, score 0-4, high risk, score 5-8.5), and high risk was associated with increased incidence of RAS (n = 13 [61.9%] vs. n = 6 [6.4%], p < 0.001). Conclusions:Radial artery pulse grading together with female sex and guiding catheter usage are independent predictors of RAS, and by using a simple risk score high-risk patients for RAS can be identified.

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“…11 Worldwide there has been a lot of studies of spasmolytics which has shown the benefit. 4,5,6,9,11,12,13,14 Among these studies it has been recommended by Kiemeneij et al 11 that the spasm is significantly reduced by 34-14% by the use of cocktail with intra-arterial nitroglycerin and verapamil. Radial access for coronary intervention has been in practice in Nepal for last several years there has been no study regarding the different vasodilator regimen for the prevention of radial artery spasm during the procedure.…”

Section: *Corresponding Authormentioning

confidence: 99%

Comparision of Various Vasodilators Regimen During Radial Corornary Angiogram: A Prospective Randomised Trial

Malla

Adhikari

et al. 2017

J Adv Intern Med

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Background and Aims: Coronary intervention through radial artery is a preferred over femoral route. Different vasodilators are used to prevent radial artery spasm. Till date there is no study to compare the effects of various vasodilator regimes during radial coronary angiogram in Nepal. We aim to compare the efficacy of different vasodilator in our patients.Methods and Result: This is a single centre, prospective randomized trial between Verapamil, Nitroglycerine (GTN) and cocktail (Verapamil with GTN). All the patient undergoing coronary angiogram via radial approach, without the contraindication were randomized by a computer generated randomization protocol. Patient undergoing coronary procedures via the radial artery were divided into three groups. Patients in group A received intra-arterial cocktail (2.5 mg of Verapamil plus 100 mcg Nitroglycerine in 10 ml of normal saline), patients in group B received Verapamil (5mg) and patient in group C received Nitroglycerine (200mcg). Heparin of 3000U was given intravenously in all three groips. Altogether 207 patients underwent transradial coronary angiogram, 203 were randomized after exclusion. Over all Radial artery spasm was reported in 28 patients (13.79%). There was no statistically significant difference in spasm between the three regimens however when grading, there was significant higher grade of spasm in Verapamil group (13.23%, P value < 0.05). When comparing Verapamil and GTN separately there was significant higher spasm (21% vs 7%, P value < 0.05) with higher grades of spasm in verapamil group.Journal of Advances in Internal Medicine 2016;05(01):11-14

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Evaluation of a spasmolytic cocktail to prevent radial artery spasm during coronary procedures

Cited by 140 publications

References 13 publications

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

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

Can radial artery pulse grading predict radial artery spasm during transradial approach?

Comparision of Various Vasodilators Regimen During Radial Corornary Angiogram: A Prospective Randomised Trial

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