Nitroglycerin is superior to diltiazem as a coronary bypass conduit vasodilator

Shapira, Oz M.; Xu, Aiming; Vita, Joseph A.; Aldea, Gabriel S.; Shah, Nishant K.; Shemin, Richard J.; Keaney, John F.

doi:10.1016/s0022-5223(99)70370-3

Cited by 66 publications

(41 citation statements)

References 26 publications

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“…He and Yang [23] compared the antispastic effects in the radial artery and showed that nifedipine was far more potent than verapamil and diltiazem and that the later two are comparable. Nitroglycerin is a superior conduit vasodilator and is more effective in preventing radial artery spasm than diltiazem [24]. Cable et al [25] also demonstrated that diltiazem and verapamil had little effect on radial artery receptor-dependent and receptor-independent contractions, whereas nifedipine and nitroglycerin were much more effective.…”

Section: Discussionmentioning

confidence: 99%

A Simple and Effective Regimen for Prevention of Radial Artery Spasm during Coronary Catheterization

Chen

Lin

et al. 2005

Cardiology

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Radial artery spasm occurs frequently during the transradial approach for coronary catheterization. Premedications with nitroglycerin and verapamil have been documented to be effective in preventing radial spasms. Verapamil is relatively contraindicated for some patients with left ventricular dysfunction, hypotension and bradycardia. We would like to know whether nitroglycerin alone is sufficient for the prevention of radial artery spasm. We conducted a randomized controlled trial to compare the spasmolytic effect between heparin alone, heparin plus nitroglycerin and heparin plus nitroglycerin and varapamil during transradial cardiac catheterization. In this study, a total of 406 patients underwent transradial cardiac catheterization and intervention. After successful cannulation and sheath insertion of radial arteries, 133 patients in group A received 3,000 units of heparin, 100 µg of nitroglycerin and 1.25 mg of verapamil via sheath, 135 patients in group B received 3,000 units of heparin and 100 µg of nitroglycerin, and 93 patients in group C received 3,000 units of heparin. Five patients in group A (3.8%), 6 patients in group B (4.4%) and 19 patients in group C (20.4%) showed radial spasms. There is no statistically significant difference between groups A and B (p = 0.804), but there are strong statistically significant differences between groups A and C (p = 0.001) and groups B and C (p = 0.003). Intra-arterial premedication with 100 µg nitroglycerin and 3,000 units of heparin is effective in preventing radial spasms during transradial cardiac catheterization.

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Section: Discussionmentioning

confidence: 99%

A Simple and Effective Regimen for Prevention of Radial Artery Spasm during Coronary Catheterization

Chen

Lin

et al. 2005

Cardiology

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“…The first can be avoided by selecting an appropriate sheath size. The second component may be prevented or treated by the use of vasodilator drugs, including nifedepine, verapamil, and nitroglycerine, alone or in combination as a cocktail [8,9]. The length and coating of the sheath may also have a role to play in RAS.…”

Section: Discussionmentioning

confidence: 99%

“…Radial artery spasm (RAS) is one of the most common complications of the TRA, causing significant discomfort to the patient and reducing the procedural success rate [6,7]. The use of various vasodilators alone or in combination as a cocktail, have been advocated to prevent spasm of the radial artery bypass graft [8,9]. Until now, the assessment of RAS has been based on the subjective feelings of the patient and the observation of the operator.…”

Section: Introductionmentioning

confidence: 99%

Measurement of radial artery spasm using an automatic pullback device

Kiemeneij

Vajifdar

Eccleshall

et al. 2001

Cathet Cardio Intervent

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Current evaluation of radial artery spasm (RAS), a frequent finding during the transradial approach for coronary angiography and angioplasty (TRA), is subjective. A quantitative measure of RAS will help in evaluation and comparison of management strategies. The objectives of the study were to assess the feasibility and safety of using an automatic pullback device (APD) for removal of transradial introducer sheaths and to establish a parameter to quantify RAS. In 50 consecutive transradial procedures, the APD was used to measure the force required for sheath removal. The mean maximal pullback force (MPF) was 0.53 +/- 0.52 kg (range, 0.1-3.0 kg). In 48 (96%) cases, the MPF was reached within the first 5 sec of pullback. All patients with clinical RAS (n = 4) had an MPF greater than 1.0 kg, while the remaining had an MPF less than 1.0 kg. All patients with severe pain during sheath removal (n = 3) had an MPF greater than 1.0 kg, while no patient with an MPF less than 1.0 kg had severe pain. It is feasible and safe to remove transradial introducer sheaths using the APD. The MPF is achieved within the first 5 sec of pullback and is a reliable parameter to quantify RAS. An MPF more than 1.0 kg correlates with clinical RAS and is associated with severe pain during sheath removal.

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“…20 Nitroglycerine has also been compared with the diltiazem and was found to be more effective. 21 Our data showed that the nitroglycerine is more effective than verapamil and the cocktail of both in preventing spasm. In this study more spasm was found among the female which may be due to the hormonal effect or due to the low pain threshold but the exact cause is still not known.…”

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confidence: 59%

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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Nitroglycerin is superior to diltiazem as a coronary bypass conduit vasodilator

Abstract: Nitroglycerin is a superior conduit vasodilator and is more effective in preventing graft spasm than diltiazem. Nitroglycerin should be strongly considered as the drug of choice to prevent conduit spasm after coronary bypass grafting.

Cited by 66 publications

References 26 publications

A Simple and Effective Regimen for Prevention of Radial Artery Spasm during Coronary Catheterization

A Simple and Effective Regimen for Prevention of Radial Artery Spasm during Coronary Catheterization

Measurement of radial artery spasm using an automatic pullback device

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

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